Just half of urgently referred cancer patients are being diagnosed on time

By Tim Gunn & Sophia Lowes

In England, people with signs of cancer may receive an “urgent referral” from their GP or from their screening results. That’s the first step on a pathway that should either diagnose or rule out cancer within 28 days. This is known as the Faster Diagnosis Standard (FDS), and the NHS aims to meet it for 75% of people.* 

NHS cancer waiting times data shows that the FDS target has been met almost every month since the start of 2024. But it leaves out something important. Until today, we’ve not known how performance against the FDS target differs for those that have cancer ruled out and those that get diagnosed.

Our new FDS report, published in partnership with NHS England’s National Disease Registration Service, reveals that while the NHS is ruling out cancer effectively, it’s not diagnosing it on time.

Between April and June 2024, only half (52.3%) of people who went on to be diagnosed with cancer after an urgent referral received their diagnosis in 28 days. That’s compared to 75.1% of people getting the all clear in the same timeframe.  

The data also suggests that things have been getting worse instead of better for people with cancer. The proportion of people diagnosed on time after an urgent referral actually fell four percentage points between 2021 and 2024.

Data published by the NHS today shows little improvement in 2025. Between May to July this year, only 53.3% of people who received an urgent referral were told they have cancer on time.

Tackling delays to diagnosis

Delays to diagnosis are a key reason why so many cancer patients are waiting longer than they should to start their treatment. 

The FDS was introduced in October 2021 to support timelier diagnosis and prompt treatment, which can lead to better outcomes. This new breakdown of the data emphasises how important it is to consider people who are diagnosed with cancer separately from those who have cancer ruled out. We need more ambitious and focused targets to deliver for people getting a cancer diagnosis.

The good news is that the NHS in England is now beginning to report separate FDS performance breakdowns for those having cancer ruled out and those who are diagnosed. There are also plans to raise the overall FDS target to 80% by March 2026, taking it closer to the originally proposed target of 95%. 

Those are important steps, but targets need to be met as well as set. That’s why we’re also calling for the UK Government to implement a cancer guarantee to meet all waiting times targets by the end of this parliament. 

“The upcoming National Cancer Plan for England must include a new commitment to diagnose cancers earlier and a pledge to meet all cancer wait time targets by the end of this parliament, including the increased FDS target,” says Michelle Mitchell, our chief executive. “This will require investment in specialist staff and equipment, coupled with reform. Without these actions, things could continue to get worse instead of better.” 

Faster Diagnosis Standard performance across cancer types

The findings of our FDS analysis reflect the fact that diagnosing cancer can be more complicated than ruling it out.

A single test might be enough to show that someone with cancer symptoms doesn’t have the disease, but saying for certain that someone has cancer may mean running multiple specialist checks to find and identify it. Each of those tests needs to be planned and conducted, and its results then need to be analysed and shared. Those steps can add up to push someone over the 28-day target. 

The same complexities also help explain some of the differences in FDS performance for different cancer types. Testicular cancer referrals actually exceeded the overall FDS target between October 2021 and June 2024, with 83.2% of patients being diagnosed within 28 days. Skin cancer (74.7%) and breast cancer referrals (70.5%) saw the second and third highest proportion of people diagnosed on time.  

Other cancer types are harder to diagnose, and they may require more investigations and tests. Urological cancer referrals (such as prostate and kidney) saw the lowest performance for getting people diagnosed within 28 days, at just 29%. Referrals for sarcomas (31.4%) and head and neck cancers (34.6%) were the second and third worst performers.  

In these cases, the wait for a diagnosis can also last much longer than 28 days. 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. 

Expanding capacity

Used correctly, data like this can be a helpful tool for ensuring the NHS makes progress for people with all different types of cancer. With regular reporting on performance for individual cancer sites, health leaders can understand the specific challenges they need to address to keep making improvements. 

For instance, our report highlights where capacity issues are contributing to delays in either diagnosing cancer or ruling it out. 

We already knew that NHS endoscopy services are under extreme pressure, but it’s now clear how this is affecting the people who receive endoscopies to check for cancers like bowel cancer. Just 43.5% of people diagnosed with lower gastrointestinal cancers after an urgent referral got the news with 28 days, and performance wasn’t much better for those who had these cancers ruled out (53.8%). 

That’s yet more evidence to show how important it is that the National Cancer Plan adequately fund and equip the NHS to expand its diagnostic capacity.  

“Waiting for a cancer diagnosis can make every single day feel like forever,” says Mitchell. “It’s promising that more people are having cancer ruled out on time, helping to put their minds at ease. However, it’s unacceptable that only half of people who have cancer are being diagnosed within the target timeframe. The UK Government needs to act.” 

*NHS England’s Faster Diagnosis Standard target is that 75% of people should be diagnosed or have cancer ruled out within 28 days of an urgent referral. This includes GP urgent suspected cancer referrals, breast symptomatic referrals and urgent screening referrals.