Unanswered Questions in NHS's New Cancer Plan
NHS England's new national cancer plan focuses on catching cancer earlier and treating it faster. The government has also promised to meet all cancer waiting-time targets by 2029. This includes a long-missed target, namely that most patients should start treatment within 62 days of being referred by their GP.
Cancer survival in England has improved , but it still trails behind countries such as Australia, Canada and Nordic nations for many common cancers .
For some of the deadliest cancers - lung, liver, oesophageal, pancreatic and stomach cancers - the UK ranks near the bottom of the league table among similar wealthy countries. Fewer patients are still alive five years after diagnosis compared to other nations.
No single cause explains this gap . A key factor is that people in the UK are more likely to be diagnosed when their cancer is already advanced. This makes it harder to cure and limits treatment options.
Getting to see a specialist can also be slow. Patients struggle to get GP appointments, symptoms may not seem urgent at first, and people often need multiple visits before getting referred to a specialist.
Once in the system, patients hit more delays. The NHS has fewer CT and MRI scanners per person than many comparable health systems, contributing to waits for imaging and other tests.
There are also longstanding workforce shortages, especially in radiology and oncology. This means fewer specialists to read scans, plan treatment and deliver radiotherapy and chemotherapy. Limited surgical capacity, operating theatre time and radiotherapy machines cause further delay treatment.
How countries record cancer survival accounts for some of the difference. But even when researchers adjust for this, the UK still lags behind the best-performing countries. The result is a system where many individual steps function under strain, and those small delays add up for patients.
The 62-day target measures the journey from urgent referral for suspected cancer to starting treatment. In principle, a person referred urgently by their GP, a screening programme or a hospital doctor should have their diagnosis confirmed and their initial treatment underway within just over two months.
That sounds straightforward. But for patients, it's a complex and emotionally draining experience.
The journey usually starts when someone notices a worrying symptom - a breast lump, unusual bleeding, a persistent cough or a change in their bowels - and gets a GP appointment. If the GP is concerned, they make an urgent referral to a specialist clinic. The patient then waits for their first hospital appointment, where they'll have further assessment and tests: blood tests, X-rays, endoscopy, CT scans, MRI scans or ultrasound.
If scans show something suspicious, the next step is often a biopsy. This lets a pathologist confirm whether it is cancer and identify the type.
Modern pathology may also include molecular and genetic tests, which help decide which treatments are most likely to be effective.
All of this information is then brought to a multidisciplinary team meeting, where surgeons, oncologists, radiologists, pathologists and specialist nurses discuss the case and agree a plan.
Only after that can the first treatment be scheduled, whether that is surgery, radiotherapy, drug treatment or active monitoring. Delays can happen at every stage: getting the first appointment, accessing scans or endoscopy, receiving pathology results, convening the multidisciplinary team, and finding an operating theatre or radiotherapy slot. And the 62-day clock keeps ticking .
For patients, what appears as a single target number actually represents weeks of waiting, uncertainty and repeated encounters with an overstretched system.
Catching cancer early has become a cornerstone of cancer policy. Cancers caught early are easier to treat and more likely to be cured .
A small, localised tumour can often be removed with surgery or treated effectively with radiotherapy or drugs. But cancers that have spread are harder to control.
This link between early detection and survival drives efforts to encourage people to seek help quickly, expand screening programmes and speed up diagnosis. But early diagnosis isn't always beneficial for everyone or every type of cancer.
Screening can lead to overdiagnosis. This means detecting very slow-growing cancers or abnormalities that would never have caused symptoms or shortened someone's life. People in this situation may live for years with a cancer label, alongside the physical and psychological consequences of surgery, radiotherapy or drugs that they might not have needed.
So-called "false positives" are another important issue. Tests sometimes flag abnormalities that aren't cancer, but still trigger scans, biopsies and procedures, as well as significant anxiety for patients and families.
For some aggressive cancers, finding the disease a little earlier on a scan may not change the eventual outcome if available treatments remain limited. The challenge is to design programmes that catch the right cancers early, using accurate and targeted tests, while clearly explaining both benefits and risks so people can make informed decisions.
