Waiting times for cancer treatment across the UK

• The devolved nature of UK healthcare policy means that healthcare is run separately, and differently, across the four UK nations; each nation has developed its own standards for the treatment of cancer, and associated targets for these standards.

• All UK countries have a standard that a patient should wait no more than 62 days from their cancer referral being received (or the "point-of-suspicion" in Wales) to starting treatment; England, Scotland, and Northern Ireland also have a standard that a patient should wait no more than 31 days from the "decision-to-treat" the cancer to starting treatment.

• Direct comparisons of the performance of the UK nations cannot be made, because of the number and complexity of the differences between the cancer waiting time standards across the UK, though comparisons in overall trends can still be made.

• The percentage of patients waiting longer than the 31-day standard for cancer treatment in England, Scotland, and Northern Ireland has generally increased over the past 12 years.

• The percentage of patients waiting longer than the 62-day standard for cancer treatment has generally increased over the past 12 years in England, Scotland, and Northern Ireland; the series in Wales covers the past five years and it has also broadly increased.

• There was a break in these trends in 2020, when the percentage of patients waiting longer than the 62-day standard to start treatment declined while coronavirus (COVID-19) lockdown restrictions were in place; there were corresponding increases around the time the UK's roadmap out of lockdown began in March 2021.

Collaboration

This article is a cross-government approach to improve the coherence of cancer waiting times standards and statistics. It has been by written us, at the Office for National Statistics (ONS), in partnership with NHS England, Public Health Scotland, Scottish Government, Welsh Government, Department of Health Northern Ireland, and the Department of Health and Social Care. 

This article describes the standards and statistics on waiting times for cancer treatment (referred to as "cancer waiting times"). It brings together these statistics between Quarter 1 (Jan to Mar) 2012 and Quarter 2 (Apr to June) 2024 from across the four UK countries, where they are available. We aim to inform users about why direct comparisons of the performance of the UK nations cannot be made.

We have partnered with health bodies to make improvements to the statistical coherence of health data. This is outlined in our Building a better understanding of UK health data blog post. This partnership has produced a series of cross-UK articles that bring together published health statistics. These include:

• Summary of ambulance response time data in the UK

• Accident and Emergency wait times across the UK: 2024

• The healthcare workforce across the UK: 2024

• Measuring NHS experience and satisfaction across the UK

• NHS planned care waiting times across the UK

To understand cancer waiting times standards and statistics, it is first useful to understand the patient journey, including the guidelines for cancer referral.

When a patient visits their primary care provider (general practitioner, dentist, optometrist, or nurse) with symptoms that may indicate cancer, they will be referred to see a hospital doctor (specialist), or to have tests. This is known as a suspected cancer referral (or an urgent suspected cancer referral). See Section 8: Glossary for more information on suspected cancer referrals.

Each UK country has guidance to help primary care providers assess whether a patient is suspected of having cancer based on their symptoms and needs a referral for further investigation: 

• National Institute for Health and Care Excellence (NICE) guidance for Suspected cancer: recognition and referral in England and Wales

• Scottish Referral Guidelines for Suspected Cancer in Scotland

• Red Flag Criteria in Northern Ireland

There are also other routes by which a patient can receive a cancer referral and a subsequent diagnosis. The terms used to describe these routes can differ by country. In this article, we are using the terms "cancer screening referral", "consultant upgrade referral", and "direct referral". See Section 8: Glossary for more information on these terms.

If a patient is then diagnosed with cancer, the next stage is the "decision-to-treat". The patient will meet with a hospital doctor (specialist) to agree a treatment plan. The patient, along with their cancer care team, will then proceed with the agreed course of treatment. This is most commonly surgery, chemotherapy, radiotherapy, specialist palliative care or active monitoring.

The devolved nature of UK healthcare policy means that healthcare is run separately, and differently, across the four UK countries. Each UK country has developed its own standards for the treatment of cancer, and associated targets for these standards.

