Stronger and clearer national leadership is urgently needed to improve cancer services, along with a greater focus on prevention, according to a report by the Auditor General

The report, published today, examines the coherence of the national arrangements to drive improvements in cancer services in Wales.

The report found that despite increased investment, there is a continuing failure to meet the national performance target that 75% of cancer patients should start their first treatment within 62 days. No health board has met the target since August 2020, and it has never been met on an all-Wales level. Performance deteriorated after the pandemic and has been stable since early 2022 with between 52% and 61% starting their treatment within the target time. Waiting times for some cancer types (lower gastrointestinal, gynaecological, and urological cancers) are particularly long, with some patients waiting over 100 days to start treatment

Early detection and diagnosis are key to survival for most cancers. Screening plays a vital role in early detection. Positively, the national bowel screening programme has expanded to include more people using a more sensitive test. There are opportunities to increase the uptake of breast and cervical screening and make a decision about a national lung screening programme.

Cancer survival outcomes in Wales have improved over recent years but are still poor compared to other countries. Wales has the second highest cancer mortality rate in the UK after Scotland. Survival rates are worse for people living in deprived areas compared to more affluent areas.

Rising demand for cancer diagnosis and treatment is a significant challenge for NHS Wales. The number of newly diagnosed cancers has increased by 22% from 2002 to 2021. Numbers of suspected cancer referrals have also increased. Those referrals create demand even though more than 84% of patients who are referred with a suspected cancer go on to find out that they do not have cancer.

There are also challenges associated with gaps in staffing capacity.

The waiting list for cancer diagnosis and treatment has continued to increase. The Welsh Government wants the waiting list to return to pre-pandemic levels. However, the report shows that this is unlikely without a significant increase in diagnosis and treatment activity.

Addressing the challenges facing cancer services in Wales requires strong and clear national leadership. However, the report points to weaknesses in this area and in particular to a lack of clarity over the status of the national Cancer Improvement Plan for Wales that was launched in 2023. It also calls for greater clarity over the respective roles of the Welsh Government and the NHS Executive in overseeing and supporting improvement.

Around four in ten cancers each year in Wales are preventable. There are considerable opportunities to save lives and reduce pressure on NHS resources by tackling lifestyle factors which increase the risks of some cancers occurring in the first place. Those opportunities go beyond the prevention of cancer because many of the lifestyle risk factors for cancer are also risk factors for other major conditions which affect people’s well-being and consume significant amounts of NHS resource.