Page last updated: 18-MAY-2010

Cancer Waiting Times

Waiting Times Statistics:

Data prior to April-June 2009 have been published by the Scottish Government .

The Statistical Publication Notice for the most recent publication can be found here .

October to December 2009  link to a microsoft excel file[119KB] - Statistics for urgently referred patients, for each of 9 cancer sites and for all target cancer sites combined.
July to September 2009 link to a microsoft excel file[118KB] - Statistics for urgently referred patients, for each of 9 cancer sites and for all target cancer sites combined.
April to June 2009 link to a microsoft excel file[102KB] - Statistics for urgently referred patients, for each of 9 cancer sites and for all target cancer sites combined.

Background and history:

In 2001, the Scottish Executive (now the Scottish Government) published Cancer in Scotland: Action for Change , which set a target that "by 2005 the maximum wait from urgent referral to treatment for all cancers will be two months." Cancers subject to this target (referred to herein as the "2005 target") were brought online between 2001 and 2005 as data collected by NHS Boards became available for reporting. The first cancer to be reported on was breast cancer (2001) followed by colorectal cancers (2002), ovarian (2003), lung (2004), and finally in 2005 cancers for head and neck, lymphomas, melanoma, upper gastrointestinal cancers and urological cancers.

All reported cancers are subject to the 2005 target, under which at least 95% of urgently referred patients will wait no longer than 62 days for treatment from the date of referral. Breast cancers are also subject to a 2001 target, where if clinically appropriate, a patient should wait no longer than 31 days from the date of diagnosis to the commencement of treatment.

The inclusion criteria for patients reported against these targets have changed over time. Prior to June 2005 the waiting times statistics covered patients that were urgently referred by their GP only. From July 2005 the statistics include the following urgently referred patients: urgent GP referral, GP referral to A&E, self referral to A&E, and urgent referrals from general dental practitioners. From July 2004, exclusion categories were introduced: patient induced non-clinical delay, patient refused treatment, co-morbidities, and patients that died before treatment. In January 2007, the exclusion categories of clinical reasons, and initial referral to other speciality were added.

Over time there has been an increase in the number of patients being reported each quarter. For example from July-September 2005 there were 2055 urgent referrals recorded in the statistics (including those excluded from the performance calculation). In July-September 2008 the equivalent number was 2468. The change is largely due to a combination of increasing reporting coverage and increasing cancer incidence in Scotland.

Data sources:

The information to support these targets comes to ISD from NHS Boards in each of the three regional cancer networks - South East Scotland Cancer Network (SCAN), North of Scotland Cancer Network (NOSCAN) and West of Scotland Cancer Network (WOSCAN). Staff working within the Networks routinely capture data for monitoring patient performance against these targets as part of data collection for prospective audit within NHS Boards.

A data seminar in November 2006, and subsequent consultation with NHS Boards, recognised that accurate and comparable reporting requires consistency in the application of data collection across Scotland. A cancer waiting times definitions document was issued in January 2007 to provide guidance and clarification on the provision of waiting times data. As such, figures collected prior to January 2007 cannot be assumed to be comparable with figures reported after the implementation of this document.

The following categorisation and exclusion criteria were detailed in the guidance, and it was emphasised that in all cases the responsible clinician would have the final decision as to whether or not a patient should be excluded from the report.

  • Clinically complex cases, where patients breach the target because medically they require a complex series of investigations (as opposed to the patient having gone through a circuitous pathway) should be coded as 'Clinical reason', and excluded from the final percentage
  • Patients who are urgently referred to one service with a range of symptoms that are not particularly suggestive of cancer, have a variety of inconclusive investigations and are subsequently referred to another service where a series of further investigations are carried out which leads to a diagnosis of cancer, should be coded as 'Initial referral to other speciality', and excluded from the final percentage
  • Patients who gave prior notice that they were unable to attend an appointment for a period of a week or more due to personal circumstances should be coded under the existing 'Patient induced non-clinical delay' or where medical reasons indicate, as a 'Co-morbidity', and excluded from the final percentage
  • Patients who, due to personal circumstances, did not attend an appointment, gave no prior notice and the resultant delay is a week or more should be coded under 'Patient induced non-clinical delay', and excluded from the final percentage
  • The guidance also amended current definitions to include steroids as first treatment for breast, lung, colorectal, gynaecological and upper GI cancers. These are coded as 'Other therapy' under the mode of first treatment

The Cancer Waiting Times: National Delivery Plan (2005) sets out key additional actions agreed with NHS Boards and the regional cancer networks, including the Top 20 Actions for Change from the Cancer Service Improvement Programme. The component parts of the total patient pathway from urgent referral are also described within the National Delivery Plan.

  
Things to be aware of:

The small number of patients diagnosed quarterly in island Health Boards: there were five urgently referred patients diagnosed with cancer in NHS Orkney during January-March 2009. Such small numbers may lead to substantial quarter-on-quarter fluctuation in the percentage of people starting treatment within 62 days. For example 50% of patients reported for Orkney in July-September 2008 were treated within 62 days whereas 100% were treated within the target time period for January-March 2009; the apparently large change may be due to the referral times of one or two individuals.

Under the Scottish Government's action plan, Better Cancer Care the current 62-day target will be amended to require 95% of patients urgently referred with a suspicion of cancer and extended to include patients who are referred through the national cancer screening programmes. The action plan also sets a new target that by 2011, all patients diagnosed with cancer, whatever the route of referral, will start treatment within 31 days from the date of decision to treat. The necessary changes to the official statistics data collection have been developed as part of this work. Reporting against the new cancer targets will replace the reporting against the current targets on the 29th June 2010 following this final publication. The statistics published here do not take account of these changes.

 

 

 

 

 


Main contact: Email Sharon Kennedy