Cancer: Wales NHS treatment targets still not being met

A cancer charity said there are 'catastrophic waits'

Targets for starting cancer treatment in Wales are still not being met, two years after they were introduced.

Just over half of patients are beginning treatment within 62 days of cancer being first suspected - the target of 75% has never been met.

NHS Wales starts the clock when cancer is first suspected, not from the first specialist referral, as in England.

July figures 56.5% of people - just over 1,000 - started treatment within 62 days of cancer being suspected.

This is an improvement on June, but the proportion has been consistently below the target since it was introduced in July 2021.

No health board has ever met the 75% target.

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The Welsh government said treatment had increased against the 62-day target, but accepted "there is still more to do in this area, despite the fact that 14,074 people were informed in one month that they did not have cancer".

Christina Bater's second experience with breast cancer has been at a new specialist clinic

Christina Bater, 61 from Pontyclun, Rhondda Cynon Taf, was first diagnosed with triple-negative breast cancer seven years ago.

Treatment started within a matter of weeks and included a mastectomy, chemotherapy and radiotherapy.

"The waiting on results is the worst. Once those results came through the process was very quick, but it is the waiting on results that's the most stressful."

She had annual mammograms for five years after treatment ended, but a few months later returned to her GP with pain in her other breast.

"I know that's not a sign of cancer, but given my history I knew I had to check that out and the process started all over again, unfortunately."

In the meantime, a new breast cancer clinic - the Snowdrop - opened at the Royal Glamorgan Hospital near Llantrisant in April, centralising breast cancer care for much of the health board area in one clinic.

It means services are more robust and less affected by staff leave or sickness, with services happening in one building.

"Since we've been on one site and appointed a specialist breast clinician we haven't cancelled any of our clinics because of surgeon annual leave and that's made a massive difference to our capacity," said Zoe Barber, consultant oncoplastic breast surgeon.

Ms Barber acknowledged that other cancer services will have different needs and pressures, but she hopes the model can be replicated elsewhere.

"It's important to recognise the NHS is under huge pressure. There is not enough capacity to deal with the demand we're experiencing, and I don't think there's an easy answer."

Meanwhile. Christina said she and her husband Michael think of the clinic's staff as family.

"They greet us both - it's not just me, we both have a hug. The empathy is amazing."

Judi Rhys, chief executive of charity Tenovus Cancer Care said services were in crisis, adding that the Welsh government had taken a "leap of faith" in introducing the new target.

She added: "We knew it would expose delays hidden by the old system, and performance data would see a dip before improving.

"However, the pandemic derailed improvement plans for cancer services, and we're now left with the frightening truth of the catastrophic waits some people are experiencing."

Cancer charity Macmillan said it showed a system "unsustainable and at breaking point".

Simon Scheeres, Cancer Research UK in Wales, said: "Although there is a slight improvement on today's figures, it's unacceptable that more than 40% of people with cancer aren't being treated quickly enough."

Cancer and the impact of Covid

Recent analysis by the Welsh Cancer Intelligence and Surveillance Unit found thousands fewer cases were diagnosed at the height of the pandemic than the average before.

It found:

• There were 3,089 fewer cases of all cancers diagnosed between April and December 2020 during the worst period of Covid compared to the pre-pandemic average

• New detected cases of all cancers fell by 14.2% to 17,461 cases in 2020 compared to 20,340 in 2019

• Numbers of prostate cancer samples were 19.5% lower in 2022 than 2019 - but fell by a third during 2020

• Breast cancer samples were 5.2% higher in 2022 than 2019 and bowel cancer samples were up 2.8% while lung cancer was down 4.8%

What about other waiting times?

Overall hospital waiting lists were back to their highest levels on record, with about 757,400 patient pathways - to account for some individuals waiting for more than one treatment - which the Welsh government called "disappointing".

It added: "Over the last 12 months waiting lists in Wales have only increased by 1.9% compared to 10.7% in England.

"Health boards are working hard to tackle the longest waits and the most urgent cases are always seen first."

Because some patients are on more than one waiting list and counted more than once, it is possible to estimate that the actual number of patients waiting is 593,000 - up 4,400 on the month and at record levels.

The figures, when adjusted to count just consultant-led specialisms so they can be compared with England, show 670,845 patient pathways.

The number of patients waiting more than a year for treatment has risen, after falling for 10 months in succession.

There were 131,523 patient pathways waiting more than a year - or 19.6% of those on the list.

This compares with 5.1% of people on the overall waiting list in England, who were waiting more than a year.

There were still 27,607 patients (4.1%) waiting more than two years in Wales.

Adele Gittoes, executive director of operations at Betsi Cadwaladr health board - which managed to slightly reduce its waiting list last month - said: "We are seeing an increase now in referrals because those patients didn't perhaps present in the pandemic. And in some specialties we're seeing as much as a 25% or 30% increase.

"But we're looking continuously at new ways to identify the highest priorities and risk within that increased demand and treat our patients in a more timely way."

For the ambulance service, 50.4% of life-threatening "red" calls arrived within the eight minute response time. The target is 75% but has been missed for the last three years.

The average response time to "red" calls was seven minutes 57 seconds.

"Handover" delays - the time ambulances spend outside A&E waiting to handover patients - fell slightly.

In accident and emergency, only 69% of people spent less than the four-hour target time waiting to be admitted, transferred or discharged.

This is the worst position since last December.

There were 10,085 patients facing a wait of 12 hours or more - worse than the previous month - while two hours and 43 minutes was the average waiting time, about four minutes slower than the previous month.

Compared with England, when we look at major A&E units only, then the performance was slightly worse in Wales - 58.2% seen within the four-hour target, against 59% in England.

Numbers waiting more than a year for a first outpatient appointment have remained stubbornly above 50,000 for the last six months.

Figures also show that 1,552 patients were in a hospital bed, who were well enough to be discharged. But they were being delayed because of issues relating to care support, residential home places or waiting to be assessed.

Assistant director of the NHS Confederation in Wales Nesta Lloyd-Jones said: "It's clear that pressure on services continues throughout the summer months, giving staff and services little room to breathe. Unless governments make wider system and societal changes, we cannot expect these exceptional levels of demand across the system to fall."

Conservative health spokesman Russell George said there had been an "incredibly lacklustre reduction in two-year waits," while the ambulance performance was "abysmal".