Cancer Waiting Times - Helpful?

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The UK government and NHS England recently announced a new and revised set of Cancer Waiting Times, CWT, that would take effect from 1 October 2023. This article aims to know if these CWTs are going to be beneficial.

There are three new CWT targets:

A. The 28-day Faster To Diagnosis

This means you will know if you have cancer or not within 28 days from the time you were referred to be tested. For example, if you are referred on the 1st of March to be tested, you can expect a definitive test result by 29 March; approximately within one month.

B. The 31-day To Treatment

This means you will receive treatment within 31 days from the time a decision to treat was taken. Let's say, you and your cancer doctor agreed on 30 July for you to be treated. Therefore, your treatment shall begin no later than 31 August.

C. The 62-day Referral to Treatment

This target seems to combine the above two. You ought to start treatment within 62 days from the time you were refereed. For example, you were referred for tests on 1 March and subsequently found to have cancer. You can then anticipate starting treatment (if so decided) no later than 30 April.

The CWTs are performance targets which NHS England hospitals are aiming to meet. Notably, patients can expect to be tested and treated within these time periods.

Before touching on performance targets, a quick take on healthcare systems can be useful.

The key word here is 'systems'. Briefly, a system is a set of interconnected things and/or people that interact and produce some result. A hospital is an example. How a system produces its results is known as behaviour and is deemed complex when it has many interacting parts. As such, it is easy to appreciate cancer hospitals as complex systems.

How and where a system is tinkered with is important. For example, a general strike by healthcare workers has far-reaching consequences within the system compared to changing the colour of the toilet bins. In general, changes to how work is carried out will have a strong impact on how the system behaves.

Key takeaway - a system's behaviour and results are interlocked.

CWTs are measurable targets. Policymakers and management seem to favour these kinds of measures since the results are rather binary and simple - either the targets were met or not. CWTs are also high-profile performance targets - it's publicised and emotive for patients. This can have an added effect on how the system behaves.

The 28-day target is likely to see many more patients being tested, including the worried well. If true, more patients will reach their diagnostic point of care, faster. If the capacity to deal with this demand falters then it becomes a bottleneck. A bit like a busy 4-lane highway coming into a single lane. NHS England is looking to create more diagnostic centres to meet this demand. More on this further down.

Previously patients were expected to meet with a cancer consultant before they were sent for testing. The consultant had a modulating effect on the system like a speed limit would for our highway example. Removing the consultant is a significant change within the system. So how will the system behave hereafter is left to be seen.

It takes several clinical experts and technologies to help diagnose or rule out cancer. The 28-day target implicitly expects the test results to be accurate. In this scenario, we can all agree there is no point in being fast and wrong! The NHS cancer diagnostic system is expected to be timely and accurate which requires teamwork, collaboration and conducive work environments within and between its hospitals (and new diagnostic centres that are being planned).

Now let's assume a cancer diagnosis is accurate. But does it have sufficient details to help with treatment-related decision-making? After all, a positive diagnosis is likely to lead to treatment. Variable reporting standards can cause delays with regard to treatment. This critically means the 28-day target is strongly linked to the 31-day treatment target as a measurable performance target AND as a quality standard.

From a systems point of view, management will require timely and reliable feedback to be able to deliver the results patients expect.

Adding capacity (for example, more diagnostic centres) to a system does not necessarily change the behaviour of the system in ways you want it to change. Many more things have to be undertaken if the system is to change its behaviour to produce different (and better) results. As the saying goes, you can't do the same thing and expect different results. The prevailing situation is that current cancer care targets are not met and lamentable variations in cancer care remain across the UK. Can newer CWT targets help ameliorate these?

At a public relations level, the newer CWTs can be easier to understand and possibly "comforting", especially to patients but from an implementation level, it requires elucidation. As such, it is difficult to immediately comprehend how these revised CWTs are going to be meaningfully beneficial to patients or care providers.

Thanks for reading.