Patients with suspected cancer may have to wait longer to get a diagnosis under government proposals due this week.
The target that all patients should see a specialist within two weeks of an urgent referral for cancer tests by a GP is expected to be scrapped under NHS England plans to streamline cancer targets.
Ministers have been consulting on the proposals to replace the nine existing cancer targets with just three.
Under a new “faster diagnosis standard”, three-quarters of patients should have a diagnosis or be told they do not have cancer within 28 days. Once diagnosed, patients should receive their first treatment within 62 days from referral or 31 days after the decision to treat.
That standard would replace the nine existing cancer targets, including the two-week wait between a GP referral and first consultant appointment; a one-month wait for care once a decision has been made to offer treatment for cancer such as chemotherapy, radiotherapy and surgery; and a two-month wait from the urgent GP referral to a first treatment of cancer.
The latest figures show that only 59% of patients in England started their first cancer treatment within two months of an urgent GP referral, well short of the 85% target. Only 62% of patients were seen within two months of a positive result from a national cancer screening test, compared with the 90% target.
When a consultation on the proposals began last year, the NHS highlighted that the current two-week target set no expectation of when patients should receive test results or have a confirmed diagnosis.
Speaking on BBC Radio 4’s Today programme, Pat Price, a visiting oncology professor at Imperial College London and co-founder of the Catch Up with Cancer campaign, accused ministers and NHS leaders of “fiddling around” in the middle of an NHS crisis and of watering down the targets.
“Changing the targets won’t help patients, unless we can treat patients better and quicker. And that means now increasing treatment capacity,” she said.
On breast cancer, the target is that 93% of women should be seen in a one-stop clinic in two weeks, but the figure is now 74%. Price said: “The target we think is only going to be 75% in 28 days – that’s actually worse. Is it really the best that government and senior NHS leaders can do is fiddle around with targets in the middle of this crisis?”
The BBC reported that the outcome of the consultation was expected to be announced within days, and implementing the changes would be subject to final approval by the health secretary, Steve Barclay.
Barclay said on the Today programme that the proposals were designed to improve outcomes and were what the sector wanted.
He said: “Any changes will be those where it’s been requested by clinical specialists within the cancer field and would be done in consultation with the leading cancer charities. The consultation has been about working with consultants, clinical leaders, as to what drives the best outcomes, what is the way of getting the best survival rates.”
Barclay said there had been a 28% increase in urgent GP referrals for suspected cancer and £2.3bn investment in 160 community diagnostic centres, with 114 of those open.
Prof Sir Stephen Powis, the NHS national medical director, said: “These proposals were put forward by leading cancer experts and have the support of cancer charities and clinicians. By making sure more patients are diagnosed and treated as early as possible following a referral and replacing the outdated two-week wait target with the faster diagnosis standard already being used across the country, hundreds of patients waiting to have cancer ruled out or diagnosed could receive this news faster.
“The proposals will also remove the need for unnecessary outpatient appointments in order to comply with waiting times rules, allowing more patients to be referred ‘straight to test’ and the wider deployment of diagnostic technologies including artificial intelligence.”
Dr Tom Roques, a vice-president of the Royal College of Radiologists, said simplifying the targets would make it easier for cancer teams to deliver care, but warned targets were no panacea.
“It’s important to remember that the targets are just a tool to try and improve care – the targets achieve nothing on their own. And the real need is investment in workforce, in newer ways of working, so we can improve the situation on the ground, which I think if you ask any cancer team is just not good enough at the moment for the patients,” he said.
“I think one of the problems that we have with targets as a whole is that they often focus on the process rather than the outcomes that are important to patients. So if you look at the old two-week target to see a doctor, you may not need to see a doctor to be diagnosed or not diagnosed with cancer, you may need teledermatology to assess your skin lesion and tell you whether it’s cancer or not. You may need to have an endoscopy test to quickly look and see whether you’ve got bowel cancer, and an artificial focus on ‘you must see a doctor by 14 days’ may not be the best way to get patients quickly through the system.”
Keir Starmer accused the government of “moving the goalpost” on cancer targets. “I want swifter diagnosis, of course I do – both for the individuals concerned and obviously for the health service,” the Labour leader said on a visit to Scotland.
“Under the last Labour government, we had targets, we hit those targets; we didn’t walk away when the going got tough,” he said. “With this government, it’s targets that they’ve repeatedly failed to hit. And now what they’re doing is moving the goalposts and even where they’re keeping targets [in place] after this streamlining, there’s targets they’re still not hitting.”
