Page last updated: 29-JUN-2010

New Cancer Waiting Times

 

Statistical Publication Notice

29 June 2010

New Cancer Waiting Times January - March 2010

INTRODUCTION

In October 2008, the Scottish Government published Better Cancer Care - An Action Plan , where it announced it would:
 
  • Extend the 62-day urgent referral to treatment target to include screened positive and all patients referred urgently with a suspicion of cancer.
  • Introduce a new 31-day target for all patients diagnosed with cancer (whatever their route of referral) from decision to treat to treatment.
The action plan states that these new targets are to be delivered by 2011.  A 5% tolerance level is applied to these targets, as for some patients it may not be clinically appropriate for treatment to begin within 62 days of referral.  Therefore, by October - December 2011, 95% of all eligible patients will wait no longer than 31 or 62 days.
 
The new 31 and 62-day targets are both included as performance measures in HEAT 2010/11.  Further information on the HEAT Performance Measures can be found on the ISD NHSScotland Performance HEAT web pages and the Scottish Government Scotland Performs HEAT web pages . 
 
To remain relevant to the changing set of targets the cancer waiting times statistics published previously by ISD have been replaced with a new series of figures.  A consultation document was produced which summarised ISD's proposals for the new series of official statistics due to be published from June 2010.  The consultation period lasted just over 10 weeks, and details of the consultation results can be found in these Summary Feedback Report and Detailed Feedback Report  documents.
 
This is the first publication release that provides statistics relating to the new cancer waiting times target, which has replaced reporting against the old cancer waiting times target.  It is important to highlight that some patients who would have been excluded in the old target are now included and have waiting times adjustments applied to take into account periods of patient unavailability and/or medical suspensions.  For these reasons, comparisons should not be made between the old and new statistics.  For information on reporting against the previous cancer waiting times targets please go to http://www.isdscotland.org/isd/6038.html.  Previous quarterly reports have been published by the Scottish Government and can be found at http://www.scotland.gov.uk/Topics/Health/health/cancer/waiting-times.
 
This publication presents information on the new 62-day target for patients urgently referred with a suspicion of cancer to first cancer treatment during the period January - March 2010 (excluding screened positive patients).  This information will be published on a quarterly basis to ensure the regular publication of new statistics, and will allow previously released information to be revised to reflect ongoing work by NHS Boards to improve data quality.  Further information on data quality and accuracy can be found on the Data Accuracy web pages .

KEY POINTS

  • This is the first publication release that provides statistics relating to the new cancer waiting times target, which has replaced reporting against the old cancer waiting times target.
  • During January to March 2010, 96.5% of patients started treatment within 62 days of referral.  This includes patients urgently referred with a suspicion of cancer to first treatment in Scotland. The target set by the Scottish Government is 95% by 2011.
  • The mainland NHS Boards that had the highest and lowest percentage of patients that started treatment within 62 days were NHS Lothian (99.2%) and NHS Ayrshire & Arran (91.9%) respectively.
  • The cancer types with the highest and lowest percentage of patients that started treatment within 62 days were Breast (98.8%) and Lymphoma cancers (91.7%), respectively.
  • The mainland NHS Boards that had the highest and lowest maximum wait in days from referral to treatment were NHS Tayside (140 days) and NHS Lanarkshire (64 days) respectively.
  • 5.5% of urgent referrals submitted in Scotland were excluded from the target calculations due to clinical reasons; or the patient died before treatment or refused all treatment.  Waiting times adjustments have been applied to take into account periods of patient unavailability and medical suspensions.  Within Scotland 183 occurrences of patient unavailability and 178 occurrences of medical suspension account for all waiting times adjustments.

INTERPRETATION

New Cancer Waiting Times data are collected by cancer trackers across NHSScotland, and are based on locally available information drawn from sources such as patient administrative systems, laboratory systems, and medical records across the country; which are then recorded onto the NHS Boards' Tracking systems.  Monthly submissions of this data are submitted to ISD, validated and loaded onto the New Cancer Waiting Times database to allow data interrogation and reporting via Business Objects.  If NHS Boards discover that data submitted is incorrect, or that data is missing, further re-submissions can be made up until the publication submission deadline date and will be reflected in the current publication.  These statistics may also be updated in subsequent publications to reflect a more accurate and complete set of data submissions.
 
These statistics on cancer waiting times are being published for the first time. The quality of these statistics is considered to be fit for publication; any data quality aspects are described in the publication. These statistics are classed as "official statistics", however due to their newness they have not yet been assessed by the UK Statistics Authority for compliance with the Code of Practice for Official Statistics. ISD expect to ask the UK Statistics Authority to assess these statistics at some point in the future, with a view to gaining the "National Statistics" quality accreditation.
 
