Response to Audit Wales’s ‘Cancer Services in Wales’ Report

A damning independent audit report on cancer services in Wales, published today, lays bare the state of cancer diagnosis, treatment and care across the nation and highlights many of the challenges and failings that a struggling Welsh NHS faces.

Cancer Research Wales believes that the people of Wales and the dedicated staff in the Welsh NHS deserve better. Unless improvements are made, Welsh cancer patients will continue to suffer worse outcomes and more families will lose loved ones unnecessarily.

The report suggests that some issues will require political drive, greater accountability and better-defined responsibility and ownership of these obligations. It is clear more investment will be needed to bring about the required change, but this must be targeted to the right areas instead of just throwing money at what has become an intractable problem.

At Cancer Research Wales we believe that incorporating research and innovation into the heart of the NHS will drive forward lasting system improvements, lead to better efficiency, attract and empower staff and futureproof the NHS against increasing demand. Such a move will serve to increase resilience within the Welsh NHS and ultimately ensure that cancer patients have better outcomes.

Embedding Research, Innovation and Technology into Welsh Cancer Services

Based on today’s report, areas that are prime targets for innovation include: better diagnostic tests that can detect cancer accurately and reduce unnecessary investigations; accurate and cost-effective screening tools to improve early diagnosis; enhancing and optimising cancer pathways to reduce waiting lists and ensure patients receive the right care in a timely manner.

Unfortunately, Wales has typically been slow to adopt the latest best practice in cancer screening, meaning opportunities are being missed to save lives. A prime example is the Lung Health Check programme, which has had a successful pilot in Wales and has been rolled out in other parts of the UK but is not yet up and running across Wales.

The most recent figures showed more than 110,000 people waiting for a diagnostic test across Wales. The colonoscopy waiting list alone accounted for almost 10,000 of those, with the audit reporting that only 21% of people receive a colonoscopy within four weeks, against a set target of 90%.

Sadly, the inability to quickly provide gold-standard diagnostic tests for suspected bowel cancer undermines the one positive finding in the report – namely, that targets for bowel cancer screening rates are being met. At worst, these delays will see patients diagnosed at a more advanced stage, making their cancer more difficult to treat, manage and cure.

The use of artificial intelligence (AI) approaches in healthcare has received enormous interest and has the potential to be transformative in several settings. Cancer Research Wales is currently funding work to develop this technology for use in bowel cancer detection, with scope for several other common cancer types to benefit from similar AI platforms. Embracing these powerful new approaches promises significant rewards for the patient journey.

The non-invasive testing of patients, through so-called ‘liquid biopsies’, has also seen great strides forward taken in recent years. The Cancer Research Wales-funded Raman Blood Test, an AI-based diagnostic test, offers many advantages including early detection of bowel cancer with timely test results and fewer unnecessary follow-up procedures. This test has the potential to both improve patient outcomes and to save valuable NHS resources, a true win-win situation.

Building the Foundations with Modern Infrastructure

To realise the full potential that research and innovation has to offer, the Welsh NHS will need to be equipped with the modern IT infrastructure these cutting-edge technologies require.

Furthermore, improved capture and handling of high-quality cancer data in ‘real-time’ will be needed to enable more accurate health modelling to be undertaken. This will serve to forecast future demands and predict capacity requirements, helping to avert future crises which are costly for both patients and governments alike.

While Wales is home to some world-leading health data systems, such the anonymised health data registry SAIL, the fragmented nature of these and the poor linkage between different systems means that Wales often fails to maximise the returns on these investments, a missed opportunity for cancer services.

The pathology services in Wales already face staff shortages, while an estimated 20-30% of clinical pathologists are set to retire in the next 5 years. To ease the burden on stretched pathology staff, Cancer Research Wales is investing in AI research to provide digital pathology solutions to speed up biopsy analysis, ensuring patients don’t face unnecessary delays in starting their treatment.

Implementation of automated systems into routine diagnostic services can save both valuable clinical time and money, reducing the current labour intensive and time-consuming processes to allow greater flexibility for the workforce. However, these systems need the right scanning equipment and data storage facilities. Today’s report demonstrates how Wales has fallen from being a leader in this area to now lagging behind the rest of the UK, due to a failure to commit the necessary investment.

Using Research to Recruit and Retain the Best Healthcare Professionals

Workforce issues feature heavily in today’s report. There is a clear lack of adequate workforce in cancer diagnostic services, treatment provision and care. It has been previously reported that North and West Wales have a shortage of oncologists, with approximately 3 oncologists serving every 100,000 older people, compared to 10 in London.

The audit report on cancer services in Wales was right to highlight the role that research, innovation and technology plays in attracting newly qualified clinicians and other healthcare professionals.

Being able to take part in innovative studies and make use of cutting-edge technologies is a major draw for medical staff and can enhance their career prospects as well, so increasing research capacity offers the possibility of at least partly addressing current workforce issues.

Cancer Research Wales believes that embedding research into the heart of the NHS will serve to attract and retain clinicians, health care professionals such as biomedical scientists, medical physicists, and other allied health care professions.

We remain committed to providing research opportunities for clinicians through our PhD training programmes and other funding streams.

It All Begins with Primary Care

What came as a surprise in today’s report was the sparse mention of primary care, despite the fact that 80% of all referrals for suspected cancer come through primary care.

A patient’s cancer journey typically begins, continues and ends with primary care. At Cancer Research Wales we believe that primary care, when adequately resourced, functioning optimally and fully interfaced with secondary care, has the potential to deliver significant improvements for cancer patients.

One area with potential for significant gains is in point-of-care testing, wherein GPs can undertake simple tests in-house to provide them with better information about patients for whom they have concerns – for example, Cancer Research Wales is funding a project developing lateral flow tests that look for specific cancer markers.

Research conducted by Cancer Research Wales previously found a series of issues within primary care settings, including varying application of NICE guidelines, inadequate safety netting processes and tensions with secondary care centres. Addressing these problems, through training programmes such as the Cancer Research Wales-funded ThinkCancer! trial, offer an excellent opportunity for quick wins for primary care.

Cancer Research Wales believes that by focussing on the changes that research can deliver, improvements will follow. The Suspected Cancer Pathway in Wales sets a target of treating 75% of cancer patients within 62 days of cancer being suspected – through innovation we may finally be able to hit this target for the first time since 2020.