Statistics on cancer waiting times are collected by each UK country to assess performance against their standards, as set out in:

• Handbook to the NHS Constitution for England, published by Public Health England and the Department of Health and Social Care

• Cancer waiting times: data and definitions manual and Scottish Cancer Waiting Times - Adjusted and Unadjusted Waits Guidance Notes (PDF, 479KB), published by Public Health Scotland

• Suspected Cancer Pathway Briefing Paper (PDF, 172KB), published by NHS Wales

• Cancer waiting time statistics, published by the Department of Health in Northern Ireland

These standards are reviewed and updated, so they remain appropriate for modern cancer care. Wales updated its cancer waiting time standards in June 2019 to the Suspected Cancer Pathway (SCP). England implemented changes to its cancer waiting time standards from October 2023.

Scotland carried out a review in a 2018, but no changes were made to the standards, as described in the Scottish Government's Cancer waiting times standards in Scotland: clinical review.

The 31-day cancer waiting times standard

Cancer waiting times standards for England, Scotland, and Northern Ireland state that there should be no more than 31 days from the "decision-to-treat" a cancer patient to when the patient starts treatment.

Each country sets its own targets for compliance to the 31-day cancer waiting times standard, which can change over time. Currently, England's target rate of compliance to the 31-day standard is 96%, Scotland's target is 95%, and Northern Ireland's target is 98%. Wales does not currently have a 31-day cancer waiting times standard. Wales had a 31-day standard for a subset of patients before changes were introduced in 2019, but these data are no longer published.

The 62-day cancer waiting times standard

Cancer waiting times standards for England, Scotland, and Northern Ireland also state that there should be no more than 62 days between a cancer referral being received by a hospital (specialist) to when a patient starts treatment. Wales also has a 62-day cancer waiting times standard, but it starts from the "point-of-suspicion" to when a patient begins their cancer treatment. See Section 8: Glossary for more information on point-of-suspicion. In some cases, the point-of-suspicion is earlier than the date referrals are received by hospitals.

Each UK country sets its own targets for compliance to the 62-day standard, which can change over time. Scotland and Northern Ireland currently have a target rate of 95% compliance. In England the target is 85%, and in Wales the target is 75%.

Other cancer waiting times standards

There are several other cancer waiting times standards that exist and are specific to certain UK countries. England has a Faster Diagnosis Standard (FDS), which is set out in the NHS Long Term Plan.

Northern Ireland has a standard that all urgent breast cancer referrals should be seen within 14 days.

To understand the comparability of UK cancer waiting times standards and statistics, we conducted a collaborative review with NHS England, Public Health Scotland, Scottish Government, Welsh Government, and Department of Health Northern Ireland.

The review analysed the comparability of definitions used in the 31-day and 62-day cancer waiting times standards across the UK, specifically:

• "clock start" and "clock stop" points

• cancer types included

• waiting time adjustments made

• sources of referrals included

• first and subsequent treatments included

Clock start

The "clock start" for the 31-day cancer waiting times standard is the "decision-to-treat", which is the date of the patient's consultation and when a treatment plan was agreed. This is defined similarly for England, Scotland, and Northern Ireland.

The "clock start" for the 62-day cancer waiting times standard is the date the cancer referral is received by the hospital (specialist) in England, Scotland, and Northern Ireland. In Wales the "clock start" is the point-of-suspicion, which in some cases is earlier than the referral date used by the other countries.

Clock stop

For all UK countries, the "clock stop" point for both 31-day and 62-day cancer waiting times standards is the date a patient starts their cancer treatment. Although the cancer treatment types that stop the clock when measuring these standards are mostly similar, there are some slight differences across UK countries. Each country will stop the clock when a patient receives treatment like surgery, chemotherapy, radiotherapy, active monitoring, or palliative care. However, there are some specific treatments that would pause or stop the clock in certain countries, but not others.

Cancer types

England, Wales, and Northern Ireland assess waiting times for all cancer types except basal cell carcinoma, a common and rarely fatal cancer. England and Northern Ireland also exclude unclassified cancers from their statistics.