It is important to highlight that some patients who would have been excluded in the old target are now included and have waiting times adjustments applied to take into account periods of patient unavailability and/or medical suspensions.  For these reasons, comparisons should not be made between the old and new statistics.
 
It should be noted that the publication reports contain small numbers which may affect the calculations. For example, in Island NHS Boards there may be a substantial quarter-on-quarter fluctuation in the percentage of patients that started treatment within 62 days, which may represent the pathway of one or two patients.  Therefore, many of the NHS Board findings relate only to mainland NHS Boards and are indicated as such.   Due to the effects of small numbers, 90th percentiles have only been calculated where there are forty or more eligible patients within a population.
 
NHS Boards have reported that some data are not yet finalised and may be subject to change in future publications.  However, this publication is considered to give a reasonable reflection of the current position, and therefore useable by the public.  Details of differences between the published figures and current local NHS Board understanding are shown in the footnotes of the publication tables, and specific information on data quality and accuracy is listed on the on the Data Accuracy web pages .

DETAILED FINDINGS

Quarterly statistics on the 62-day target for patients urgently referred with a suspicion of cancer (excluding screened positive patients) to first cancer treatment are presented by NHS Board, Cancer Network and Cancer Type within this publication release.

Performance against the 62-day target

The percentages of all urgently referred patients with a suspicion of cancer that started treatment in January - March 2010 within 62 days, against a target of 95% by NHS Board and regional Cancer Network are detailed below:

Area of receipt of referral Percentage that started treatment with 62 days
NHSScotland

 96.5
NHS Grampian

 96.4
NHS Highland

 98.4
NHS Orkney

 100.0
NHS Shetland

 100.0
NHS Tayside

 94.9
NHS Western Isles#

 100.0
North of Scotland Cancer Network (NOSCAN) Total

 96.6
   
NHS Borders

 98.5
NHS Dumfries & Galloway

 97.3
NHS Fife

 96.2
NHS Lothian

 99.2
South East Scotland Cancer Network (SCAN) Total

 97.9
   
NHS Ayrshire & Arran

 91.9
NHS Forth Valley

 94.6
NHS Greater Glasgow & Clyde

 96.3
NHS Lanarkshire

 98.1
West of Scotland Cancer Network (WOSCAN) Total

 95.6

# Data is incomplete due to a submission error.  According to local systems, the Western Isles percentage treated within target for All Cancer Types, Upper GI and Urology is 81.8%, 75.0% and 75.0% respectively and not 100%.  The resulting NHS Scotland figure for All cancer Types is 96.4% rather than 96.5%.  The updated/revised figures will reflected in the next publication.

  • During January - March 2010, 96.5% of reported urgently referred eligible patients with a suspicion of cancer to first cancer treatment in Scotland started treatment within 62 days of referral.  The corresponding figures for NOSCAN, SCAN and WOSCAN were 96.6%, 97.9% and 95.6% respectively.  The target set by the Scottish Government is 95% by 2011.
  • The mainland NHS Boards that had the highest and lowest proportion of patients that started treatment within 62 days from receipt of an urgent referral with suspicion of cancer to first cancer treatment were NHS Lothian (99.2%) and NHS Ayrshire & Arran (91.9%) respectively.  The difference between achieving and not achieving the target can involve small numbers of patients not being treated within target time. 

The overall Scotland percentages of all urgently referred eligible patients with a suspicion of cancer that started treatment within 62 days by Cancer Type are displayed below:

 Cancer Type  Percentage that started treatment with 62 days
 All Cancer Types*

 96.5
 Breast

 98.8
 Colorectal

 96.2
 Head and Neck

 97.0
 Lung

 96.8
 Lymphoma

 91.7
 Melanoma

 93.8
 Ovarian

 98.4
 Upper GI

 97.5
 Uroloogy

 94.7

*All cancer types for which data are recorded: breast, colorectal, head and neck, lung, lymphoma, melanoma, gynae - ovarian, upper GI, and urological.

  • The cancer types with the highest and lowest proportion of patients that started treatment within 62 days from receipt of an urgent referral with suspicion of cancer to first cancer treatment were Breast (98.8%) and Lymphoma cancers (91.7%), respectively.
  • The mainland NHS Boards that had the highest and lowest maximum wait in days from referral to treatment were NHS Tayside (140 days) and NHS Lanarkshire (64 days) respectively.  The NHS Boards with the highest and lowest maximum waits had the same 90th percentile figure (56 days) i.e. 90 percent of patients waited 56 days or less from urgent referral with a suspicion of cancer to first cancer treatment.
  • For Scotland, the median wait was 33 days and the 90th percentile was 58 days.

