Why the NHS can’t win the battle on treating cancer

Every month, the NHS releases data on waiting times and in the last year the headlines on cancer waits have become increasingly grim.

A recent analysis by major cancer charity Macmillan warned 2022 was the worst year on record for cancer waiting times in the NHS.

It is widely recognised how much damage Covid wrought on the country’s healthcare system. But we cannot just pin all of this on the pandemic – NHS data clearly shows that the problem predates the pandemic.

Statistics on the proportion of patients waiting more than two weeks to see a cancer specialist following a referral have been getting worse since at least 2017-18, before taking an even sharper downturn in 2020-21.

The scenario is similar for patients who are meant to receive swift surgery and radiotherapy treatment for cancer. The NHS is expected to ensure at least 85 per cent of patients with urgent referrals start treatment within 62 days – but it has not met this target since 2013-14.

The government has promised to improve diagnosis rates by introducing community hubs, for example, but the waiting list hit a high of 1.62 million in March.

Part of the problem is a historic under-investment in equipment such as CT, MRI units and X-ray machines.

And, although Covid will have delayed many from seeing or going to their GPs or being screened, referrals are increasing. This suggests bottlenecks in diagnosis and treatment rates are among the biggest barriers facing the NHS.

If the recent warnings are to be heeded, it is clear workforce shortages are seen, by healthcare leaders, as the key problem driving up waiting times.

Two weeks ago, clinical leaders from major medical bodies - the Royal College of Radiologists, Association of Cancer Physicians & Consultant Medical Oncologists, UK Oncology Nursing Society and British Oncology Pharmacy Association - wrote to health secretary Steve Barclay over their “serious concerns about a critical lack of capacity within oncology departments.”

The letter said departments were dealing with an increasing workload, preventing patients from being seen in a timely way. Despite more treatments being made available, a lack of investment to increase staff levels means departments are failing to keep pace, the letter said.

Worryingly, the letter added: “Many departments are having to make difficult decisions over whether to withhold access to approved treatments or prioritise which patients can receive treatment within a safe time at the expense of others.”

The fact that workforce is one of the key barriers to cutting the cancer waiting list is not a surprise. NHS performance almost always comes down to workforce levels – and without a major overhaul, that won’t change any time soon.