Why more patients than ever before are missing NHS cancer waiting times targets

In England, 40% of new cancer diagnoses come from an urgent referral from a GP [1]. NHS hospitals are required to start cancer treatment for everyone who’s been urgently referred within 62 days. These cancer waiting times standards help ensure people are rapidly diagnosed and treated – critical for long-term outcomes such as survival.

More patients than ever are now waiting more than 62 days for treatment. Of all completed pathways, the number of patients waiting longer than 62 days to receive treatment has almost doubled [2] from 6,242 in September 2019 to 11,910 in September 2022 – 39.5% of 62-day pathways, meaning that only 60.5% of patients are meeting the 62-day target. What factors are contributing to this?

Referrals are at record highs

After a drop in urgent referrals [3] in 2020 due to the Covid-19 pandemic, demand for cancer services is now at its highest since 2019 (a 38.0% increase from September 2019, corresponding to 249,994 urgent referrals in September 2022). There are several possible reasons behind this increase – from changes in referral patterns to the “missed” referrals during the pandemic that are now coming back to the system.

As shown in Figure 1 below, there seems to be a positive correlation between the increase in the number of 2 weeks wait referrals and the decrease in the percentage of patients meeting the 62-day target.

Figure 1

Diagnostics capacity is a bottleneck

The faster diagnosis standard, introduced as part of the long-term plan, ensures that people urgently referred from a GP [4] receive their diagnosis by day 28 of their pathway. From April 2021 to September 2022, the number of patients meeting this standard has dropped from 73% to 67%. This suggests that increased referrals are also constraining cancer diagnostics capacity. We can’t say for sure without patient-level data, but likely, many of the same patients who miss their diagnostic target (33%) also miss their treatment target.

Hospitals are working through their backlogs

Figure 2 illustrates that while capacity has been constrained throughout the pandemic, 5.1% more patients are now being treated every month compared to the 2019 average (27,332 vs 28,735). This suggests that Trusts are working hard to increase their capacity to meet the increase in demand.

Figure 2

There has been an increase in the number of extremely long waiters treated, with the percentage of people waiting longer than 104 days doubling from 5.5% in September 2019 to 12.9% in September 2022.

Trusts are focussing their increased capacity on their longest waiters – temporarily decreasing performance, but an indicator that Trusts are working to reduce their backlogs.

Managing increased referrals will continue to be a challenge for Trusts in the months to come. How will they meet this challenge?

In our next three blog posts in this series, we will explore potential solutions – including approaches to streamlining cancer diagnostics, the potential of mutual aid and strategies for identifying and reducing health inequalities.

———————–
[1] As of 2016, https://www.ncin.org.uk/publications/routes_to_diagnosis

[2] Grown by 90.8%

[3] Note that the two-week wait (2WW) appointments are a proxy for incoming referrals. Referrals may be higher given that only 73-78% of 2WW appointments have been within the standard from July-September 2022.

[4] Along with patients referred by their GP with breast symptoms where cancer is not initially suspected; or referred by the National Screening Service with an abnormal screening result.