Faster diagnosis

Rapid Diagnostic Centre (RDC) pathways and the Faster Diagnostic Standard (FDS) are designed to speed up cancer diagnosis and improve patient experience. They will also provide a mechanism to monitor and support the NHS Long Term Plan ambitions.

Rapid Diagnostic Centres

Overview

The rollout of Rapid Diagnostic Centres (RDCs) across England is an ambitious five-year programme, which started in 2019, designed to speed up diagnosis of cancer and other serious conditions.

Rapid Diagnostic Centre pathways make sure everyone with suspected cancer gets the right tests at the right time in as few visits as possible. Driving innovation and new diagnostic practice, RDC pathways  promote continuous improvement of cancer diagnostics.

The programme, committed to in the NHS Long Term Plan, builds upon the ‘Accelerate, Coordinate, Evaluate’ (ACE) model to support innovation across cancer pathways and build a body of evidence that supports healthcare commissioners and providers to select the best approaches.

The service provides:

  • Coordinated access to a diagnostic pathway for all patients with symptoms that could indicate cancer.
  • A personalised, accurate and rapid diagnosis of symptoms by bringing existing diagnostic capabilities and clinical expertise together.

RDCs also introduce a new non-specific symptom pathway for patients who display symptoms that could indicate cancer that don’t align to specific cancers, such as unexplained weight loss, fatigue or vague abdominal pain. The new non-specific pathway complements current cancer diagnostic pathways, as well as providing elements that can be applied to existing pathways.

By 2024 the programme will achieve full population coverage across England for non-specific symptom pathways and be applying the RDC pathway principles to every site-specific symptom pathway

For further information on these principles, please read the Rapid Diagnostic Centre vision and 2019/20 implementation specification.

Experience of care

32 practical ideas were written in the form of questions and developed under three ‘quality markers’ themes: Personalised care/a whole person approach and accessibility and user involvement. The quality markers have been developed with patients and unpaid carers as practical ideas to guide local systems on how to provide the best experience of care along cancer diagnostic pathways. All Alliances are advised to embed all quality markers within RDC pathways. More information on the quality markers can be found in the Urgent cancer diagnostic services during COVID-19 guidance (2021).

Three quality markers have been identified as particularly important to positive experience of care during COVID-19.

Number Consideration COVID-19 response focus
1 How does the service ensure that a patient’s ability to attend appointments is considered? (including how information is shared with them in a way that they understand: taking into account language, cultural, sensory, learning or other needs). ‘How are patients supported during the appointment if unpaid carers and families are unable to attend the appointment?

What action will be taken to ensure that information is provided in a way that is accessible to all?’

2 What actions are services taking to reduce anxiety for patients and unpaid carers – specifically with
regards to initial appointments?
What actions will be taken to reduce anxiety with regards virtual consultations?

What actions will be taken to reduce anxiety around infection prevention and control?

3 How does the service make sure that patients and unpaid carers are told about the voluntary services
that will best meet their support needs at
every stage of the pathway?
How are patients and unpaid carers told of additional support available – through – for example the NHS Volunteer Responders.

For information on wider experience of care work please visit our patient experience pages.

National evaluation

NHS England and NHS Improvement has commissioned an independent partner (Ipsos MORI, in collaboration with Midlands and Lancashire Commissioning Strategy Unit and York Health Economic Consortium) to undertake a comprehensive evaluation of the RDC programme. The evaluation will provide rapid, ongoing feedback to inform the delivery of RDC pathways and the strategic direction of the programme.

The evaluation will use mixed quantitative and qualitative methods to assess the processes, impact and economics of RDC pathways to understand:

  • What impacts can be achieved in terms of patient experience and impacts on the health and care system.
  • The best approach to delivering national pathways for specified cohorts of patients;
  • What pathway changes are optimal, in what context(s);
  • How patients move through RDC pathways and the outcomes they experience as a result by analysing the impact of RDC pathways on metrics such as waiting times and cancer staging; and
  • The cohorts of patients being referred into RDC pathways and the sequences of tests performed to enable continuous improvement of the services.

The initial evaluation strategy has been agreed by national governance structures, and will include:

  • A sampled experience of care survey
  • Qualitative interviews with patients and RDC programme staff
  • Case studies of selected RDC pathways
  • An economic survey and evaluation
  • An impact evaluation using a collation of patient level data through a newly developed Trusted Research Environment for Cancer hosted by NHS Digital.

Useful resources

Faster Diagnosis Standard

Overview

The Faster Diagnosis Standard (FDS) is a new performance standard being introduced to ensure patients who are referred for suspected cancer have a timely diagnosis.

Following an initial recommendation in the 2015 report of the independent Cancer Taskforce, reaffirmed in the NHS Long Term Plan, the standard will ensure patients will be diagnosed or have cancer ruled out within 28 days of being referred urgently by their GP for suspected cancer. For patients who are diagnosed with cancer, it means their treatment can begin as soon as possible. For those who are not, they can have their minds put at rest more quickly.

The Faster Diagnosis Standard will apply to patients:

  • Referred by their GP on a suspected cancer pathway;
  • Referred by their GP with breast symptoms where cancer is not initially suspected; or
  • Referred by the National Screening Service with an abnormal screening result.

Benefits

The Faster Diagnosis Standard will:

  • Reduce anxiety for patients who will receive a diagnosis or an ‘all clear’ but do not currently receive this message in a timely manner;
  • Improve the consistency of care across all hospitals, by ensuring improvements are driven by data;
  • Reduce the time between referral and diagnosis of cancer.
  • Work alongside the delivery of the 62-day referral to treatment cancer waiting times standard, including the standard to reduce waiting times, through improved analysis and pathway improvements of faster diagnosis
  • Contribute towards the NHS Long Term Plan commitments for earlier diagnosis, including that, by 2028, 55,000 more people each year will survive their cancer for five years or more, and 75% of people with cancer will be diagnosed at an early stage (stage one or two).

Cancer waiting times system

To prepare for the Faster Diagnosis Standard, NHS England introduced a new cancer waiting times system in April 2018. The system collects data for the Faster Diagnosis Standard, in addition to other cancer access standards, on a monthly basis. Cancer waiting times guidance (v11) was published in September 2020 to explain how providers should record data, using the updated dataset (v2.1).

For more information on what the Cancer Waiting Times System does, please visit the NHS Digital website.

Best practice timed pathways

To support care providers in being able to meet the Faster Diagnosis Standard, NHS England published four national best practice timed pathway handbooks in 2018/2019. The pathways aim to support improvements in operational performance and patient experience, as well as providing models to support sustainable improvement.

The four pathways are suspected lung, prostate, colorectal, and oesophago-gastric (OG) cancers. The features of faster timed pathways will be delivered as part of the rapid diagnostic centre programme.

For further information on the benefits of these pathways, please read the rapid diagnostic centre vision and 2019/20 implementation specification.

Useful resources