The Faster Diagnosis Standard (FDS) was introduced by NHS England in 2021. This standard sets out that patients who receive an urgent suspected cancer referral, from their GP or screening results, should find out whether they have cancer, or receive the all-clear, within 28 days. The NHS aims to meet this standard for 75% of patients and performance against this target has been monitored since its introduction.
Around 6% of urgent suspected cancer referrals result in a cancer diagnosis, and delayed diagnosis can impact treatment options, patient experience and outcomes. We investigated FDS performance for people that have cancer diagnosed compared to those that have cancer ruled out. We looked at the period from the introduction of the target in October 2021 up to June 2024. This included looking at results for different suspected cancer types.
Identifying variation in performance between patients who go on to be diagnosed with cancer and those that don’t is important to try and understand the challenges of a timely diagnosis. This helps to understand where delays to diagnosis are avoidable and where improvements can be made to diagnostic pathways.
This analysis was conducted in partnership with the National Disease Registration Service, part of NHS England.
Between April and June 2024, only half (52.3%) of people who were diagnosed with cancer after an urgent referral received their diagnosis in 28 days. That was compared to 75.1% of people getting the all clear in the same timeframe.
Overall FDS performance improved over the study period (70.9% in October-December 2021 to 73.6% in April-June 2024). Performance also improved when looking specifically at people with cancer ruled out (71.9% to 75.1%). However, there was a decrease in performance for people diagnosed with cancer (57.3% to 52.3%). The gap in performance between the two groups increased over the study period.
Looking at specific cancer types:
For people receiving a cancer diagnosis, the 75% target was only met for testicular cancer referrals, at 83.2%. Testicular referrals were also the only referral type where diagnosed referrals had higher performance than ruled-out referrals.
For skin cancer, performance was similar in those that had cancer diagnosed compared to those who had it ruled out (74.7% vs 76.1%).
Head and neck cancer referrals had the largest difference between performance for diagnosed and ruled out referrals – a 41.2 percentage point difference (34.6% vs 75.8%).
Urological cancer referrals (such as prostate and kidney) saw the lowest performance for getting people diagnosed within 28 days, at just 29%. Over half of people diagnosed after a urological cancer referral between April and June 2024 (54.6%) waited more than 42 days (six weeks) for a diagnosis.
The findings suggest that there has been positive progress in the FDS performance target being met. However, this is driven predominantly by improvements for people who have cancer ruled out, rather than improvements across all outcomes and diagnosing cancer faster.
This in part reflects the fact that diagnosing cancer can be more complicated than ruling it out. It is expected that diagnosing cancer can require a longer referral pathway due to additional testing needed to confirm a cancer diagnosis. This report confirms this but also highlights that the gap between referral outcomes in FDS performance is increasing. It also highlights variation between referrals for different cancer types.
The report identifies trends previously not visible in the national statistics. NHS England publishing breakdowns nationally by these two categories (cancer diagnosed or ruled out) is helpful to monitor ongoing performance. This type of analysis can facilitate more focus on where patients are waiting too long to receive a cancer diagnosis.
Read the Highlight reportYou can also view a more in-depth report with more detailed analyses and results:
Read the full reportThe Highlight report is provided by the Evidence and Implementation Department at Cancer Research UK and staff from the National Disease Registration Service (part of NHS England).
Main report authors: Shane Johnson, Kirstin Roberts, Fahmina Fardus-Reid, Scarlett Cartwright-Hughes, Lorna Wills, Lucy Ironmonger, Sophia Lowes, Jon Shelton, Lyndsy Ambler, Sam Harrison, Lizz Paley, Carolynn Gildea, Prof. Mike Richards.
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