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Update

Co-founder of the #CatchUpWithCancer campaign, Professor Pat Price, a leading oncologist commenting on today’s monthly cancer waiting times (January 11)  said:

“Sadly, these figures are an ominous opening to what looks to be another deeply worrying year for both cancer patients and the frontline staff who are battling against the odds to care for them.

“Today’s data shows that only 59.7% started treatment on time in November 2023, from an urgent GP referral: worse than this time last year.

“There is also a lack of real improvement in the new combined NHS cancer target.

“Despite the NHS reporting the data in the most positive light, cancer treatment remains a disaster. It is particularly worrying that performance is worse than this time last year. What’s so frustrating and desperately sad is that it simply doesn’t have to be this way.

“We are on a path that is flying in the face of the evidence. Evidence from around the world is very clear, we need a radical new cancer plan.

“Countries with dedicated cancer plans have better survival than ones that don’t. And it can’t just focus on diagnosing more patients.

“We need investment to treat them on time because every four weeks of delay in treatment can increase the risk of death by 10%. It is so frustrating that ministers and NHS England seem to have abandoned the idea of a dedicated cancer plan in favour of a multiple-disease strategy. These new figures reinforce a picture of years of abject failure and cancer treatment delays. The clear message for 2024 is that we need a radical new cancer plan and we need it yesterday.”

Original post

NHS England cancer targets changed in autumn 2023. Ten became three, with some key markers merged. WATCH OUR VIDEO EXPLAINER

As a result, things appear to look better for cancer patients than they are on the ground. And the data is presented in such a way that 2024 began with widespread positive headlines around cancer services – and just one report that had dug into the data.

What follows is an overview and explanation of what is happening, and why it matters for cancer patients and their loved ones.

62-day treatment target

Once again, the focus is around the 62-day treatment target, a target that has already been subject to a lot of confusion. WATCH OUR VIDEO EXPLAINER

By combining three different routes to treatment, October 2023 figures show 63% of patients reaching a first treatment on time.

There are two points to raise around with this:

• Hitting 63% is far below the 85% target
• Lumping two faster routes into the most common route to treatment for most patients hides a fall in the number of patients treated on time. Down from 59.3% in September to 58.2% in October (the second worst on record)

If you read no further, we ask only that you remain extremely vigilant around the recent ‘good news’ headlines around cancer services in this country. In reality, some of the worst waiting times on record are becoming ‘baked in’ and survival rates are still some of the poorest in the Western world.

The issue in detail

Before October 2023, the 62-day treatment target measured the three different routes through which cancer patients are sent for treatments separately.

• Route 1: through their GP when they initially present with symptoms (the vast majority of cancer patients)
• Route 2: through cancer picked up by a national screening service (around 6%)
• Route 3: through a consultant upgrade for patients in the system who are found to have cancer

The first, through a GP, is by far the most common, and so the best marker of how well the cancer pathway is working. Around 15,000 to 16,000 patients begin treatment through this route each month.

The second and third are less common. Screening refers around 1,700 patients a month and the third via an upgrade, around 5,700 a month. In both these routes patients have already started on their cancer pathways and so typically will be measured as reaching their 62-day treatment target faster.

Three routes added together

Since December 2023, the three routes have been added together to measure and benchmark cancer waiting times for starting treatment. Adding a small number of slightly better performing groups of patients to the main group then looks to improve the overall performance.

This change is not clearly understood by the public and the media and makes it difficult to track performance. The new Combined Target risks masking long-standing failures against the original 62-day target (route 1) from urgent GP referral to starting treatment.

The new combined target has now been presented to the media as a continuation of the previous long standing 62-day cancer target,  seeming to show a performance improvement. The media has then dutifully reported this to the public. Instead it should be made clear that this new target is quite different.

Important to measure ‘like for like’

The new Combined Target showed that in October 2023, 63% of patients began treatment within the 62-day treatment target (see table 2). This was widely reported as an improvement. But for accuracy, like must be measured against like. When the data is read correctly, we see that 59.3% of patients referred by their GP were treated on time in September (Table 1). This then fell to 58.2% in October, the second worst wait on record.

So, patients were less likely to be treated on time in October, and the target of getting 85% of patients to a first treatment on time remains painfully out of reach.

The data in detail

Table 1 below shows the performance against the 62-day target for route 1 (GP referral and the most common) over the last year.

Leaving out key data

Most confusingly of all, the long-standing 62-day target from urgent GP referral to first treatment (route 1) does not even feature within the NHS England cover note aimed at media and stakeholders. This means that unless considerable time is spent looking through the data breakdown it is not possible to compare performance on this crucial target that has long been used as the benchmark for performance for starting cancer treatment. This masks the continuing failure to deliver for cancer patients in England and meet that 62-day treatment target.

Target of 85% is painfully out of reach

Table 2 below shows the new Combined Target and its performance over the last year.

Table 2: Two Month (62-days) Wait from an Urgent Suspected Cancer or Breast Symptomatic Referral, or Urgent Screening Referral, or Consultant Upgrade to a First Definitive Treatment for Cancer. The operational standard for this is 85%.

Conclusion

Even with data presented in the best possible light, there is no significant progress towards the 85% target set. The energy wasted on creating ‘good news’ headlines could be used to actually improve outcomes for cancer patients. How heartbreaking, and what a waste of time: as cancer forecasts show Britain heading towards one diagnosis a minute.