Reflections on improving performance against access to cancer standards

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We spoke to our Director of Elective Care Improvement, Nigel Coomber, about improving access to cancer standards and our new cancer intensive support team.

Waiting times for cancer patients are currently under the microscope because this important standard has only been met nationally twice since April 2014 (April 2014 and December 2015), despite providers working hard to maintain or achieve the expected waiting times for their patients. I thought it might be useful to reflect on our experience in helping providers reduce patient waits and introduce our new cancer intensive support team.

The 29 October cancer patient tracking list (PTL) snapshot showed 7,351 patients who have been waiting over 62 days. This is rightly a concern for everyone but focusing only on these patients is unlikely to have a sustainable impact on the total numbers waiting too long for treatment or, in many cases, being told they don’t have cancer.

This group of patients on examination will no doubt include many who might be classified as ‘complex’ or have exercised their right to delay parts of their pathway. It can be difficult to know what to do to resolve what appears to be a cluster of complex issues.

Nigel Coomber, Director of Elective Care Improvement, reflects on improving access to cancer standards and tells us what resources to use to help you.

How can we help improve cancer pathways

Our experience is that real gains can be made in reducing the number of patients waiting over 62 days by focusing attention on the start of the pathway. Achieving and maintaining short waits (7 days) for first appointments and access to all diagnostic modalities can have far-reaching benefits. One obvious result is that more people who do not have cancer are seen and removed from the pathway at an earlier stage. Not only does this result in a much smaller total PTL size − which makes tracking and managing the remaining patients easier - it also allows you to perform more diagnostics in a 62-day period than if your waits were 14 or even 10 days in your diagnostic modalities.

One provider we worked with on these areas saw a reduction in total PTL size of over 40% (2319 to 1286) and a reduction in patients waiting over 62 days of over 70% (232 to 66) in 6 months. This then allowed them to focus on pathway and process issues to further reduce the 66 patients over the following months.

This is, of course, easier said than done. It requires effective capacity-planning and in some cases investment. We have capacity planning models available to help you and there is further information on these models and some excellent instructional videos from NHS England.

Diagnostics in cancer pathways

Patients referred with suspected cancer are heavy users of diagnostic capacity. Almost all tumour sites now have recognised straight-to-test or one-stop options that speed up the start of the pathway. If your organisation currently does not deliver these, please get in touch and we can share examples or put you in touch with providers that do. 

If you are already providing these options we advise reviewing the percentage of patients that go through these routes. Our experience is that there is large variability across the country and it is worth the clinical team examining their triage protocols to see if more patients can be directed down these routes.

There is obviously growing concern nationally about access to diagnostics and the approaching capacity challenge. NHS England’s cancer taskforce is currently running programmes designed to improve the situation.

Our support offer

Cancer intensive support team

With the increased need for dedicated support to regions and providers around cancer waiting times, we have set up a small dedicated intensive support team. It is working with our regional teams and providers to compile good practice that we can share via our Improvement Hub.

We already have guides and tools on the cancer section of the hub and I would also like to point you in the direction of our elective care forum where anyone can ask questions which one of the team will respond to.

We’d love to hear from you about what support would be helpful and if you have any questions on the rules or how to interpret them. Please get in touch via our forum, on Twitter or by email at nhsi.electiveist@nhs.net.

Patient tracking lists

Finally, and linking back to my first point, we are developing some guidance around PTL size. Our experience, (backed up by clearance times in referral to treatment waits) suggests that the number of people on the cancer PTL directly influences the length of wait. Cancer is a bit more complicated because the data on treatments only includes patients who have cancer, not those who are not diagnosed, so we are trying to understand the relationship between 2 week wait referrals and overall PTL size. 

Our initial work suggests a PTL size of around 2.5 to 3 times the average 2 week wait referrals may be the upper limit but we’d love to hear from any organisations that could help us refine our analysis.

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