Improvement strategy

The NHS Cancer Programme has described (here) three main strands to its strategy for improving cancer waiting times:

  1. New investment in diagnostic capacity, which is being prioritised for cancer

  2. Focusing attention and support on the trusts facing the most significant challenges

  3. National action to improve the productivity of cancer pathways facing the biggest challenges

Diagnostic capacity

In October 2020, a review of NHS diagnostic services recommended that new diagnostic centres should be established in the community. The government then announced, in 2021, a £2.3 billion investment in diagnostic capacity, including at least 100 ‘community diagnostic centres’. This new diagnostic capacity is intended to be prioritised for urgent suspected cancer, to help achieve the national objectives for cancer waiting times standards.

The government has most recently set a target that 160 community diagnostic centres will be open by 2025 (with 106 centres operational as of April 2024).

Focused support for providers

NHS England has grouped NHS providers into ‘tiers’ based on their performance on cancer waiting times standards. According to 2024-25 guidance, Cancer Alliances with providers in tier 1 need to set out a funding allocation and details of improvement plans, to be approved by both NHS regional and national teams. Details of plans for trusts in tier 2 will be approved by regional teams only.

Commissioners (Integrated Care Boards) with performance of less than 70% on the Faster Diagnosis Standard have also been targeted to develop improvement plans (see here).

Priority cancer pathways

The NHS 2024-25 priorities and operational planning guidance prioritised three cancer types for improvement of the diagnostic pathway: lower gastrointestinal, skin, and prostate.

  1. Lower gastrointestinal - the use of a Faecal Immunochemical Test (FIT) in primary care has been promoted to reduce unnecessary referrals for suspected cancer.

  2. Skin - teledermatology has been encouraged to reduce the number of patients who need an in-person appointment unless their lesion is of concern.

  3. Prostate - initiatives include the adoption of local anaesthetic transperineal biopsy, use of risk-stratification tools, and prioritisation of capacity for MRI scans.

Diagnostic pathways for breast pain and unexpected bleeding for women receiving hormone replacement therapy were also highlighted, to support achievement of the Faster Diagnosis Standard for suspected breast and gynaecological cancer, respectively.