Scotland formally measures and publishes waiting times data for 10 cancer site groupings, detailed in Section 8: Glossary. These sites were selected based on the availability of cancer audit data and the incidence of the cancers. Scotland do not collect waiting times data for cancer types like non-melanoma skin cancer, leukaemia, endometrial, and brain and central nervous system.

Analysis using Annual Cancer Incidence data published by Public Health Scotland shows that 76% of the cancer cases registered in 2021, excluding basal cell carcinomas, were for cancer sites included in Scotland's cancer waiting times statistics.

Because different cancers have different treatment pathways and associated waiting times, the differences in the cancer sites included could potentially affect cancer waiting times statistics. Public Health Scotland has carried out a programme of audits of additional pathways to ensure that cancer patients not included in existing cancer waiting times standards are not negatively affected by longer waiting times, as described in their Extended tumour sites guidance.

Waiting time adjustments

If there are delays to starting cancer treatment because of medical reasons or patient unavailability, waiting time adjustments can be made to the recorded wait times.

There are several differences between countries regarding the waiting time adjustments that are made to both the 31-day and 62-day cancer waiting times standards.

In Scotland and Northern Ireland, waiting time adjustments are made to the 31-day and 62-day cancer waiting times standards for both medical (for example, a viral infection or a temporary co-morbidity) and patient unavailability reasons (for example, a holiday). An adjustment is also made if a patient cancels or, in Scotland, does not attend an appointment.

In England, waiting time adjustments are not made to the 31-day and 62-day cancer waiting times standards if a patient has agreed to a reasonable offer of treatment and then cancels or does not attend, except when a patient does not attend their first appointment. Waiting time adjustments can be applied to both standards for personal commitments, like a holiday. However, any required treatment for another medical condition will only pause the clock for the 31-day standard, and so does not cover the diagnostic phase of the 62-day standard.

In Wales, no waiting time adjustments are made to the 62-day cancer waiting times standard for medical or patient-related delays. Adjustments are only made if a patient does not attend the same appointment twice, or they have been unavailable for two months.

See Section 8: Glossary for more detail on waiting time adjustments.

Source of referral

For the 31-day cancer waiting times standard, the source of referral is irrelevant, because the "clock start" is the "decision-to-treat". This means all sources of referral are included within the 31-day standard by default for England, Scotland, and Northern Ireland.

For the 62-day cancer waiting times standard, there are differences between the countries. In England, patients with a suspected cancer referral, cancer screening referral, or a consultant upgrade referral are included. England also includes patients with a breast symptomatic referral. This is a specific referral type, only made in England, when breast cancer is not initially suspected.

In Scotland, suspected cancer referrals and cancer screening referrals are included in the 62-day cancer waiting times standard. Scotland also includes direct referrals. This is defined as when a patient self-refers, or when a general practitioner (GP) or NHS24 healthcare professional tells them to go directly to Accident and Emergency (A&E) for treatment.

In Northern Ireland, the 62-day cancer waiting times standard applies to referrals that were initially made by a GP, including suspected cancer referrals and any routine referrals that have subsequently been reclassified as a cancer referral by a consultant.

Wales makes no exclusions based on the source of the referral for its 62-day cancer waiting times standard.

First and subsequent treatments

The 31-day cancer waiting times standard for Scotland and Northern Ireland, and the 62-day cancer waiting times standard for all UK countries, relate only to "first treatments". See Section 8: Glossary for more information on first treatments.

England's 31-day cancer waiting times standard was changed to include both first and subsequent treatments, following a consultation in 2023. From October 2023 to June 2024, first treatments accounted for around 55% of cases, and subsequent treatments accounted for around 45% of remaining cases, based on 2023 to 2024 Monthly Cancer Waiting Times Statistics published by NHS England. The "clock start" for subsequent treatments can be either the "decision-to-treat" date for that treatment, or the earliest clinically appropriate date.

