8 | Cancer Commissioning Strategy Framework Cancer Commissioning Strategy Framework | 9 National Cancer Commissioning Landscape Core20 PLUS5 • 75% of cases diagnosed at stage 1 or 2 by 2028. NHS Constitution for England (updated August 2023) • Cancer waiting times are a key performance measure and many elements of the cancer pathway are currently covered by national waiting time standards. Independent Investigation of the National Health Service in England (2024) • Breast and cervical cancer screening rates have declined since 2010, while bowel screening needs further improvement. • Only 60% of cancer genomic tests meet agreed timeframes, delaying treatment and limiting personalised care. • The 62-day cancer treatment target has not been met since 2015, with many patients facing delays. • Access to new cancer drugs varies by region, with some taking over a year to adopt NICE-approved treatments. • UK cancer survival rates lag behind Europe, with higher mortality rates. NHS national cancer screening programmes Reforming elective care for patients – January 2025 • Reduce Cancer Waiting Times: Improve cancer pathway performance, align with the 18-week elective target, and publish a dedicated national cancer plan. • Expand Diagnostic Capacity: Open 170 Community Diagnostic Centres (CDCs) by 2025, running 12 hours/day, 7 days a week, with same-day tests and 10 straight-to-test pathways. • Faster and More Efficient Testing: Increase FIT testing for bowel cancer, teledermatology for skin cancer, and triple-assessment for breast cancer. Boost DEXA scans (+29,000) for bone health. • Enhance Cancer Treatment and Patient Choice: Patients can track real-time cancer appointments in the NHS App (by 2025) and choose faster treatment via NHS or independent providers. • Workforce and Performance Oversight: Cancer Alliances will redesign pathways to reduce delays, AI tools will optimise scheduling, and NHS England will publish ranked cancer performance data for transparency. Children and Young People Cancer Taskforce (2024) • Provide high-quality personalised therapies for children and young people. • Make new treatments and personalised medicines more accessible. • Review the availability of these treatments in devolved administrations. • Enhance early cancer diagnosis to improve survival rates for children. • Improve training and integrate artificial intelligence to support the healthcare workforce. • Increase public awareness to encourage early diagnosis and intervention. • Optimise the allocation of research funding specifically targeted at cancer. • Review and expand children’s access to clinical trials. • Facilitate greater access to data to inform future therapies and treatments. • Encourage healthcare teams to adopt innovative solutions in their practice. The National Institute for Health and Care Excellence (NICE). Guidelines on Suspected cancer: recognition and referral NG12 (updated October 2023) • Sets out thresholds for suspected cancer referrals and timings for referrals to support faster diagnosis. NHS Cancer Programme: Faster Diagnosis Framework (2022) • Faster Diagnosis Standard: Patients are to be diagnosed or have cancer ruled out within 28 days following an urgent GP referral for suspected cancer. • Non-Specific Symptoms Pathway (NSS): Introduced in 2019, this pathway is for patients who exhibit “red flag” symptoms indicative of cancer but whose symptoms do not correspond to a specific tumour type. • Framework for Best Practice Timed Pathways: The goal is to implement these best practice timed pathways across all cancer pathways by the end of the 2023/24 period. Roadmap for integrating specialised services within Integrated Care Systems (2022) Services suitable and ready for greater ICS leadership • Adult specialist endocrinology services (27E Adrenal Cancer). • Specialist cancer services (adults) (01C Chemotherapy, 01J Anal cancer, 01K Malignant mesothelioma, 01M Head and neck cancer, 01N Kidney, bladder and prostate cancer, 01Q Rare brain and CNS cancer, 01U Oesophageal and gastric cancer, 01V Biliary tract cancer, 01W Liver cancer, 01Y Other rare cancers, 01Z Testicular cancer, 04F Gynaecological cancer, 19V Pancreatic cancer, 24Y Skin cancer). • Specialist cancer services for children and young people (01T Teenage and young adult cancer, 23A Children’s cancer). • Specialist colorectal surgery services (adults) (33D Distal sacrectomy for advanced and recurrent rectal cancer). Services suitable but not ready for greater ICS leadership (ready in future) • Specialist cancer services (adults) (01L Soft tissue sarcoma, 01X Penile cancer) pathways by the end of the 2023/24 period. Government Action on Major Conditions and Diseases Statement (2023) • Implementation of genomic testing for early detection of genetic predispositions (e.g., Lynch syndrome, BRCA mutations). • Expansion of screening programs and early diagnostic strategies. • Investment in diagnostic services, with over 114 community diagnostic centres operational. • Focus on early detection using markers like circulating tumour DNA (ctDNA). • Commitment to providing access to specialised care for all cancer patients. • Enhanced support and care services for those living with and beyond cancer. • Tailored support and care initiatives specifically designed for children with cancer. • Continued investment in research to develop new diagnostic technologies and treatments. • Data integration across healthcare services to enhance treatment transparency and coordination. • Implementation of targeted screening programs for underserved populations. • National rollout of lung cancer screening expected to cover all eligible individuals by 2030. The 2025/26 Priorities and Operational Planning Guidance Key Cancer Care Priorities 1. Improved Waiting Times • 62-day cancer standard target: 75% by March 2026. • 28-day Faster Diagnosis Standard: 80% by March 2026. • Focus on reducing elective cancer treatment delays. 2. Streamlined Cancer Pathways • Low-risk cases managed outside cancer settings to free up specialists. • Teledermatology expansion for faster skin cancer assessments. • Nurse/AHP-led prostate cancer biopsies to improve efficiency. 3. Prevention and Early Detection • Prioritised cancer screening for early diagnosis. • Core20PLUS5 approach to reduce inequalities in access. 4. Digital Integration in Cancer Care • Enhanced digital tools for appointments, communication, and test results. • NHS App to give patients more control over referrals and results. 5. Financial and Productivity Challenges • NHS to cut costs by 1% and boost productivity by 4%. • ICBs given funding flexibility, impacting local cancer services. Clinically led review of NHS cancer standards. Models of care and measurement (2022) • Lower the age for bowel screening to catch cases earlier. • Extend lung health checks to more populations. • Provide primary care teams with direct access to diagnostic tests and clinical decision support tools to identify cancers sooner. • Implement new referral routes from community pharmacies to facilitate early detection. • Use genomic testing to identify individuals at high risk for cancers (i.e. Lynch syndrome or BRCA mutations). • Regularly monitor individuals identified as high-risk to manage their health proactively. • Enhance diagnostic services with a £2.3 billion investment over three years. • Expand the number of community diagnostic centres to increase the capacity and speed of cancer checks and scans. • Promote public health campaigns to reduce smoking, excessive alcohol consumption, and obesity. • Encourage physical activity and healthy eating as preventive measures against cancer. • Address environmental risk factors like reducing sun exposure and air pollution. • Implement NSS pathways to support quicker diagnosis. • Establish best practice timed pathways to ensure swift and efficient treatment following diagnosis. • Ensure every cancer patient has access to a CNS or other support worker. • Provide personalised care plans and health and wellbeing information for all patients living with and beyond cancer. • Roll out a national targeted lung cancer screening program. • Continue to invest in research for new treatments, diagnostic technologies, and possibly vaccines. click on document to open it. The NHS Long Term Plan (2019) Ambitions for cancer by 2028: This will be updated following the publication of the NHS 10-Year Plan (Spring 2025) and the National Cancer Plan (Summer 2025) to reflect any changes in strategic priorities and operational guidance. 1. 75% of people with cancer will be diagnosed at stage 1 or 2 to improve survival outcomes. 2. Each year 55,000 more people will survive five years or more following their cancer diagnosis.
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