Staged national milestones
5.16 National targets will be introduced in stages. The ultimate goal is to shorten the whole period of waiting from the point of urgent GP referral up until first treatment.
Milestones will be set towards this, recognising that it will be possible to make progress more quickly for some types of cancer than for others. National monitoring systems will be developed, building on local experience.
5.17 To help ensure progress, there will also be targeted action to cut down waits at each step along the pathway. Targets are already in place for maximum waits for urgent outpatient appointments. The next task will be to focus on waits between diagnosis and treatment.
5.18 A key step in the pathway of care for all cancer patients is the wait between diagnosis and treatment. The initial target will be to reduce maximum diagnosis to treatment waits to a month, with an average wait of two weeks.
5.19 Cutting down waits for individual steps along the pathway of care also makes it possible to plan to reduce the total wait for the period from the GP's urgent referral through diagnosis to the beginning of treatment. With a maximum two week wait in place for an urgent outpatient appointment, and with waits of two to four weeks from diagnosis to treatment, it becomes possible to set a maximum target of two months wait for the whole period from urgent GP referral through to treatment.
National Milestones
1. Acute leukaemia, children's cancer and testicular cancer
For some cancers the wait between urgent referral and treatment is already generally very short. In these cases the ultimate goal (less than one month from urgent referral to treatment) is already being achieved. Cancer networks will need to ensure that this can be guaranteed for all patients referred urgently with these cancers by 2001.
2. Breast cancer
Over 90% of women referred urgently with suspected breast cancer are already being seen within two weeks. The diagnostic phase is generally short (days). Most patients are already treated within four weeks of diagnosis.
Target
i All patients to be treated within one month of diagnosis by 2001.
ii All patients to be treated within two months of urgent referral by 2002.
3. Other cancers
For other cancers the two week standard for urgent referrals is only just being rolled out. The diagnostic phase can be protracted. The wait between diagnosis and treatment varies considerably according to tumour type. Progress on other cancers will depend on implementation of the major programme of investment in staff and equipment. The Department of Health will work with clinicians, cancer networks and the NHS Modernisation Agency, to firm up later milestones in the light of early local experience.
Target
i All patients to be treated within one month of diagnosis by 2005.
ii All patients to be treated within two months of urgent referral by 2005.
For some rare tumour types, and for some individual cases, it may take a little longer to ensure an accurate diagnosis that will enable the most appropriate treatment to be offered. Some patients may make an informed choice to defer their treatment. So there will always be a small number of cases which, for good reason, fall outside the national targets.
