Proposed changes to cancer waiting times in England and what this could mean for people who are referred to a breast clinic with possible signs of cancer.
In this blog, we'll look at the proposed changes to cancer waiting times in England and what this could mean for people who are referred to a breast clinic with possible signs of cancer.
What are the current waiting times for cancer diagnosis and treatment?
The NHS in England has a number of different standards which set out how quickly patients with possible cancer symptoms should be seen and treated. Probably the most well-known of these standards is the two-week wait, under which people referred urgently by their GP with potential cancer symptoms should be seen by a specialist within two weeks. The target for this is that 93% of people referred should be seen within two weeks.
People who go on to be diagnosed with cancer should start treatment within 31 days of agreeing a treatment plan with their doctor, and within 62 days of their urgent referral. The target is for 96% of people to meet the 31-day standard, and for 85% of people to meet the 62-day standard.
What changes are being put forward?
The new proposals include some important changes to the way waiting times for cancer diagnosis and treatment would be measured in England.
The biggest change is the standard for urgent GP referrals to be seen by a specialist within two weeks is being replaced by a target for patients to be diagnosed with cancer, or have cancer ruled out within 28 days of referral. This measure is called the ‘Faster Diagnosis Standard’ (FDS) and NHS England have said they want 75% of patients to meet this by March 2024.
The idea behind this change is that, by setting a target for on how long it should take for a patient to be given their results, the NHS will focus on making sure people are getting diagnosed with cancer or be reassured that they don’t have cancer as soon as possible. This is being prioritised over offering everyone an appointment within two weeks.
These changes only apply to England; there is no two week wait standard in Scotland or Wales, and the two week wait for urgent breast cancer referrals in Northern Ireland will not be affected by these proposals.
What does this mean in practice?
The proposed changes do not affect the way in which patients with possible cancer symptoms should be assessed or referred to a specialist. GPs can continue to refer patients with possible signs and symptoms of cancer and these people should still be offered an appointment with a specialist as soon as possible.
However, the removal of the two-week wait means that there will no longer be an expectation for those urgently referred to be seen by a specialist within 14 days. The time taken from referral to being seen will no longer be used to measure a hospital’s performance on cancer waiting times. Instead, cancer services will be assessed by looking at the percentage of patients who are diagnosed with cancer, or have it ruled out within 28 days of referral, regardless of when their assessment takes place within that time.
How might this affect people referred with possible symptoms of breast cancer?
We know the importance of giving patients their breast cancer diagnosis or ruling it out as soon as possible. Rapid diagnosis allows patients to start treatment quickly, and helps to minimise the stress and anxiety felt by those waiting.
But we’re concerned that the lower target attached to the FDS compared to the two-week wait will not lead to people referred with possible breast cancer being seen or diagnosed any sooner. Because of the way breast cancer is diagnosed – with the majority of hospitals doing all the necessary tests in one appointment - most people who are seen within two weeks are already likely to be given their results ahead of the 28-day deadline.
What we want to see happen
The FDS was originally proposed in 2015 and the target then was for 95% of people urgently referred to be given their results within 28 days, and for 50% to be given their results within 14-days, which would be much more likely to encourage faster breast cancer diagnosis. We want NHS England to put a clear plan in place for increasing the target for the FDS.
There should also be an aim to give patients a full diagnosis (including whether their tumour has hormone receptors or HER2 receptors or is triple negative) within the 28 days, as this can affect the type of treatment they have. This will enable patients to agree treatment decisions and start treatment as soon as possible.
Currently, people need only be told whether or not they have breast cancer within the 28 days, with no time period for when they should be given their full diagnosis.
Most people referred for assessment will not have breast cancer, and it often takes less time to rule breast cancer out than it does to confirm it. We must ensure that as many people as possible are having breast cancer confirmed within the 28 days so they can start treatment as quickly as possible.
As well as the proportion of people being given an outcome within 28 days, NHS England must separately report the proportion of patients who are diagnosed with breast cancer and those who have it ruled out within 28 days.
What we’re doing
We will continue to raise these issues with NHS England to ensure that people referred with potential symptoms of breast cancer get an outcome more quickly. As part of this, we will be responding to NHS England’s consultation on their proposed changes, setting out how the FDS can be improved to encourage faster breast cancer diagnosis.
This consultation is also an opportunity for people affected by breast cancer to share their own experiences and views on cancer waiting times directly with decision-makers. You can do this by taking part in the consultation through the NHS Cancer Review of Standards webpage. The deadline for this consultation closes on 6 April 2022.