A doctor in surgical clothes looks at mri scan results ahead of surgery
Public health services in England will likely miss a major cancer waiting time target as the country struggles to get through its care backlogs.
Before the pandemic, around 14,000 patients with suspected cancer were waiting more than 62 days to be diagnosed and begin treatment following an urgent referral from a primary care doctor.
With hospital capacity stretched and patient demand ballooning, this backlog hit an all-time high of 34,000 last summer.
National Health Service leaders had wanted to bring that figure back down to the pre-pandemic level by March this year. But that target will not be met, National Cancer Director Dame Cally Palmer told lawmakers at a Health and Social Care Committee meeting on Tuesday.
The number of people waiting 62 days or more has improved since the summer, falling to approximately 23,500 last week, she said. But it remains far shy of the 14,000 goal.
Leaders are now considering pushing that target by a year to March 2024.
The vast majoring of people on this waiting list will ultimately be told they do not have cancer. But waiting for such news can still cause serious anxiety for patients.
And for those who do discover they have cancer, delays like to care can lead to worse outcomes, as cancers are typically easier to treat the earlier they’re caught.
NHS England’s National Clinical Director for Cancer, professor Peter Johnson, told ministers: “I don’t think anybody is comfortable with the fact that we have a large number of people who are waiting too long to get their diagnosis and start their treatment.”
He said high demand for diagnostic services was outpacing capacity.
“What we need to do is contend with a very large number of referrals. Between 200,000 to 260,000 people every month are referred for investigation of possible cancer, [of] whom only about 6% will have cancer,” he told the committee.
With patients less afraid to seek care than they were earlier in the pandemic, the number of referrals from family doctors has risen.
It’s likely many people put off seeing their doctors for all kinds of symptoms, including those that might indicate cancer, during the first two years of the pandemic. Now, those patients seem to be coming forward.
The NHS aims for 85% of patients to start treatment within two months of this kind of referral. But it’s worth noting this standard had slipped in the years before the pandemic.
In fact, it hasn’t been met since 2015 — five years before the World Health Organisation declared Covid-19 a pandemic.
According to health think tank the Nuffield Trust, this performance has “decreased considerably over time” from 87% in early 2009 to 72% at the start of 2021.
This performance indicator is one of several cancer standards that have deteriorated significantly over the pandemic, and before.
Like many healthcare metrics, the measures themselves have long been controversial. They were subject to a review that last year recommended combining 62-day waits from an urgent primary care referral with similar measurements for national screening services.
The review authors wrote: “Having a single headline measure and ensuring the clinical guidance governing inclusion within it reflects modern clinical practice, adds clarity and greater focus on what really matters to patients.”
Another metric — the “Faster Diagnosis Standard” — has also been put in place in an effort to simplify targets. It aims to give 75% of patients a definitive diagnosis within 31 days of referral from one of these services. When it was first introduced, hospitals were given a target of March 2024 to meet the standard.