NHS England publishes breakdowns of its new 31-day and 62-day standards, which allows its pre-consultation standards to be derived.

Additional considerations for cross-UK comparisons of cancer waiting times statistics

There are several other differences affecting the comparability of cancer waiting times statistics across the UK. For example:

• Scotland includes patients over the age of 16 years in its statistics, but cancer patients of all ages are included for England, Northern Ireland, and Wales

• patients who died before treatment, or refused treatment, are excluded in all nations

• Scotland does not include patients with a clinically complex pathway

• private patients referred to the NHS for cancer treatment are included by some UK nations, with different rules for when the "clock starts" for these patients

The Office for National Statistics (ONS) does not have access to the datasets used to calculate these statistics, so we have not provided further analysis of the effect of these differences on cancer waiting times.

Although there are several similarities between the cancer waiting time standards across the UK, there are also many important differences. See Section 4: Similarities and differences in the cancer waiting times standards for further explanation. Because of the number and complexity of these differences, we have concluded that direct comparisons of the performance of the UK nations cannot be made. For example, the performance of the UK nations cannot be ranked based on these statistics.

There are wider differences between the countries, beyond those in cancer waiting times, that should also be considered when interpreting the statistics from each country. These include:

• different policies and programmes for the identification of cancer in the population (for example, screening programmes)

• differences within populations across the four countries (including levels of deprivation and age profile) that can influence the prevalence of cancer in that population

• the mix of healthcare facilities available, within countries and across the UK, that may affect overall capacity and how quickly treatments are available

• the rural and urban split of areas within countries, which can lead to differences in the ease of access to healthcare and the services offered

Therefore, data in Section 6: Trends in cancer waiting times statistics set out:

• country-specific analysis of the percentage of patients waiting longer than the 31-day standard to start cancer treatment in England, Scotland, and Northern Ireland

• country-specific analysis of the percentage of patients waiting longer than the 62-day standard to start cancer treatment in all UK countries

• analysis of the overall trend of these data across all UK countries

Figures 1 to 4 show the cancer waiting time statistics for the treatment of cancer, that are published for England, Scotland, Wales, and Northern Ireland.

This section provides country-specific analysis of the percentage of patients waiting longer than the cancer waiting time standards.

This section also comments on the overall trends of these data across all UK countries. Because of the reasons given in Section 5: Comparability of cancer waiting times statistics, direct comparisons of the performance of the UK nations cannot be made using cancer waiting times statistics.

England

As mentioned in Section 4: Similarities and differences in cancer waiting times standards, England changed its 31-day cancer waiting times standard to include both first and subsequent treatments in 2023. The data on England's 31-day standard presented in Figure 1, and commented on in this article, includes only first treatments. This is because it aligns better with the 31-day standard used in Scotland and Northern Ireland. It also allows for greater continuity of the time series. It should be noted that these statistics are no longer reflective of the current 31-day cancer waiting times standard in England.

Figure 1 shows that there has been a general upward trend in the percentage of patients waiting longer than the 62-day standard and 31-day standard in England, between Quarter 1 (Jan to Mar) 2012 and Quarter 2 (Apr to June) 2024.

In Quarter 1 2012, 11.0% were waiting longer than the 62-day standard, compared with 33.4% in Quarter 2 2024.

In Quarter 1 2012, 1.6% of patients were waiting longer than the 31-day standard for treatment, compared with 8.9% in Quarter 2 2024.

In February 2022, NHS England published its Delivery plan for tackling the COVID-19 backlog of elective care guidance, which aimed to address backlogs built up during the coronavirus (COVID-19) pandemic and to tackle long waits for care. Since then, the percentage of patients waiting longer than the cancer waiting time standards in England has been broadly stable.

