In early January 2022 there were nearly six million people in England waiting for routine operations and treatment: a record high. As health trusts are struggling to cope, the Health and Social Care Select Committee described the backlog as an 'unquantifiable challenge'.

Included in the six million are around half a million people with a suspected cancer diagnosis.

The NHS has national targets across the board relating to the timeframe within which patients receive care.

NHS England Targets

In cases of suspected cancer, the first benchmark target is for GPs to refer their patients to a specialist consultant within 1 working day.

That specialist consultation should then take place within 2 weeks, known as the "2WW" (2 week wait) referral.

Once a decision has been made to treat cancer, patients should receive their first treatment within 31 days from the date of that decision.

Patients should receive their first treatment no later than 62 days after the first GP referral.

The Reality

Results of recent research show that the targets are not being met and a record number of patients are waiting longer than the target timeframes for cancer treatment.

We are all well aware of the knock-on effect of the COVID-19 pandemic on cancer treatment. Despite being classed as essential treatment that was to continue during the pandemic, the reality of the situation sadly led to long delays and a backlog of patients waiting to receive and/or continue their cancer treatment. Nonetheless, government figures state that cancer treatment was at 94% of pre-pandemic levels but acknowledge there were 34,000 fewer cancer diagnoses in England from March 2020 - November 2021.

Patients are not just experiencing delays in the treatment stage but also delays in being offered a first consultation with a specialist. The percentage of patients who had attended a first specialist appointment within 2 weeks of their GP's referral fell from 94.5% in January-March 2009 to 88.6% in the same period of 2021. The first drop to levels below 90% occurred after early 2021.

Research published in the BMJ found that people whose cancer treatment is delayed by even one month, have a 6-13% higher risk of dying from their disease. This figure applies to several types of cancer, including breast, lung and colon, no matter if the delayed treatment is surgery, chemotherapy or radiotherapy. The entire cancer care pathway needs to operate efficiently with targets for both diagnosis and treatment times being met if patients are to be afforded their best chance for successful treatment. The worry of having a cancer diagnosis and the uncertainty of not knowing the test results following a referral can only add more stress and anxiety to a person's mental health and wellbeing once they have a suspected diagnosis. Any delays in addition to this must be another layer of unnecessary stress and concern to the patient and his or her family.

Legal storm brewing

Leading cancer specialists are warning that the NHS could face a 'legal storm' for compensation claims from patients whose cancer has spread due to delays in diagnosis and treatment. Professor Gary Middle, a cancer surgeon said, 'I think the likelihood is enormously high that potentially we're sitting on a legal minefield with this.'

Waiting list recovery plan

The government recently unveiled their plan for the NHS to construct more than 100 community diagnosis centres in which teams of specialists will provide a faster clinical service in an attempt to address the record high waiting lists. New surgical hubs will also be created, ensuring efficient use of resources and creating extra capacity so patients are seen quickly.

The future

New targets have just been announced for a shorter period of time between the first GP referral to a specialist and having a cancer diagnosis confirmed or rejected. The aim is for this to happen within 28 days but the programme is due to be implemented across England by 2024. We can only wait and see if the current backlog of patients awaiting treatment is caught up with in time for these new plans to be implemented or whether they turn out to be too optimistic given the current state of affairs.

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