A new report by Policy Exchange, A Wait on Your Mind?, has found that four million NHS patients are currently waiting to have a condition or complaint diagnosed, many of which are thought to be undiagnosed cancer cases.

The think tank analysed the Referral to Treatment (RTT) Statistics from NHS England, revealing that 80% of the current NHS waiting list (4.2 million people) are still without a decision to admit at effectively the earliest point of diagnosis. 

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Average wait times across specialisms are now approaching ten months, or 37 weeks, representing an enormous unknown clinical risk to both individuals themselves and the NHS as a whole. 

There is particular concern for cancer patients since one in five cancers are picked up following a non-cancer referral. With 90,000 cases of cancer usually detected in patients on non-cancer pathways, the paper warns there are likely to be be hundreds of undiagnosed cancer patients sitting on a routine referral within each NHS hospital in England.

Calls for the government to invest £1.3bn in funding for diagnostics

As a result of these findings, the report's authors are calling for the Government to invest £1.3bn in new capital funding for diagnostics to achieve a much faster, 8-week diagnosis. Policy Exchange say that combined with existing funding, this package would bring NHS capacity in line with the OECD average.

They suggest the funding should be delivered in tranches over the next three years, commencing with £500m at the upcoming Comprehensive Spending Review.

Policy Exchange also ask the NHS to urgently improve communication with the millions of people on the waiting list after focus groups highlighted how many patients reported feeling "left in the dark". 

To improve this communication, the report asks the government to invest in a priority NHS-led digital offer to support these patients. The services could include appointment scheduling, list status, and signposting to wider services; all of which could be made available through the NHS App. 

"Innovative solutions and investment are sorely needed"

Robert Ede, Head of Health and Social Care Policy at Policy Exchange and the lead author of the report, said: “Operational transparency must improve. Current clinical prioritisation and waiting times are hidden from patients. Few are informed about their likely wait time, how this compares to their rights as set out in the NHS constitution, or how new prioritisation methodologies is being applied to their case. The ‘consumer’ of the service is being left in limbo, with limited support whilst they wait. There is evidence that the existing approach is also cementing health inequalities.”  

“There has been a lot of focus on those waiting a long time for treatment. But the figure that should be keeping the new NHS Chief Executive up at night is 4.2 million – the number of people with a routine referral still awaiting a decision from a specialist. This is an enormous clinical risk. A proportion of these patients will have a cancer and other urgent hidden condition. As we look to the spending review, Policy Exchange is calling for reform to the system, putting the funding and incentives in place to prioritise an NHS diagnostics revolution, whilst supporting patients as they wait for treatment.”

In response to the paper's findings, Professor Neil Mortensen, President of the Royal College of Surgeons of England said: “We agree that the current state of the waiting list in England is politically unacceptable. With more than 5.3 million on the waiting list, innovative solutions and investment are sorely needed.

"Policy Exchange are right to highlight that surgical hubs are one part of the answer. 73% of people say that if they needed an operation, they would be willing to travel to a surgical hub, if it was not their nearest local hospital. The recommendation that hubs should facilitate three session days and seven-day working is ambitious, but increasing activity is essential to bringing down the long backlog of operations. We urge every Integrated Care System (ICS) in England to identify at least one 'surgical hub' where planned surgery can continue, with Covid cases now rising again.”