Figure 1: The percentage of patients waiting longer than the 31-day or 62-day standard for cancer treatment in England has increased since 2012

Quarterly percentage of patients waiting longer than the 31-day or 62-day standard for cancer treatment, England, Quarter 1 (Jan to Mar) 2012 to Quarter 2 (Apr to June) 2024

Notes:

1. For the 31-day standard, the length of time spent waiting is measured from the point of "decision-to-treat" to when a patient starts cancer treatment, and has completed their wait.
2. For the 62-day standard, the length of time spent waiting is measured from when a cancer referral is received by a hospital (specialist), to when a patient starts cancer treatment, and has completed their wait.  
3. The 31-day standard displayed in this chart is for cancer waiting times from decision-to-treat to first treatment only. It does not reflect the current 31-day standard in England, implemented in October 2023, which includes both first and subsequent treatments. 
4. The 62-day standard data displayed in this chart up to September 2023 aggregates separate 62-day standards for different sources of referral (suspected cancer referrals, cancer screenings, and consultant upgrades). The data presented from October 2023 onwards only has one 62-day standard that is irrespective of source of referral.  
5. Coronavirus (COVID-19) pandemic lockdown restrictions in all four countries began in March 2020, and the UK’s roadmap out of lockdown began in March 2021.
6. The data presented in this chart are correct as of the 23 August 2024.

Download the data

Scotland

Figure 2 shows that there has been a general upward trend in the percentage of patients waiting longer than the 62-day standard in Scotland, between Quarter 1 2012 and Quarter 1 2024 (5.2% and 29.6%, respectively).

The percentage of patients waiting longer than the 31-day standard has been more stable over time. In Quarter 1 2012, 2.0% of patients in Scotland waited longer than the 31-day standard, compared with 5.9% in Quarter 1 2024.

In August 2021, the Scottish Government published the NHS Recovery Plan 2021 to 2026 (PDF, 686KB), which sets out plans to increase NHS capacity, including maintaining the 31-day and 62-day cancer waiting time standards. Despite this, the quarterly percentage of patients waiting longer than the 62-day standard for cancer treatment in Scotland increased from 2022, before levelling off from 2023.

Figure 2: The percentage of patients waiting longer than the 62-day standard for cancer treatment in Scotland has increased since 2012

Quarterly percentage of patients waiting longer than the 31-day and 62-day standard for cancer treatment, Scotland, Quarter 1 (Jan to Mar) 2012 to Quarter 1 2024

Notes:

1. For the 31-day standard, the length of time spent waiting is measured from the point of "decision-to-treat" to when a patient starts cancer treatment, and has completed their wait.
2. For the 62-day standard, the length of time spent waiting is measured from when a cancer referral is received by a hospital (specialist), to when a patient starts cancer treatment, and has completed their wait.  
3. Cancer patients under the age of 16-years are not included in Scotland's cancer waiting times data.
4. Cancer waiting times standards in Scotland are measured for 10 cancer site groupings.
5. Coronavirus (COVID-19) pandemic lockdown restrictions in all four countries began in March 2020, and the UK’s roadmap out of lockdown began in March 2021.
6. The data presented in this chart are correct as of the 23 August 2024. 

Download the data

Wales

In June 2019, Wales introduced a new 62-day cancer waiting times standard called the Suspected Cancer Pathway (SCP). This was designed to include all referral sources, with only minimal waiting time adjustments. Data are not available on a comparable basis before the introduction of the SCP.

In Quarter 3 (July to Sept) 2019, 38.7% of patients in Wales waited longer than 62 days from when cancer was first suspected to starting treatment. This percentage has increased to 44.7% in Quarter 2 2024 (see Figure 3).

In April 2022, the Welsh Government published Our programme for transforming and modernising planned care and reducing waiting lists in Wales (PDF, 447KB). This plan focuses on early diagnosis and treatment of suspected cancer patients. Since 2022, the percentage of patients waiting longer than the 62-day standard for cancer treatment in Wales has been relatively stable.

