Written Statement: Progress on the Single Cancer Pathway

I would like to update members on the development of the Single Cancer Pathway. This is a ground breaking approach within the UK at the heart of our national approach to improving cancer outcomes in Wales. The Welsh Government worked with cancer teams, through the Wales Cancer Network, to determine if there was a better way of measuring the length of time people wait for cancer treatment. Following this work I agreed that there is a compelling case to measure cancer waiting times differently.

Our two cancer waiting times were not always capturing the patient’s journey from when cancer was first suspected. We found that separating people into two different waiting time pathways – urgent and non-urgent suspected cancer – was more designed to suit the system based on where the patient presented. NHS bodies didn’t have the data and the system intelligence tools to properly plan their services. In addition, we found there was too much variation in how cancer pathways operate and that this is likely to contribute to differences in outcomes.

In November 2018, I announced that NHS Wales would introduce a Single Cancer Pathway, starting from the moment a cancer is first suspected. This new 62-day waiting time measure includes patients referred from primary care or found to have cancer in hospital care. But most importantly of all, this new Single Cancer Pathway starts when cancer is first suspected – at the ‘point of suspicion’ – no matter how a person presents to the health system. The Single Cancer Pathway is therefore a much more accurate way of measuring the times to treatment our patients are experiencing in the health system.

There has been widespread clinical support for this change and support from the Wales Cancer Alliance which brings cancer charities together.

A lot of work has gone on since November 2018 to determine how this new measure could be recorded and to put in place the means of reporting it. In August 2019, the first figures were published. These gave us a much better understanding of the real time it is taking for our patients to be diagnosed and treated. This measure provides a much greater opportunity for the system to respond and improve. This is not about hiding performance – indeed it is a more challenging measure. To ensure there is complete transparency, NHS Wales has continued to report the original cancer waiting times. It is clear from these metrics what the same patient journey looks like on the original two pathways compared to the new Single Cancer Pathway. The difference in those figures provided further evidence to support the adoption of the Single Cancer Pathway. We can now see more accurately than ever before how long it takes for a suspected cancer to be referred, investigated and for treatment to be started.

As we now restart the publication of official statistics I have decided that from February 2021, we will report only against the Single Cancer Pathway and will no longer report the previous measures. Having listened to clinicians I have also decided that the Single Cancer Pathway will not include any adjustments – we will report the real wait. At present pathways can be adjusted when a patient takes a holiday, is unable to attend their appointment or needs stabilising treatment. These will now be included in the reporting so the waits reported will reflect the real wait that the patient experienced.

With this in mind our starting performance measure until March 2022 will be 75%. I expect the performance measure to be revised upwards in subsequent years.

The Single Cancer Pathway is a UK first for measuring waiting times for cancer but more importantly it provides an ambitious platform for transforming cancer care. The new business intelligence tools underpinning the Single Cancer Pathway will allow NHS Wales to track and manage people with suspected cancer in much greater detail. This will allow the NHS to plan its services much more around the needs of the patient and provide more timely care. Tackling variation in how clinical care is delivered is at the heart of our approach to quality and to consistently achieving better clinical outcomes. In order to support the Single Cancer Pathway, our clinical community has come together and agreed nationally optimised pathways of care for tumours developing in various parts of the body. This means that expert clinicians have set out what should be delivered for breast or bowel or lung cancer – no matter where in Wales someone is diagnosed.

These ‘optimised pathways’, developed through clinical consensus, will allow services to gradually converge on a more standardised way of delivering care. These are highly ambitious, timed pathways of care which will take time to embed. We will use our cancer peer review programme to see how these are being implemented. To support health boards and trusts in this new method of improving care and outcomes I have announced an additional £3m allocation per year for five years. This £15m investment will assist in the implementation of these optimised pathways. Most of this investment has been focused on changing the diagnostic element of the pathway – shortening it by making greater use of straight-to-test pathways or building in immediate onward referral – in order to speed up the diagnostic phase.

This is an important platform for cancer services in Wales to build on but we must recognise the scale of demand that NHS Wales faces. During the last calendar year there were over 120,000 urgent route referrals, an increase of more than 50,000 for the same period five years ago. These all need to be thoroughly investigated to find the 6-7% of these people who actually will have cancer. Altogether, around 19,000 people per year are being newly diagnosed and requiring complex, expert and compassionate care. I know how hard our staff are working to meet that demand.

Whilst survival rates improved prior to covid-19, the pandemic will have an adverse impact on outcomes. It reinforces the need to reform and improve services across NHS Wales including cancer services.  The Single Cancer Pathway will enable us to tackle variation, improve outcomes and deliver better experience for patients.