Distribution of waits

  • Within Scotland for all cancer types, 96.5% of eligible referrals were treated with 62 days since receipt of urgent referral with suspicion of cancer (excluding screened positive patients) during quarter 1 (Jan - Mar 2010).
  • Analysis of the length of wait from receipt of an urgent eligible referral with suspicion of cancer to treatment broken down by categories shows that 29.0% of eligible referrals were treated within 0-20days, 36.3% within 21-41 days, 31.3% within 42-62 days, 2.1% within 63-83 days, and 1.3% over 84 days.

Exclusions and Waiting Times Adjustments

  • It should be noted that aspects of the new cancer waiting times definitions such as, the reclassification of exclusion categories and waiting times adjustments are new concepts that are still being embedded fully at service level.
  • 110 (5.5%) of urgent referrals submitted in Scotland were excluded from the target calculations due to clinical reasons or because the patient died before treatment or refused all treatment.
  • The mainland NHS Boards that had the highest and lowest percentage exclusions were NHS Tayside (13.7%) and NHS Grampian (3.0%).
  • Waiting times adjustments have been applied to take into account periods of patient unavailability and medical suspensions.  Within Scotland, 183 occurrences of patient unavailability and 178 occurrences of medical suspension account for all waiting times adjustments.  The corresponding median adjustment in days for the patient and medical categories are 16 and 21 days respectively.
  • The mainland NHS Boards that had the highest and lowest patient unavailability adjustments were NHS Greater Glasgow & Clyde (51) and NHS Dumfries & Galloway (4) respectively.  The corresponding figures for medical suspension adjustments shows that NHS Grampian and NHS Dumfries & Galloway are the highest and lowest at 35 and 2 respectively.
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MAIN CONTACTS:

Kirsty Anderson
Principal Information Analyst
0141 282 2243
kirstyanderson@nhs.net

Sarah Callaghan
Data Development Manager
0131 275 7707
sarahcallaghan@nhs.net

Kathryn Burt
Information Analyst
0131 275 6676
kathryn.burt@nhs.net

Alan Finlayson
Waiting Times Programme Principal
0131 275 6271
alan.finlayson@nhs.net

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GLOSSARY:

Eligible referral - urgent referral submitted with a suspicion of cancer by a GP or GDP or direct referral to hospital (self, GP or NHS24 referral to A&E or other), excluding patients who had a clinically complex pathway, died before treatment or who refused treatment.

Exclusion - patients who had a particularly complex clinical pathway, died before treatment or who refused treatment.

Gynae-ovarian - Gynaelogical ovarian.

Maximum wait - the largest value of referral to treatment days.

Median adjustment - the middle value of waiting time adjustment days.  Medians are only calculated where there are three or more waiting times adjustments.

Median wait - the middle value of referral to treatment days.  Medians are only calculated where there are three or more eligible patients.

NOSCAN - North of Scotland CAncer Network.

Percentile - the value of a variable below which a certain percent of observations fall. For example, the 90th percentile is the value (referral to treatment days) below which 90 percent of the waits may be found.  The 50th percentile is also known as the median.  90th percentiles have only been calculated where there are forty or more eligible patients.

Referral - a request to a care professional, team, service or organisation to provide appropriate care to a patient/client. A referral may be made by a person, team, service or organisation on behalf of a patient/client, or a patient/client may refer him/herself.

SCAN - South East Scotland CAncer Network.

Upper GI - Upper Gastrointestinal.

Urgent referral - referral submitted with a suspicion of cancer by a GP or GDP or direct referral to hospital (self, GP or NHS24 referral to A&E or other).

Waiting times adjustment - an adjustment (in days) applied to take into account periods of patient unavailability (e.g. because the patient did not attend an appointment) or medical suspension (e.g. the patient had another condition requiring treatment before cancer treatment could be started).  Waiting Times adjustments are not made when delays are caused by hospital operational circumstances.

WOSCAN - West of Scotland Cancer Network.

Further information on New Cancer Waiting Times Data & Definitions can be found on the Guidance  section of the website.

In addition, further details are also available in the NHSScotland Health & Social Care data dictionary.

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PRE-RELEASE ACCESS:

Under terms of the "Pre-Release Access to Official Statistics (Scotland) Order 2008", ISD are obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre-Release Access and, separately, those receiving extended Pre-Release Access.
 
Standard (five day) Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
NHS Board Chief Executives
NHS Board Communication leads
 
Extended Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
This extended Pre-Release Access is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access).
 
 
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HISTORY OF THIS PUBLICATION:

Last Published: 18 May 2010
Next Due: 28 September 2010
Data Available Since: Information on old cancer waiting times is available on the Scottish Government website from October 2004 until March 2009. Information on old cancer waiting times is available on the ISD website from April 2009 until December 2009.

 


Main contact: Email Kirsty Anderson