Cancer care in Wales: Report highlights long waits and leadership failures

A report from Audit Wales has exposed significant gaps in the implementation of cancer services in Wales, with confusion over national leadership and delays in meeting targets contributing to poor outcomes for patients.
No health board has met the target of starting treatment for 75% of cancer patients within 62 days of first suspicion since 2020.
Audit Wales criticised the Welsh Government for failing to clarify the status of the Cancer Improvement Plan, launched in 2023, and its alignment with other national initiatives.
The lack of clear leadership and coordination has resulted in slow progress and persistent disparities in care across health boards.
Adrian Crompton, Auditor General for Wales, said: “Too many people are experiencing unacceptably long waits for cancer diagnosis and treatment. Stronger national leadership is needed to drive improvements.”
Implementation Gaps and Leadership Failures
The Cancer Improvement Plan, developed by NHS Wales’ Cancer Network, lacks the national backing needed for effective implementation.
Although it was introduced at the request of the then health minister, the Welsh Government does not consider it a government plan. This has left health boards and third-sector organisations unclear about their roles in its delivery.
Audit Wales also identified confusion over the responsibilities of the Welsh Government and the NHS Executive, a body established in 2023 to provide strategic direction.
Stakeholders expressed frustration, with some describing current arrangements as “worse than ever” and admitting, “we don’t know who is in charge.”
Innovative Practices Delayed by Systemic Challenges
The report praised pioneering work by Betsi Cadwaladr University Health Board, which transformed its pathology services in 2014 through digital cellular pathology.
The approach enabled faster pathology results by allowing samples to be scanned and analysed remotely, improving recruitment by facilitating flexible working.
However, the report criticised the slow progress in rolling out a national approach to digital cellular pathology.
Uncertainty over funding for scanning equipment and digital storage has stalled adoption across Wales, leaving the country lagging behind the rest of the UK in this area.
Data Gaps Undermine Progress
The report highlighted significant gaps in data, which obscure the true scale of the challenges facing cancer services.
Ethnicity data, crucial for understanding inequities in care, is incomplete for over two-thirds of patients.
Additionally, current figures focus only on the first treatment, failing to account for the multiple episodes of care or the increasing complexity of treatments like immunotherapy.
Regional variation remains a pressing issue, with some health boards performing significantly worse than others.
For example, in August 2024, Cardiff and Vale University Health Board achieved 68% compliance with the 62-day target, while Hywel Dda University Health Board reached just 48%.
Screening Challenges and Delayed Decisions
Early detection through screening is essential, yet the report found significant shortcomings in this area. While the bowel screening programme has been expanded and uptake is good, breast and cervical screening rates remain below target.
A national lung screening programme, recommended by the UK National Screening Committee in 2022, has yet to be implemented in Wales, despite a successful pilot in Cwm Taf Morgannwg University Health Board.
Public Health Wales has been tasked with developing interim proposals by 2025, meaning any national rollout could still be years away.
Workforce Challenges and Wasted Investment
Workforce shortages are a key barrier to improving cancer care, with critical gaps in radiologists, oncologists, and histopathologists.
Although the Welsh Government invested £3.4 million in a National Imaging Academy to train radiologists, many newly qualified staff have been unable to find jobs within NHS Wales due to recruitment freezes and inadequate workforce planning.
This situation is compounded by outdated equipment and a shortage of modern diagnostic scanners, which hinder efforts to increase capacity.
Stakeholders warn that these systemic issues make Wales less attractive to healthcare professionals, exacerbating staffing challenges.
Macmillan: Patients Deserve Better
Kate Seymour, Head of External Affairs at Macmillan Cancer Support, described the findings as “crucial,” criticising the lack of progress in tackling the crisis in cancer waiting times. She said:
“This crucial report from Audit Wales clearly shows the failure of the Welsh Government to tackle the crisis in cancer waiting times. Their analysis demonstrates a lack of strong national leadership is impacting on waiting times, and Wales should be doing better.
“We must not forget there are real people facing agonising delays and worrying about whether they have cancer or when their treatment is going to start. People in Wales with cancer deserve better.”
The findings have sparked criticism from opposition politicians, who blamed the Welsh Government for the state of cancer services in Wales.
James Evans MS, Welsh Conservative Shadow Cabinet Secretary for Health and Social Care, said:
“Under Labour, barely half of Welsh cancer patients are receiving treatment within the target time. That cannot continue. Audit Wales are clear, throwing money at the problem will achieve nothing. Only through a change in government will we see the ‘stronger and clearer national leadership’ required to drive through the improvements that we need to see for patients.”
Darren Millar MS, Leader of the Welsh Conservatives, added:
“After 26 years of Labour Governments, the Welsh NHS is broken. Let’s be frank, patients are suffering and dying unnecessarily due to excessive waits for cancer diagnosis and treatment. The Welsh Conservatives will fix our health service and hit these targets by screening more patients to ensure earlier detection of cancer and by delivering more NHS capacity for faster treatment.”
Future Prospects
The Welsh Government has set a target of 80% of patients starting treatment within 62 days by 2026, but Audit Wales warns this is unlikely without significant reforms.
The report calls for stronger leadership, better data systems, and an urgent focus on prevention, as an estimated 40% of cancers in Wales are preventable through lifestyle changes.
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