NHS waiting times for elective and cancer treatment

National Audit Office | March 2019 | NHS waiting times for elective and cancer treatment

A new report from the National Audit Office (NAO) has found that waiting time standards continues to get worse for both elective (non-urgent care) and cancer treatment, and the waiting list for elective care continues to grow. The review- NHS waiting times for elective and cancer treatment– presents data on the NHS’s performance against current waiting times standards for elective and cancer care in England, and some of the factors associated with that performance. It collates existing evidence and analysis by the Department, NHS England, NHS Improvement and other stakeholders.

NAO build on this evidence base with their own analysis to provide additional insight into:

  • changes in waiting times performance, and variations in that performance;
  • the impact of waiting times performance on patients;
  • the factors that influence waiting times performance; and
  • NHS England’s and NHS Improvement’s approach to managing and improving waiting times performance

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ONS’ findings indicate that while increased demand and funding constraints affect the entire system, other factors that are linked to declining waiting time performance include NHS staff shortages for diagnostic services, a lack of available beds and pressure on trusts from emergency care.

The elective care waiting list grew from 2.7 million to 4.2 million between March 2013 and November 2018, while the number waiting more than 18 weeks grew from 153,000 to 528,000. During this period, the number of people treated each month increased from 1.2 million to 1.3 million.

A growing and ageing population only accounts for a relatively small proportion of the increase in referrals for elective care and cancer. For cancer, the major factor is likely to be NHS England’s policy of encouraging more urgent referrals to improve early cancer diagnosis. However, the reason behind the increase in elective referrals is less well understood by the NHS.

The plan also commits to increasing the proportion of patients diagnosed with cancer at early stages from 50% to 75% by 2028. The NHS is now preparing local implementation plans for these new commitments. It is hard to see how the NHS will be able to recover its position on waiting times in the near future without significant investment in staffing and infrastructure (Source: NAO).

Full details from NAO

Full report- NHS waiting times for elective and cancer treatment

Summary- NHS waiting times for elective and cancer treatment 

ePub- NHS waiting times for elective and cancer treatment

See also:

NAO Press release 

NHS England publishes Combined Performance Summary

NHS England has published its Combined Performance Summary, which provides data on key performance measures for January and February of this year. Here Jessica Morris of the Nuffield Trust shows some of these statistics and how they compare with previous years.

Commenting on the latest Combined Performance Summary, Prof John Appleby says the A&E slump and spike in cancer waits are of real concern and a reminder of the pressure that NHS staff face: A&E slump and spike in cancer waits mean stormy waters for new NHS targets

Full analysis: Combined Performance Summary: January – February 2019 | Nuffield Trust

The NHS England resource contains a summary of the performance statistics on:

Urgent and emergency care

Planned care

Cancer

Mental Health

Full detail: Combined Performance Summary | NHS England

Cervical Cancer statistics

Statistics from Cancer Research UK show that in 2015 there were around 2,500 new cases, and nearly 700 deaths attributable to cervical cancer, in England. The overall age standardised incidence rate has been declining since the 1990s, however incidence is increasing in younger women.

Cervical cancer is 99.8% preventable through the cervical screening and the human papilloma virus (HPV) vaccination programmes. A cervical screen collects cells from the cervix to be tested for abnormalities. In 2019, primary HPV testing will also be introduced as part of the screening process.

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Most cases of cervical cancer are linked to HPV and the vaccine, currently offered by the NHS for free to girls aged 12 and 13 in UK schools, protects against the most of the virus strains responsible. The national HPV vaccination programme has successfully reduced infections of HPV type 16/18 in 16-21 year old women by 80%.

Full detail at Cancer Research UK

Campaigns

Skin cancer rates in England far higher than previously thought

Data from a newly established UK skin cancer database, the largest database of its kind in the world, has revealed that there are over 45,000 cutaneous squamous cell carcinomas (cSCC) every year in England, 350 per cent more than previous estimates suggested | JAMA Dermatology | via ScienceDaily

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Developed by experts at Queen Mary University of London and Public Health England (PHE), and funded by the British Association of Dermatologists, the database fills in gaps in the recording of skin cancer, ensuring that accurate numbers for the three most common types of skin cancer: melanoma, basal cell carcinoma (BCC), and cSCC, are available for the whole of the UK.

