Q.    What do we mean by the cancer waiting time standards and why are they important?

Cancer waiting times are a way to look at how well NHS cancer services are performing. They are set by NHS England and define clear expectations of the providers of those services, primarily hospital Trusts. They outline the maximum time most patients should expect to wait for cancer diagnosis and treatment and come with an associated set of targets. They set expectations of what providers of cancer services should deliver.

They are important because waiting for results, or to start cancer treatment, is a very anxious time for patients and their families. Also the earlier a cancer is diagnosed and treated, when it is smaller and hasn’t spread, the more likely it is to be treatable. Prompt diagnosis and treatment is therefore critical.

Waiting times standards are one of a range of outcomes against which the quality and timeliness of cancer care is measured. Others include the stage of cancer at which a patient’s cancer is diagnosed; the point in the healthcare system that they receive their diagnosis (the earlier it is, the more likely it is to be treatable) and the numbers of cancers that are detected through screening programmes. 

Q.    What are the changes being proposed?

At the moment, there are 10 different standards in place to measure how long patients wait to see a specialist doctor, to undergo the tests that they need and to begin receiving treatment. A consultation has taken place to find out what patients, professional staff, cancer charities and the public think about plans to modernise and simplify the standards, and to reduce the number from 10 standards to three. Following the results of the consultation, the Government is supporting the changes, with effect from 1st October 2023.

Q.    What does this mean for patients?

Catching cancer early saves lives. The three standards from 1st October have been recognised as the best way for the NHS to ensure that patients are not only diagnosed quickly but are also able to start their treatment as soon as possible. The changes will still set the same high-performance bar for the same groups of patients covered by the previous standards. The number and proportion of patients covered by the standards will increase. 

The three standards are designed to focus on two clear goals – achieving the fastest possible diagnosis, and, for those who are diagnosed with cancer and require treatment, the standards will ensure they receive treatment as quickly as possible. They put all patients with suspected cancer on a level playing field, regardless of the origin of their referral – for example, via their GP, via a screening programme, through emergency hospital admission. 

Q.    Why are changes being made?

Catching cancer early saves lives. The three standards from 1st October have been recognised as the best way for the NHS to ensure that patients are not only diagnosed quickly but are also able to start their treatment as soon as possible.

The changes are all about modernising and simplifying the standards, The changes will ensure that waiting times for all cancer patients will be measured equally, irrespective of how they enter the healthcare system – not just those who are urgently referred by their GP, or their dentist in some cases (for oral cancers).  or their dentist in some cases (for oral cancers).  

Q.    What standards will remain in place once the changes have been made?

The three standards from 1st October have been recognised as the best way for the NHS to ensure that patients are not only diagnosed quickly, but are also able to start their treatment as soon as possible. These three standards are based on recommendations made by the Independent Cancer Taskforce in 2015 and the subsequent clinical review, which was started in 2018.

The three standards will be:

  • The Faster Diagnosis Standard (FDS) – an expectation that patients who have been referred urgently by their GP or via a screening service will wait a maximum of 28 days before they find out whether or not they have cancer. This was initially introduced in 2021.
  • A target for all patients to wait a maximum of 62 days from an urgent referral with suspected cancer to their first episode of treatment.
  • A target which states that no cancer patient, irrespective of how they entered the healthcare system, will wait longer than 31 days between the decision to treat them and their first (or subsequent) episode of treatment.

What this means for patients is that, within one month of being referred when cancer is suspected, the aim is to ensure that they can be informed whether they either do, or do not, have cancer.  The aim for those people who are informed that they have cancer is for their treatment to start within one month of this point.  

Some patients have very complex diagnostic pathways, or they would prefer to wait for assessment and treatment, or sometimes they need to have highly specific tests to work out which treatments are likely to be the most effective.  This is based on what we know about the cancer and how different types of tumours respond to treatments.  This is why the target is not set at 100% - to allow clinicians and patients to plan this care well, in the person’s best interests.

Note: People in West Yorkshire and Harrogate should be reassured that hospitals across our area will continue to monitor the delivery of the first appointment or interaction within two weeks, as a critical element of the pathway to either confirm or exclude cancer definitely within 28 days. 

Q.    Why is the Faster Diagnosis Standard (FDS) important?

The current ‘two week wait target’ sets an expectation that people who are suspected of having cancer will see a specialist within 14 days of being referred by their GP or following a screening appointment.  However, seeing a specialist is only the first step and sometimes the best first step is to order a diagnostic investigation – called “straight to test” - so that the specialist can use the results of this test to plan what happens next. 

The two-week wait target doesn’t set any expectations for how long someone will have to wait for any tests they need, for the test results to be returned and for them to be told whether they do or don’t have cancer. The Faster Diagnosis Standard (FDS) was introduced in 2021. Although it is therefore relatively new, it is already in force as one of the ten standards. The FDS sets an expectation that this entire process will be completed within 28 days of the initial referral. 

Currently, the Faster Diagnosis Standard is for three in four patients (75%) to receive their diagnosis within 28 days. In West Yorkshire and Harrogate, most of our hospitals are already achieving that standard, and we will continue to work with them to improve that position still further. All our hospitals will continue to strive to provide the first interaction, or test, with patients within two weeks.

By 2025/2026, this will gradually increase to four in five patients (80%). Hospital Trusts will be expected to prioritise cancer patients in allocating the capacity they have for providing diagnostic tests to ensure this higher threshold is achieved. 

Q.     Which waiting time standards are being removed?

The main changes are:

  • The removal of the two week wait standard, which focuses solely on a patient receiving an appointment with a specialist within two weeks of referral
  • Combining together the previous standards relating to urgent suspected cancer GP referrals, urgent screening and consultant upgrade 62-day standards to create one headline performance standard for all patients of 62 days from referral to the first episode of treatment
  • Combining the first and subsequent 31-day treatment standards to create one headline performance standard for all patients  – 31 days from decision to treat to the episode of treatment for all cancer patients, irrespective of how they entered the healthcare system with their suspected cancer

Q.    Why is the two week wait standard being removed?

The two-week wait standard looks at one part of the Faster Diagnosis Standard (28 day) pathway.  The FDS includes the wait to initially see a specialist, as it starts when the patient is referred and ends when the patient is either diagnosed or informed that they do not have cancer. This process will often involve several tests and investigations, overseen by a specialist.  

To achieve the FDS, the first step will usually need to take place in a two-week window.  So, overall, NHS England have decided that it is not necessary to monitor both targets in the same way and the Government has supported that step.  

However, people in West Yorkshire and Harrogate should be reassured that hospitals across our area will continue to monitor the delivery of the first appointment or interaction within two weeks, as a critical element of the pathway to either confirm or exclude cancer within 28 days.

Q.    Does the removal of the two week wait standard mean a change in the urgency with which GPs will refer patients with suspected cancer to a specialist?  

No. There will be no change to how GPs refer patients onto a suspected cancer pathway. 

Q.    How will performance against the new cancer waiting times standards be published?

Statistics will still be published by NHS England monthly. Once the changes are in place, the published figures will cover the three standards. However, the NHS will still continue to collect and publish some data on other standards, such as first and subsequent radiotherapy or chemotherapy treatments, even though hospital Trusts will not be formally monitored against them. This is because this information remains important in helping to understand any variations in performance against the three main standards, thereby facilitating improvements where needed.

At the same time as these standards come into effect, NHS England is planning to provide a more detailed breakdown of cancer waiting times statistics, with figures broken down by cancer type. A consultation will begin shortly on the nature of these changes.

Q.    Where can I read more about the outcomes of the consultation?
Visit the NHS England website for more information and background to the changes.

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