Figure 3: The percentage of patients waiting longer than 62-days for cancer treatment in Wales has increased since 2019

Quarterly percentage of cancer patients waiting longer than 62-days for cancer treatment, Wales, Quarter 3 (July to Sept) 2019 to Quarter 2 (Apr to June) 2024

Notes:

1. The length of time spent waiting is measured from when cancer is first suspected to when a patient starts cancer treatment, and therefore has completed their wait. 
2. This chart presents data on Wales’s SCP, which was introduced in June 2019 to include all referral sources in the standard, with only minimal waiting time adjustments; these data are not available before June 2019. 
3. Quarter 2 (Apr to June) 2019 has been excluded from this chart because it only includes data from June 2019.
4. Coronavirus (COVID-19) pandemic lockdown restrictions in all four countries began in March 2020, and the UK’s roadmap out of lockdown began in March 2021. 
5. The data presented in this chart are correct as of the 23 August 2024. 

Download the data

Northern Ireland

Figure 4 shows that there has been a general upward trend in the percentage of patients waiting longer than the 62-day standard in Northern Ireland, between Quarter 1 2012 and Quarter 3 2023 (20.1% and 66.0%, respectively).

There has also been an upward trend in the percentage of patients waiting longer than the 31-day standard in Northern Ireland. In Quarter 1 2012, 3.9% of patients waited longer than the 31-day standard in Northern Ireland, compared with 12.1% in Quarter 3 2023.

In March 2022, the Department of Health Northern Ireland published A Cancer Strategy for Northern Ireland 2022 to 2032 (PDF, 5.2MB). This set out important actions to stabilise and reform cancer services over the following 10 year period.

Figure 4: The percentage of patients waiting longer than the 31-day or 62-day standard for cancer treatment in Northern Ireland has increased since 2012

Quarterly percentage of patients waiting longer than the 31-day and 62-day standard for cancer treatment, Northern Ireland, Quarter 1 (Jan to Mar) 2012 to Quarter 3 (July to Sept) 2023

Notes:

1. For the 31-day standard, the length of time spent waiting is measured from the point of "decision-to-treat" to when a patient starts cancer treatment, and has completed their wait.
2. For the 62-day standard, the length of time spent waiting is measured from when a cancer referral is received by a hospital (specialist), to when a patient starts cancer treatment, and has completed their wait. 
3. The most recent complete data available for Northern Ireland are for Quarter 3 2023; the ongoing roll-out of a new digital records system means data for more recent quarters are incomplete.
4. Coronavirus (COVID-19) pandemic lockdown restrictions in all four countries began in March 2020, and the UK’s roadmap out of lockdown began in March 2021. 
5. The data presented in this chart are correct as of the 23 August 2024. 

Download the data

Trends across the UK

Differences in how the cancer waiting times standards are defined and measured in each country mean that direct comparisons of the performance of the UK nations cannot be made using cancer waiting times statistics. For example, the performance of the UK nations cannot be ranked based on these statistics.

However, comparisons of the overall trends in these statistics can be made.

The percentage of patients waiting longer than the 31-day standard for cancer treatment in England, Scotland, and Northern Ireland has generally increased over the past 12 years, with a small decline when coronavirus (COVID-19) lockdown restrictions were in place in 2020, as shown in Figures 1, 2, and 4.

The percentage of patients waiting longer than the 62-day standard for cancer treatment in England, Scotland, and Northern Ireland has also generally increased over the past 12 years. There was a decline during 2020, when lockdown restrictions were in place,and a subsequent increase around the time the UK’s roadmap out of lockdown began in March 2021, as shown in Figures 1, 2, and 4. The 62-day standard for Wales covers the past five years and it has also broadly increased, as shown in Figure 3.

After the UK's roadmap out of lockdown began in March 2021, there was a larger increase in the percentage of patients waiting longer than the 62-day standard for cancer treatment in England, Scotland, and Northern Ireland, compared with the increase in the percentage of patients waiting longer than the 31-day standard for cancer treatment. This difference is likely caused by longer waiting times for cancer diagnosis.

