What waiting time target changes mean for nurses
Intended for healthcare professionals
Opinion Previous     Next

What waiting time target changes mean for nurses

Kathy Oxtoby Health journalist

The NHS had its worst year for cancer waiting times in 2022 but a streamlining of standards may lead to improvement

NHS targets for waiting times in cancer treatment have been streamlined from ten standards to three. NHS England (NHSE) says the reduction will simplify standards it sees as outdated.

Cancer Nursing Practice. 23, 1, 9-10. doi: 10.7748/cnp.23.1.9.s4

Published: 02 January 2024

But the change comes against a backdrop of targets routinely being missed and reports of some patients having operations cancelled two or more times. So what will these changes mean for nurses?

cnp_v23_n1_4_0002.jpg

There could be an opportunity for more nursing contact at the screening/diagnostic pathway point, to support patients with their concerns and fears

Picture credit: iStock

What are the changes to cancer treatment waiting time targets and why have they been changed?

NHSE received government approval to implement changes to cancer waiting time standards in England from 1 October. The move follows a consultation on their proposed changes in 2022.

The changes involve the streamlining of ten waiting time targets to three outcomes-focused standards that are broader and encompass the previous ones. These are:

  • » Faster diagnosis standard: patients to receive a diagnosis or have cancer ruled out within 28 days of referral (75% of patients).

  • » 31-day treatment standard: all cancer patients to commence treatment within 31 days of a decision to treat (85% of patients).

  • » 62-day treatment standard: patients to commence treatment within 62 days of being referred either by a GP or through cancer screening or from consultant upgrade (96% of patients).

The 31- and 62-day standards are in line with Scotland and Northern Ireland, while Wales has its own Suspected Cancer Pathway targets. Northern Ireland also has a specific two-week red flag referral target for those with suspected breast cancer.

How were services doing with the previous targets?

Cancer waiting time targets were routinely being missed. Macmillan Cancer Support chief nursing officer and nurse consultant Claire Taylor says that while there were ‘minor improvements’ for some cancer waiting times in July compared with the previous month, ‘all but one of the national targets were missed once again, showing that NHS cancer services in England are still struggling under intense pressure’.

This situation follows analysis by Macmillan earlier this year showing that performance against current waiting time targets in 2022 was the worst on record across the UK.

Why are most of the targets being merged?

The two-week wait target was introduced 20 years ago and more targets were added since then, so the process for measuring performance had become ‘increasingly unwieldy for trusts to manage as well as confusing for patients,’ says Dr Taylor.

The new standards are ‘more in line with the requirements of modern cancer care, with a greater focus on outcomes over process’, says NHSE. The standards will ‘ensure equitable access to care because the new treatment standards will measure waiting time for all patients regardless of their route of referral into the system and the type of treatment they receive’.

What has been the reaction to the changes?

NHSE says there has been ‘widespread clinical support for reforming NHS cancer standards to speed up diagnosis for patients’.

Dr Taylor says there has been ‘a mixed reaction’ to the changes. Macmillan’s view is that ‘these changes will help shift us towards a focus on whole system performance and outcomes for patients, rather than individual parts’, she says. ‘But this needs to come with concerted efforts from the UK government to address the systemic workforce challenges in cancer treatment and care.’

‘We all want these targets to translate into a benefit for patients’

Claire Taylor, Macmillan Cancer Support chief nursing officer and nurse consultant

She says some have concerns about how these targets will be accurately collected and reported, while others worry that patients may be missed from upgrades in this more streamlined system.

Ruth Hammond, UK Oncology Nursing Society board member and education lead, as well as a clinical service manager, says the revised cancer waiting targets ‘are aligned to the National Cancer Strategy – the need for early diagnostics and early treatment/intervention’, and appear to be focused on ‘optimising health outcomes and quality of life’.

However, she says with fast-track pathways ‘we need to ensure patients are psychologically supported – so there may be a need for advanced nurse practitioners and clinical nurse specialists to have greater involvement in the front end of the diagnostic pathway’.

Cancer Research UK’s director of evidence and implementation Naser Turabi says the changes to waiting time targets for England are positive and will be helpful for people affected by cancer. But changing the targets will not address systemic challenges in cancer care, he adds. ‘To accelerate research, boost our cancer workforce, and diagnose more cancers earlier, we need long-term funding and a clear, ambitious strategy for cancer.’

Will a simplification of targets enable nurses to have greater capacity and time to focus on diagnosis and treatment?

The changes ‘should reduce the admin burden for nurses,’ says Dr Taylor. ‘But it won’t necessarily mean that they have more time. It depends on their role and the extent to which they are involved in the diagnostic process. There may be more impact on certain specialist nursing roles such as acute oncology, or those who work in primary care or are based at the rapid diagnostic centres.

‘It’s also important to remember that only a relatively small proportion of those referred in via an urgent referral to the acute trust will be found to have cancer.’

Ms Hammond says the simplification of waiting time targets may also make it easier for nurses to support and manage patient expectations.

How could the revised targets change nursing roles and work pressures?

The waiting time changes themselves ‘should not affect nurses’ roles and work pressures’, says Mr Turabi. But he adds: ‘Wider improvements to the pathway should see opportunities for nurses to develop diagnostic skills, such as in endoscopy.’

Changes in the cancer treatment waiting time targets

Old targets

  • » A maximum two-week wait from urgent referral to first outpatient attendance

  • » A maximum two-week wait from referral to hospital of a patient with breast symptoms where cancer is not suspected

  • » A maximum four-week wait from referral to patient being informed of diagnosis or ruling out of cancer

  • » First treatment within 31 days of diagnosis for all treatments, radiotherapy, surgery or chemotherapy

  • » A maximum 6 2-day wait for first treatment from urgent referral, urgent referral from NHS Cancer Screening Programme (breast, cervical or bowel) or consultant upgrade

Current targets

  • » Faster diagnosis standard (FDS): patients to receive a diagnosis or ruling out of cancer within 28 days of referral. This replaces the old two-week wait target. The FDS gives patients a definitive diagnosis of cancer or rules it out. The old two-week wait standard marked when the first appointment happened and further tests and appointments were almost always required

  • » 31-day treatment standard: patients to commence treatment within 31 days of a decision to treat

  • » 62-day treatment standard: patients to commence treatment within 62 days of being referred

Source: Cancer Research UK (2023) and NHS England (2023)

Dr Taylor says the revised targets should ‘help nurses to focus on helping people through the whole diagnostic period – to be able to give them a diagnosis or rule out a diagnosis faster – rather than focusing as much on getting the first appointment or test done in time’.

Will the targets be any easier to hit?

Dr Taylor says: ‘It’s unlikely that changing the targets will make it much easier to reach them, but it does make it clearer what healthcare professionals are working towards.’

The targets may also ‘offer more parity as there is now the same standard to be working towards for those referred with symptoms, regardless of their route into the system’, she says.

Will nurses have fewer patient contact opportunities?

Patient contact ‘will vary from one role to another’, says Dr Taylor. ‘It is unlikely to impact Macmillan nurses as they are most likely to start seeing patients at the point of diagnosis.’

Ms Hammond says there could be an opportunity for ‘greater nursing contact at the screening/diagnostic pathway point, to support patients with their concerns and fears’. She adds: ‘This may require consideration of how specialist support services are designed and delivered.’

‘We all want these targets to translate into a benefit for patients,’ says Dr Taylor, ‘as we know that more timely care and treatment makes a difference to patient experience and can have a positive impact on outcomes and even survival.’

Share this page