In this blog, we review the three years of data now available since NHS England (NHSE) first introduced the faster diagnosis standard (FDS). It shows unacceptably long wait times have become the new normal for breast cancer patients.
Introduction
Waiting to be seen and diagnosed can be an anxious time for people with breast cancer symptoms, and it is vital people get an answer as quickly as possible. This is why Breast Cancer Now has been campaigning to ensure that people can get access to a timely diagnosis and treatment.
It has now been over 3 years since NHS England (NHSE) first introduced the Faster Diagnosis Standard (FDS) in April 2021, a target for 75% of people urgently referred to have cancer confirmed or ruled out within 28 days. Thanks to our campaigning and in response to our concerns that the 75% target lacked ambition, in August 2023, NHSE introduced a 90% expectation for breast cancer diagnosis within 28 days.
However, our analysis has found in the 3 years since FDS was introduced, people have been waiting longer at every stage of the breast cancer pathway, from referral, to diagnosis, to treatment. Waiting times which once would have been considered poor are now accepted as normal.
Time to be seen
In October last year, NHSE officially removed the ‘two-week wait’, the previous target for 93% of people to be seen within 14 days of an urgent cancer referral. Being referred for a suspected cancer can be unsettling for people, and NHSE’s best practice guidance still says that people should be seen within 10 days.
Despite this, people are now waiting longer to see a specialist. Pre-COVID, from April 2019 to 2020, between 81% to 93% of urgent breast cancer referrals were seen within two weeks. By March 2024 only 64% of people were seen within the two weeks.
Time to diagnosis
Since the introduction of the 90% target for breast cancer diagnosis within 28 days, NHSE has failed to consistently meet it.
From August 2023, if NHSE had managed to meet the 90% expectation for a diagnosis or ruling out of breast cancer within 28 days 6,784 more people would have received a timely diagnosis.
Our analysis also found much longer waiting times to confirm breast cancer, which are masked in the headline data by shorter waits for people to have cancer ruled out.
Between March 2023-April 2024,1 on average only 66% of people were told they had cancer within the 28-day target, compared to 90.9% of people who were ruled out. It took 10 to 12 days longer to confirm breast cancer than to rule it out.
Time to treatment
As well as facing much longer waits to see a specialist, and then be diagnosed, people with breast cancer are also waiting longer to start treatment. NHSE’s target is for 85% of people to start treatment within 62 days of their initial referral for urgent suspected cancer, a target they’ve not met for breast cancer since November 2020.
We estimate that if the 85% target had been reached over the last three years, an additional 10,130 people would have started treatment on time. Since April 2021, the number of people experiencing the longest waits (above 104 days) for treatment each month has increased fourfold, with 2,980 people waiting more than 104 days for treatment.
Even people starting treatment for breast cancer within the target time of 62 days are waiting longer. A staggeringly low 8% of patients received their first treatment within 31 days of being urgently referred in April 2024, compared to 37% at the start of the pandemic.
There are also problems with the way targets are measured and reported, as NHSE doesn’t track any delays between having your cancer confirmed and receiving a full diagnosis. This means potential delays in areas like pathology, which provide test results that are crucial for deciding a person’s treatment, are not being tracked.
What should happen now?
In too many areas, very long waits and falling standards have become normal. NHSE and the Government need to accept that this new status quo is unacceptable and take action to ensure people with breast cancer have fast access to diagnosis and treatment.
We welcome the government’s commitment to meet the current targets for cancer waiting times, but more needs to be done. This must include improving the way data on waiting times is collected and measured at each stage of the pathway, so the specific points of delay and the underlying causes can be identified and addressed.
We are calling on NHSE to:
- Commit to publishing separate data on waiting times for confirming breast cancer, separate to ruling out breast cancer.
- Focus on improving the average waiting times for starting breast cancer treatment, as well as meeting the existing commitment to reduce the 62-day cancer backlog.
- Offer breast services the support needed to close the waiting times gap between breast cancer being diagnosed and ruled out.
In the long term, the government’s long-term ambition:
- Expand the Faster Diagnosis Standard (FDS) to require a full breast cancer diagnosis, including all the information needed to make a treatment decision, rather than simply ruling cancer in or out within 28 days.
- Raise the overall FDS target to 95%, as was originally proposed in 2015.
The Government also needs to provide more details on how the long-term workforce plan will address gaps in the cancer workforce, including projections of staff needed to provide vital services for all breast cancer patients.