These statistics need to be considered in the context of related cancer statistics. This includes cancer incidence and cancer referrals statistics. These have been generally increasing over time, mainly because of the growing and ageing population. These statistics and some wider context are set out in Cancer in the UK: Overview 2023 (PDF, 1,452 KB) published by Cancer Research UK. There was a decrease in the number of cancer referrals being made at the start of the pandemic in March 2020. This then recovered in early 2021, as explained in Cancer Research UK's One year on: How has COVID-19 affected cancer services? blog post.

Cancer screening referral

Cancer screening involves testing apparently healthy people for signs of the disease. We have categorised patients who are sent for further testing as a cancer screening referral in this article.

In the UK, there are screening programmes for breast cancer, bowel cancer, and cervical cancer. The eligible age groups and the frequency of screening vary between the nations of the UK.

Bowel cancer

• In England, bowel cancer screening is available every two years to everyone aged 60 to 74 years, although the programme is currently being expanded to also include people aged 50 to 59 years.

• People who live in Scotland are invited to complete the bowel screening test if they are aged 50 to 74 years and have not been screened in the last two years.

• In Wales, people aged between 51 and 74 years who are registered with a doctor in Wales will be offered bowel screening every two years.

• The Northern Ireland Bowel Cancer Screening Programme offers screening every two years to all individuals aged 60 to 74 years who are registered with a general practitioner (GP).

Breast cancer

• The NHS Breast Screening Programme in England, the Scottish Breast Screening Programme, Breast Test Wales and the Northern Ireland Breast Screening Programme invite all people aged 50 to 70 years, who are registered with a GP, for screening every three years.

Cervical cancer

• In Scotland and Wales, cervical screening is offered every five years to women and anyone with a cervix between the ages of 25 and 64 years.

• In England and Northern Ireland, cervical screening is offered every three years to women and anyone with a cervix between the ages of 25 and 49 years, and every five years for women aged 50 to 64 years.

Cancer type

Cancers are classified to a code using the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). The cancer types, called tumour sites in Northern Ireland and Wales, reported in the statistics for each nation are based on an aggregation of the applicable ICD-10 codes. Each country uses slightly different aggregations. Patients with basal cell carcinoma, a common and rarely fatal cancer, are omitted from the statistics in England, Wales, and Northern Ireland.  England and Northern Ireland also exclude unclassified cancers from their statistics.

In Scotland, performance is only monitored for the following cancer types:

• breast

• colorectal

• head and neck

• lung

• lymphoma

• ovarian

• melanoma

• upper gastro-intestinal

• urological

• cervical

For example, patients diagnosed with other cancers like non-melanoma skin cancer, leukaemia, endometrial, and brain and central nervous system cancers are not included in the cancer waiting time statistics for Scotland.

Consultant upgrade referral

A consultant upgrade referral occurs when a patient was initially referred from primary care to a hospital (specialist) and cancer was not initially suspected. At any point during their hospital care, a consultant can upgrade the patient onto a cancer pathway by referring them to a cancer specialist for further investigation.

Direct referral

This is used in Scotland when a patient goes directly to the hospital with symptoms that need to be investigated. This may be voluntarily, or following guidance from their GP or NHS24, and with no intermediary steps to formally refer them into hospital care.

First cancer treatment

This is the first treatment intervention that stops the clock.

In England, this is defined as the start of the treatment to remove, debulk, or shrink the tumour. Where no definitive anti-cancer treatment is planned, almost all patients will be offered a palliative intervention (for example, stenting) or palliative care (for example, pain relief), which should be recorded as a first treatment.

In Scotland, the definition of first treatment is the treatment or drug that genuinely attempts to begin the patient's first treatment, including if this is palliative care or supportive care.

In Wales, the first treatment is agreed with the clinician responsible for the patient's management plan. It may not necessarily be the first planned treatment decided on by the multi-disciplinary team.

In Northern Ireland, the first treatment is normally the first intervention that is intended to remove or shrink the tumour. Where there is no definitive anti-cancer treatment planned, almost all patients will be offered palliative intervention (for example, stenting) or palliative care, which should be recorded as a first treatment.

