Cancer Reform Strategy - NHS Cancer Screening Programmes

CHAPTER 4: ENSURING BETTER TREATMENT 574.3 This chapter sets out the actions which willbe taken to ensure delivery of better treatment.Chapter 7 sets out how treatment and care canbe delivered in the most appropriate settings.4.8 Following this work and based onadvice from key stakeholders, we will nowextend the range of patients who benefitfrom the current standards:Going further on cancer waits4.4 Excellent progress has been made on thecurrent waiting time targets, with achievementat a national level as follows:●●●two week standard (urgent GP referral tofirst hospital assessment): >99%;31 day standard (from diagnosis/decision totreat to first treatment): >99%; and62 day standard (from urgent GP referral tofirst treatment): >96%.4.5 This progress has been achieved as a resultof concerted effort and coordination acrossprimary and secondary care. In 2006/07, over630,000 people were seen under the two weekstandard, over 200,000 under the 31 daystandard and over 80,000 under the 62 daystandard, with less anxiety caused by waitingand greater chance of successful treatment ifthey are found to have cancer.4.6 However, the current standards do notapply to all cancer patients. Only around onethird of patients diagnosed with cancer comethrough the urgent GP referral route and thusfall under the two week and 62 day standards.Also, the 31 day standard only applies to thefirst treatments for cancer. It therefore does notcover second or third treatments when patientsrequire several treatments in sequence, forexample radiotherapy after surgery, nor does itapply to patients requiring treatment forrecurrence of cancer.4.7 The government made a commitment to“go further on cancer waits” in its 2005election manifesto. Extensive consultation hasbeen undertaken with key stakeholders todetermine what the priorities should be in thisarea and how they should be achieved.The Cancer Services Collaborative has beenundertaking pilots to test a range of newapproaches to implementation.●●●●The 31 day standard will be extended tocover all cancer treatments. Primary CareTrust (PCTs) and trusts will need toensure that they are compliant with thisextended standard for all patientsreceiving surgery and drug treatment byDecember 2008. The largest impact ofthis change will be in radiotherapydelivery, where increased capacity willparticularly be needed and some areaswill not be able to meet this deadline.PCTs should set out challenging goals forachieving this standard for radiotherapy,which should be approved by their SHA.We expect this standard to be fullyimplemented by December 2010;In addition to patients referred urgentlyby their GP, all patients with suspectedcancer detected through nationalscreening programmes will in futureenter the 62 day pathway. Detailedguidance will be provided early in 2008;Hospital specialists will now have theright to ensure that patients who werenot referred urgently by their GP, butwho have symptoms or signs indicatinga high suspicion of cancer, are managedon the 62 day pathway. In some parts ofthe country, this is already being done.As a matter of good clinical governance,such arrangements should be put inplace in all localities during 2008; andAs announced in September 2007, allpatients referred to a specialist withbreast symptoms, even if cancer is notsuspected, should be seen within twoweeks of referral. This is already beingachieved in several centres and could beachieved elsewhere, for example byincreasing capacity by training nursepractitioners to undertake clinicalassessment. We expect this standard tobe fully implemented by December 2009.