Clinical Review of Standards

Refining cancer standards – next steps as part of the Clinically-led Review of NHS Access Standards

What matters most to cancer patients is survival, quality of life and patient experience. We have robust measures of survival and patient experience in cancer, and are currently developing a new quality of life metric. We will continue to measure and publish these key outcomes as we deliver the NHS Long Term Plan.

Each of these outcomes measures is necessarily time lagged (for instance, one-year survival rates cannot be published until at least the one year survival point, and need to go through robust data processing before publication), and we – and the public – want to know more quickly than that about the quality and performance of cancer services for patients. Time to diagnosis and time to treatment are key indicators for patients about the services they receive, and both can contribute to longer-term outcomes.

That’s why we need to move to the new Faster Diagnosis Standard – to measure the time from referral to communication of diagnosis (whether it’s cancer or not) – and retain key time-to-treatment measures for all cancer patients. We need to ensure focus on diagnosis and treatment, and make sure that the way that the standards work support actions to drive earlier diagnosis, improved survival, better quality of life and patient experience.

The interim report of the Clinical Review of Standards put forward proposals to reduce the number of cancer standards from the current nine (10 with the introduction of the Faster Diagnosis Standard) down to three to ensure focus on diagnosis and treatment.

The report also stated an ambition to reflect modern clinical practice and increasing personalisation of treatment in the three standards so that they better support meeting the NHS Long Term Plan ambitions on survival and stage.

The Clinical Review of Standards will propose changes to come into force from April 2020.  Before then, we will take the first steps to modernising the standards, will engage broadly with clinicians, patients and charities and test revised standards in real-life settings.

Step one: Updating the guidance for 19/20

We have updated the guidance for 19/20 (CWT Guidance v10.0) as the first step in modernising cancer waiting times standards.

The National Cancer Waiting Times Monitoring Dataset Guidance (referred to as ‘CWT Guidance’) provides information about the Cancer Waiting Time Standards and how to record data in the National Cancer Waiting Times Monitoring Data Set. It aims to ensure that staff from both informatics and clinical teams understand which patients they need to be reporting on, and how they should record data to monitor the standards.

The updated guidance:

  • Provides detail for Trusts on how to record Faster Diagnosis Standard data items, such as when the clock should start in different situations, and when to record a communication of diagnosis
  • Modernises the guidance on which treatments should stop the clock on time-to-treatment pathways, including some treatments for bowel and liver cancers
  • Aligns with the best practice timed pathways (published for lung, prostate and colorectal cancers last year and for oesophageal cancer this year)
  • Clarifies how referrals made on the new e-Referral Service should be managed in the CWT systemProvides more detail on recording data in different inter-provider transfer scenarios

Step two: Engaging on the detail of the standards for 20/21 onwards

The interim report of the Clinical Review of Standards set four key questions for the revised cancer standards:

  1. what should be included in the detailed clinical guidance governing the CWT standards to ensure they reflects the latest clinical practice;
  2. are these standards sufficient, without the need for others;
  3. what threshold should be applied as the standards are combined (any threshold will be set at a level that provides access that is at least as timely as current performance);
  4. should incomplete pathways be reported, in line with the current reporting for all other referral to treatment pathways.

We will engage with the cancer community over the next few months on these questions. If you want to comment on these questions to us separately, please do email england.cancerpolicy@nhs.net by 30 May 2019.

Clinical experts have already put forward a number of clinical changes to the standards that require changes to the IT system that measures cancer waiting times. So that they are ready to come into force from April 2020 along with other proposed changes, we will also be consulting on these data set changes alongside our broader engagement.

Step three: Testing the revised standards in real-life settings

From July to December, we will test the standards in a number of real-life settings across the country. The evaluation of this testing will inform the recommendations for changes from 2020/21 onwards.

Step four: Publish revised guidance for CWT standards

New CWT guidance will be published before the revised standards come into force.