Point-of-suspicion

The point-of-suspicion is a "clock start" point that is only used in Wales. It refers to the point that a primary care provider is concerned a patient may have cancer and refers a patient or requests a test. In screening, it is the point of an abnormal test report.

Suspected cancer referral

A suspected cancer referral, sometimes known as an urgent suspected cancer referral, is when a primary care provider suspects cancer. Each country provides guidance to help decide when to refer a patient for further investigation.

Waiting time adjustment

During the patient pathway, there may be delays to cancer diagnosis and treatment that are not counted as part of the waiting time. These are known as waiting time adjustments. A waiting time adjustment may occur because of patient unavailability or conflicting medical needs of the patient. Acceptable waiting time adjustments vary between countries.

In Scotland and Northern Ireland, an adjustment is made for both the 31-day and 62-day cancer waiting times standards if a patient cancels an appointment, or defers their treatment because of other commitments, like a holiday, or to have time to think. An adjustment is also made if the patient has another medical condition that needs to be resolved before cancer treatment starts. In Scotland, an adjustment is also made if a patient does not attend an appointment and rescheduling a diagnostic scan before a decision-to-treat would result in an adjustment to the 62-day cancer waiting time standard, but not the 31-day cancer waiting time standard.

In England, waiting time adjustments are not made to the 31-day and 62-day cancer waiting times standards if a patient has agreed to a reasonable offer of treatment and then cancels or does not attend, except when a patient does not attend their first appointment. Waiting time adjustments can be applied to both standards for personal commitments, like a holiday. Any required treatment for another medical condition will only pause the clock for the 31-day cancer waiting time standard, and so does not cover the diagnostic phase of the 62-day cancer waiting time standard.

Adjustments can also be made after a decision-to-treat has been made for the 31-day cancer waiting times standard, if it is deemed clinically necessary to treat another medical condition before treatment for cancer can be given. However, the clock would continue for the 62-day cancer waiting times standard in this case.

For the 62-day cancer waiting times standard in Wales, waiting time adjustments are only allowed if a patient does not attend the same appointment twice, or if the patient has been unavailable for two consecutive months. The clock is not paused for other medical or social reasons.

This article brings together the data on waiting times for cancer treatment published by each UK country.

England

Data on England's compliance with its cancer waiting times standards come from NHS England's Monthly Cancer Waiting Times Statistics. These data are official statistics. They show the number and percentage of suspected and diagnosed cancer patients meeting cancer waiting time standards in England, by cancer type and treatment type. This dataset was used to calculate the quarterly percentage of patients waiting longer than both the 31-day and 62-day standards to start cancer treatment in England.

Northern Ireland

Data on Northern Ireland's compliance with its cancer waiting time standards come from Northern Ireland waiting time statistics: cancer waiting times quarterly report, which is published by the Department of Health Northern Ireland. These data are accredited official statistics. They show the number of patients treated within and over the 31-day and 62-day cancer waiting time standards in Northern Ireland, by tumour site and Health and Social Care Trust. This dataset was used to calculate the quarterly percentage of patients waiting longer than both the 31-day and 62-day standards to start cancer treatment in Northern Ireland.

Scotland

Data on Scotland's compliance with its cancer waiting time standards come from Table 1 - Compliance to the standard dataset in Public Health Scotland's Cancer Waiting Times quarterly release. These data are accredited official statistics. They show the quarterly number and percentage of eligible referrals treated within the 31-day or 62-day standard in Scotland, by NHS Health Board and cancer type. This dataset was used to calculate the quarterly percentage of patients waiting longer than both the 31-day and 62-day standards to start cancer treatment in Scotland.

Wales

Data on Wales's compliance to its 62-day cancer waiting time standard come from the Welsh Government's Cancer waiting times monthly datasets. These data are accredited official statistics. They show the number and percentage of patients starting treatment within 62 days in Wales, by age group, sex, month, and tumour site. This dataset was used to calculate the quarterly percentage of patients waiting longer than the 62-day standard to start cancer treatment in Wales.