• Shola Adegoroye

NHS Cancer Waiting Times: Will it be a happy 20th anniversary?

Next year the NHS in England will witness the 20th anniversary of the birth of Cancer Waiting Times performance targets as originally pledged by the Labour government in The New NHS: modern – dependable (1997). But following the 20th consecutive quarter of non-compliant 62-day cancer performance, will it be a cause for celebration or embarrassment?

Unlike their sibling access targets (A&E and RTT), the cancer waiting times performance targets were on the whole welcomed on their inception. Applauded as tough, but necessary. Their main objectives: to give confidence to patients and to prove the NHS’ commitment to improving access to specialist services and cutting waiting times for the diagnosis and treatment of cancer. This commitment was made to the public, and the public accepted it as sacred and binding.

So, when it comes to the history of NHS targets, of the three major access standards (A&E, RTT and cancer), no NHS leader would have been able to imagine that the NHS would not deliver on its cancer waiting times promises.

Over the years, there have been some tweaks to the definitions and some major performance expectations added along the way in addition to the original 14-day GP referral target: in 2005, 31-day standard and 62-day standard; in 2008, 62-day screening, 62-day consultant upgrade, 31-day subsequent surgery and drug treatment; in 2009, breast symptomatic; and in 2010, 31-day subsequent radiotherapy and other treatments. And in 2020, cancer services will be expected to deliver the new 28 Day Faster Diagnosis standard.

And yet, despite all the changes, the cancer waiting times expectations have largely remained the same for the past eight years – which is why so many of us across the health service are asking, ‘How have we let things stay so bad for so long?’

At its height, implementation of the goals of the cancer reform appeared to be going incredibly smoothly. The first 10 years following the 2000 Cancer Plan saw unprecedented government investment in cancer. There was a new found focus on NHS leadership. New dedicated positions were created to deliver the promises of the Cancer Plan. The NHS invested in building strong infrastructure and new governance arrangements. Improved technology and modern systems were introduced, as well as good practice approaches, pathways, and processes. More importantly, significant work was underway to foster more honest, open and productive inter-organisational relationships.

That dirty word – austerity - hadn’t entered into the common lexicon.

Of course, things began to shift as the new coalition government came into power in 2010. Providers, commissioners, SHAs and the cancer arm’s length organisations were distracted with the scrutiny and demands of a new government. The Lansley vision was being repeatedly debated and ineffectively fought against. Across the board, the planning was underway for dismantling and reorganising the long-established and well-understood governance arrangements.

Still to this day, I believe that the fatal blow was delivered by the unexplained miscommunication that appeared to grip the mindsets of managers and clinicians around the expected “relaxing” of these access targets. Somehow, once the foot gets taken off the performance delivery pedal in the NHS, it’s very difficult to power back up those engines.

The moment of reckoning for the 62-day target came in Quarter 4 of 2013/14 - the target was missed for the first time ever. That moment is engraved in my mind. It was a painful realisation of the instability that the NHS was facing. It was clear to many of us that it would take time to re-organise and get back on track with cancer performance.

At that time, I was working as part of the NHS Interim Management and Support Intensive Team (which later moved under the remit of NHS Improvement), in a role originally funded by the National Cancer Action Team who were part of the National Cancer Programme with a clear mission: “Driving improvement and quality in cancer services”. We stood in solidarity. It’s hard to remember a time when we were all so joined up in our vision.

Yet, here we are - nearly five years later, with the provisional Q3 2018/19 Cancer Waiting Times performance data reporting another quarter of failure. It’s disheartening, to say the least, that we continue to stand here as witnesses to the NHS’s inability to recover from that performance blow to the 62-day target from all those years ago.

Perhaps an even more difficult pill to swallow is that the 62-day target isn’t the only cancer waiting times failure the NHS has witnessed. In every quarter so far in 2018/19, the two week wait standard has failed to be met nationally, and this appears to be the case also for Quarter 3 2018/19.

So, will we be able to mark the 20th anniversary year as a celebration of the NHS’ achievement in keep waiting times down and improving patient access? Time is tight but I believe it’s still possible. In fact, I’ve witnessed first-hand the incredible work that can be done by the NHS when push comes to shove and when a unified plan is implemented.

Over the coming months, leaders and teams across NHS providers, CCGs, STPs and Cancer Alliances will need to take some serious steps forward and, in some cases, some very tough decisions to get some real traction on improving the problem.

Despite the grim results we’ve received over the last five years – I still have faith. December 2018’s provisional monthly data shows that for the first time since April 2018, the two week wait target was achieved for a single month. A glimmer of hope.

Perhaps this news isn’t something to jump up and down about just yet – but it does prove that performance recovery is possible. And it’s this small flicker of potential that keeps me fighting for the NHS to eliminate unnecessary delays.

Author: Shola Adegoroye, Founder and Director of Reach Up Consultancy

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Do you have a plan you believe in to turn around your organisation’s cancer waiting times performance?

I set up Reach Up Consultancy with a mission to help the NHS achieve its waiting time commitment to patients and deliver sustainable cancer waiting times systems once again. Please get in touch to arrange a free consultation to discuss how we can support your organisation’s cancer waiting times and overall system improvement goals