One of the most eye-catching promises in the new plan is to deliver 9.5 million more tests and scans by 2029. Much of this extra activity is expected to take place in community diagnostic centres, which bring CT and MRI scanners, ultrasound, endoscopy and blood tests closer to where people live.
Extending opening hours into evenings and weekends should give patients more flexibility and, in theory, shorten waiting times for investigations and diagnosis.
But tests and machines are only part of the picture. Every scan needs a professional to interpret it, and every endoscopy list requires trained staff and recovery space.
England already has a shortage of imaging specialists, and increasing the number of scans without increasing the number of people who can report them risks swapping one bottleneck for another.
Laboratories also need enough biomedical scientists and pathologists to process additional blood tests and tissue samples. If staffing does not keep pace, the promise of millions more tests could translate into longer queues for results and less time for doctors to explain findings and discuss options with patients.
New technologies, including artificial intelligence to support image reading and automated laboratory systems, may help to increase efficiency, but they still rely on human oversight and do not remove the need for a well-trained, reasonably staffed diagnostic workforce.
The success of the plan depends heavily on people, not just equipment. Yet there are already substantial gaps in the cancer workforce, especially among radiologists, oncologists, pathologists, specialist nurses and radiographers.
Professional bodies have warned for several years that the shortfall in key specialties is growing, with services relying on overtime, outsourcing and temporary staff to keep up with demand. These pressures affect not only the speed of diagnosis and treatment, but also the time healthcare professionals can devote to communication, compassion and shared decision-making.
Training more specialists is essential but slow. From entry to medical school to becoming a consultant radiologist or oncologist typically takes well over a decade, meaning that decisions made now will only fully affect services in the 2030s.
Meanwhile, the NHS will keep relying on recruiting from abroad, the private sector, and new ways of working that expand what nurses and other non-doctor professionals can do.
The risk is that without serious attention to burnout, working conditions and retention, new trainees will simply replace experienced staff who leave because of workload and stress. Any realistic staffing fix will therefore need to combine expanded training with measures that make cancer services sustainable places to work: manageable rotas, protected time for training, supportive leadership and a sense that delays and shortages are being addressed rather than normalised.
Cancer care in England is already unequal , and a national plan that ignores this risks making the gap worse . People in poorer areas are more likely to develop certain cancers, get diagnosed late, and die from them.
Access to primary care varies widely. Some communities face long waits for appointments or can't see the same doctor regularly.
Rural patients may need to travel far for scans, endoscopy or radiotherapy, while some urban communities face language barriers, cultural differences or mistrust that make screening and early diagnosis programmes harder to access.
Expanding community diagnostic centres, mobile services and workplace partnerships could reduce some barriers - but only if they're deliberately placed where they are needed most. But if new facilities go to already well-served areas, or if information campaigns and booking systems don't reach marginalised groups, the extra capacity will mostly benefit people who already navigate the system easily.
Ensuring that the benefits of earlier diagnosis and faster treatment reach everyone will require careful use of data on stage at diagnosis, waiting times and outcomes, broken down by region, ethnicity and deprivation, and a willingness to direct extra resources where need is greatest, not just where uptake is easiest.
Politically, the headline ambition is framed in terms of five-year survival, and improving that is undeniably important. From a patient's perspective, though, success is more than being alive at a particular time point.
Many people live with the long-term consequences of treatment, including fatigue, pain, bowel or bladder changes, sexual difficulties, early menopause, cognitive effects and altered body image. These can disrupt work, relationships and everyday activities long after the end of chemotherapy or radiotherapy.
Anxiety about recurrence is common, and routine follow-up appointments can be both reassuring and a source of renewed fear.
A cancer plan that truly serves patients has to focus on how people are living , not just how long. That means investing in rehabilitation, psychological support, specialist nursing, social care and fair access to financial and employment advice.
It also means recognising that some patients will never be "finished" with cancer but will live for many years with incurable disease, requiring ongoing treatment and support to maintain the best possible quality of life .
When we judge whether the new targets have been met, we should therefore look beyond the headline numbers . Success would be a future in which more people are diagnosed early, treated promptly and supported to rebuild their lives, with fewer left waiting in pain or confusion, and fewer feeling abandoned once the last dose of treatment has been given.
Justin Stebbing does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
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