A report titled “Cancer Services in Wales: A review of the strategic approach to improving the timeliness of diagnosis and treatment” has been published by the Auditor General for Wales, outlining that “despite increased investment, there is a continuing failure to meet the national performance targets for cancer”, highlighting risks to patient safety from fragmented digital systems and the need for more consistent national data.
Specifically, the review notes that national targets to ensure 75 percent of cancer patients start their first definitive treatment within 62 days of first suspicion have “not been met by any of Wales’ health boards since August 2020”, instead remaining “between 52 percent and 61 percent”. It notes the vital role of screening in early detection, and challenges in particular relate to “inflationary cost pressures”, capacity including gaps in the workforce, and “concerns about a shortage of modern scanning equipment”.
Although the review identified examples of investment in cancer services and planned care such as rapid diagnostic centres and Velindre NHS Trust’s new cancer centre, it found the pace at which new developments like digital cellular pathology and lung cancer screening are taken forward “can be slow”.
On the reasons for slow uptake of digital cellular pathology in particular, the review shares how the National Pathology Programme has been working with health boards and the Welsh Government to “develop a consistent all-Wales approach” since 2019, but that progress “has been restricted by uncertainty about who would fund modern scanning equipment and digital storage”. It cites uncertainty specifically around whether or not the government will fund this equipment and storage, but states that work is still underway on agreeing a business case with health boards “to share ongoing annual costs of around £3 million for the scanning equipment and storage”.
It goes on to feature data and digital as two key areas for improvement, pointing to inaccuracies and a need for “more consistent” national data that helps track delivery across the patient pathway, as well as sharing that work to replace the previous “outdated” cancer information system has been “slow”, meaning “services continue to rely on fragmented digital systems that consume time and carry risks to patient safety”.
The review shares findings from NHS bodies detailing how the lack of integration between digital systems is “consuming valuable staff time” using manual workarounds to transfer patients, and risking patient safety “because details could be transferred incorrectly or not at all”. On this, findings also indicate “numerous examples” of NHS organisations “procuring their own digital systems” or “adapting national products”, resulting in limited interoperability. And despite commitments from The Cancer Improvement Plan for a cancer version of the national Digital and Data Strategy for Wales to be developed by the end of June 2023, the review finds “no such plan had been created at the time of our review and we found confusion about the commitment to create one in the first place”.
The review then moves on to offer ten recommendations across areas including setting out a “coherent, long-term strategic approach” for cancer in Wales, developing the strategic approach to population health improvement and disease prevention, “exploiting specific opportunities for improvement”, and improving data and digital. More specifically, these call for the Welsh Government to set out “a coherent model” for system leadership in respect of cancer services, and to undertake a review of its oversight and performance framework to “focus on a broader range of issues”.
It continues to note the recommendation to encourage greater regional working between health boards, and to work with the NHS Executive, HEIW, and other NHS bodies to “ensure there are employment opportunities for radiologists who have been trained in the National Imaging Academy”. Success in establishing regional working and collaboration will depend, however, on action taken to tackle barriers such as lack of integration between digital systems that make sharing waiting lists across health boards difficult, the review later continues.
Recommendations for digital and data note working with DHCW to identify digital solutions to support shared waiting lists for cancer diagnosis and treatment, and clarifying roles and responsibilities at national level for monitoring and compliance around data standards including how the government will “hold NHS bodies to account for poor compliance”.
The report also recommends the need to produce a “more comprehensive set of publicly available data on cancer services” including data such as the number of people waiting for cancer diagnosis or treatment and performance against targets and across patient pathways.
To read the review from the Auditor General for Wales, Cancer Services in Wales: A review of the strategic approach to improving the timeliness of diagnosis and treatment, January 2025, click here.
Digital in supporting cancer identification and treatment
In October, we explored recent updates from across the NHS which share insight into the ways artificial intelligence (AI) tools are being implemented, including for the purposes of identifying cancer; from supporting the diagnosis of skin cancer, to assisting in detecting cancerous tumours during a colonoscopy.
Barking, Havering and Redbridge University Hospitals recently shared details of how AI and imaging tools are being utilised across the trust, with an aim to reduce waiting times for x-ray results, and support cancer diagnosis and cancer treatment. This work includes a new project aiming to speed up the diagnosis of mouth cancer, with results from a pilot showing 95 percent of patients had been “reassured they do not have cancer without facing an anxious wait to see a consultant”, whilst six patients had been diagnosed with mouth cancer and directed to the care they required.
Somerset NHS Foundation Trust recently launched a new self-referral service aimed at supporting the process of getting checked for bowel cancer. The service utilises cancer detection specialist C the Signs technology, where patients can check their symptoms on the platform and use an online self-referral form if required. The referral form is said to take around 10 minutes to complete and can be completed online or over the phone.
And University Hospitals Coventry and Warwickshire has been utilising a new imager for cancer patients undergoing tumour removal surgery. Known as the AURA 10 mobile PET-CT imager, the device scans a specimen and uses high-resolution, submillimetre images to decipher whether all of a tumour has been removed. It was developed by Belgian company XEOS and has since been used for the first time by UHCW on a patient with a carcinoma of the jaw.