These data are important as they enable researchers and policy makers to evaluate the effectiveness of prevention initiatives, screening, staging (the process of grading a cancer in terms of size, depth and whether it has spread to other parts of the body), and treatments for what is a very common cancer. The study has been published in JAMA Dermatology.

Full story at ScienceDaily

Journal reference: Venables, Z. et al. |  Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England |  JAMA Dermatology | 2018

Cancer survival trends

Little evidence for any direct impact of national cancer policies on short-term survival in England and no evidence for a reduction in socioeconomic inequalities in cancer survival. Findings emphasise that socioeconomic inequalities in survival remain a major public health problem. |  London School of Hygiene & Tropical Medicine | British Medical Journal

New research from the London School of Hygiene and Tropical Medicine found that despite overall improvements in cancer survival, the gap in survival between the most affluent and most deprived groups of patients remains unchanged for most cancers.

Survival trends were examined for 21 cancers in men and 20 cancers in women.

For each cancer, the chances of survival at one year after diagnosis were estimated separately for men and women in five levels of socio-economic deprivation, from the most affluent to the most deprived, and in each of the three calendar periods.

Researchers focused on one-year survival because most of the inequalities in cancer survival in England arise shortly after diagnosis. The survival estimates were corrected for the risk of dying from other causes of death. Estimates were also adjusted for differences in the age profile of cancer patients between men and women, and over time.

The “deprivation gap” in survival between the most affluent and most deprived groups of patients remained unchanged for most cancers. There was a clear and persistent pattern of lower survival among more deprived patients. It narrowed slightly for some cancers, where one-year survival was already more than 65% in 1996, such as cervical cancer and skin melanoma in men. By contrast, the deprivation gap in survival widened between the late 1990s and 2013 for brain tumours in men and lung cancer in women.

Full story at London School of Hygiene and Tropical Medicine

Link to the research: Aimilia Exarchakou et al.  (2018). Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study. BMJ.

Cancer diagnoses and incidence rates in England in 2016

The Office for National Statistics and Public Health England  have released statistics for Cancer diagnoses in England for 2016.

The main points are:

  • The number of new cases of cancer in England continues to rise and, in 2016, there were 303,135 cancers registered (excluding non-melanoma skin cancers); this is an increase of 3,212 from 2015 and is equivalent to 828 new cases being diagnosed each day during 2016.
  • More cancers were registered in males (155,019) than females (148,116) and across the majority of cancer sites, more males were diagnosed with cancer than females; this is a persistent feature of the data, as reported in previous cancer registration years.
  • The age-standardised incidence rates for newly diagnosed cancers were 663.4 per 100,000 males and 541.1 per 100,000 females; age-standardised rates for newly registered cases of cancer (incidence) were higher in males than females, which is a repeating trend of the data, as outlined in previous cancer registration statistics.
  • Breast (15.2%), prostate (13.4%), lung (12.7%) and colorectal (11.5%) cancers continue to account for over half of the cancer registrations in England for all ages combined.

The bulletin can be downloaded here 

The dataset for 2016 (and previous years)  can be found here 

UK has 6th highest rate of obesity – OECD

Health at a Glance 2017: OECD Indicators | Organisation for Economic Cooperation and Development | OnMedica

A report from the Organisation for Economic Cooperation and Development (OECD) has found that the UK has the sixth highest rate of adult obesity. The report looks at health indicators across its 100 member countries.

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It shows that almost 27% of the adult population of the UK is obese, compared with the OECD average of 19.4%. The UK has a smoking prevalence of 16.1%, which is below the OECD average of 18.4%.

However average alcohol consumption per UK adult is higher than the OECD average, with consumption averaging at 9.5 litres per adult.

The report highlights cancer by way of an example of both the good progress made and continuing challenges. Cancer survival has improved over time, due in part to high screening rates. Breast and rectal cancer survival rates are now slightly higher than the OECD average, with, respectively, 85.6% and 62.5% of people diagnosed living for at least a further five years, versus 85% and 61% in the OECD as a whole. Both rose at a faster pace than average over the course of ten years. But bowel cancer survival is still below the OECD average (60% compared to 62.8%), and overall cancer mortality rates remain relatively high (222 deaths per 100 000 people, compared with an OECD average of 204).

Full document: Health at a glance 2017 – OECD indicators.