Cancer waiting times standards in Scotland: clinical review

4. Defining Cancer Waiting Times (CWT) Standards in Scotland

The Scottish Government's current position has been to focus on 'whole cancer pathway' standards. The pathway to diagnosis and staging (and therefore to a decision-to-treat date) can be complex for cancer patients, involving several medical investigations and decision-making processes.

There are two waiting times standards which are applicable to adults ( NHS Scotland patients over 16 at the date of diagnosis), with a newly diagnosed primary cancer against the ten major cancer types:

31-day target from decision to treat until first treatment, regardless of the route of referral.

62-day target from urgent referral with suspicion of cancer, including referrals from national cancer screening programmes, until first treatment.

There is currently a 5% tolerance on each standard in Scotland.

To ensure first treatment occurs within the 62 day timescales, an early first appointment for diagnostic investigations or clinic is advisable. For the CWT standards to be met, all steps included in the pathway require completion in a timely manner.

For patients with cancer, Scottish Government waiting times policy applies to first treatments. The first treatment standards provide assurance to patients that the immediate cancer control measures are being started as soon as possible and reduce the period of uncertainty whilst awaiting clarification of a diagnosis.

The 31-day standard was introduced as around 45% of all cancers diagnosed in Scotland are through non USC referral routes. A 31-day treatment standard is in place to ensure that access from decision-to-treat to first definitive treatment is equitable for all cancer patients, regardless of their flow into the system.

Patients are excluded from the standard who have died before treatment, refused all treatment or are regarded as clinically complex. On reflection of a whole patient pathway there may be some areas of delay not attributable to NHS Board performance. These pathways may be adjusted to discount periods of patient unavailability, for patient-induced delays and/or medical suspensions.

4.1 Comparing Scotland's definition to other UK nations

There are notable differences between the cancer standard definitions across the UK – these are outlined by the Government Statistical Service here ( https://gss.civilservice.gov.uk/health-waiting-time-statistics/).

Below is a summary of latest published performance statistics across the four nations however caution should be exercised when comparing CWT performance in other UK countries to Scotland.

Table 1: Latest published CWT performance across the UK (62 day standard)

62 day standard

Table 2: Latest published CWT performance across the UK (31 day standard)

Sources:

England: https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

Scotland: http://www.isdscotland.org/Health-Topics/Waiting-Times/Publications/

Wales: http://gov.wales/splash?orig=/statistics-and-research/nhs-cancer-waitingtimes/

Northern Ireland: https://www.health-ni.gov.uk/articles/cancer-waiting-times