Last week’s changes to cancer targets seem, at first glance, like an instance of NHS benchmarks being altered for political motivations. The truth is a little more complicated – the changes are good, but targets are just a small part of the picture. Until we properly tackle the capacity crisis in cancer, we will continue to let down our patients. That’s where the attention should be focused.
The planned updates include consolidating nine overlapping standards into three major ones. These capture the time from an urgent GP referral to either a diagnosis or an all-clear; the time from a “decision to treat” to starting treatment; and finally, the total time from GP referral to starting treatment. The six scrapped targets focus on smaller parts of the process, which are still important, but not as much as the big three. And reassuringly, NHS England will still publish performance against those, they just won’t be assessed in the same way.
The most controversial change is the removal of the “two-week wait” target, which set the goal that 90 per cent of patients should have their first consultant appointment within two weeks of a GP referral. While it’s reassuring to know you’ll be seen quickly, this doesn’t mean everyone would get test results quickly, and it doesn’t necessarily lead to a faster diagnosis.
Its replacement is the faster diagnosis standard (FDS), which means that patients should not wait more than 28 days from a referral to find out whether they have cancer or not. This has a much more meaningful end point – either an all-clear, or for an unfortunate minority, a cancer diagnosis. This is meant to focus minds on what’s important, and will result in both a quicker diagnosis and faster treatment for patients. Early findings from NHS pilots show it does indeed help.
Rather than being politically driven, this target was initially proposed by the Independent Cancer Taskforce in 2015 – a coalition of cancer charities, clinicians and patients. And it still has broad support, with cancer charities and medical royal colleges like mine speaking out in favour of the changes.
There is, however, room for debate about the new FDS target’s level of ambition. Its threshold is for 75 per cent of patients to meet the 28-day standard – far lower than the initial 95 per cent proposed by cancer charities. Seventy-five per cent is still a step forward, but I’d like to see that increased: NHS England has said it plans to increase that threshold over time, and we will be holding the organisation to that.
It is true to say the goalposts have been moved, and they’ve been moved in a way that better aligns with what’s meaningful to patients. But it isn’t true that cancer targets have been downgraded. Comparing the two-week wait with the faster diagnosis standard is like comparing poor-quality apples with high-quality pears.
Finally, the unfortunate reality is that whatever targets we pick, we have a very long way to go with cancer waiting time performance. Cancer targets have been consistently missed for years, and in the meantime countless patients suffer. Now that these changes have been confirmed, we must focus on what matters the most – putting the resources in place to ensure we can meet these new targets, and giving more patients the timely diagnosis and treatment they deserve.
[See also: Kevin Fenton: “Racism is a major public health challenge”]
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