Case study: Improving performance against national standards

North East London Cancer Alliance (NELCA) led a whole-system improvement programme to help people get faster cancer diagnosis and treatment, leading to the best results in the country against the national cancer standards.

The three standards are:

• Faster Diagnosis Standard: a diagnosis or ruling out of cancer within 28 days of referral (set at 75%)
• 31-day treatment standard: commence treatment within 31 days of a decision to treat for all cancer patients (set at 96%)
• 62-day treatment standard: commence treatment within 62 days of being referred or consultant upgrade (set at 85%)

Working with Barts Health, Homerton Healthcare, Barking, Havering and Redbridge University Hospitals, primary care and community services, we focused on reducing delays and improving the reliability of the cancer pathway.

We introduced Best Practice Timed Pathways across tumour sites, supported by stronger performance tracking and collaborative working, so delays were identified and acted on quickly.

At the same time, we increased diagnostic capacity through improved use of imaging, better scheduling and expanded use of community diagnostic services.

Across our Trusts, we introduced innovations in cancer care at scale, including:

• Artificial Intelligence-enabled diagnostic pathways, designed to identify abnormal chest X-rays quickly and prioritise urgent cases. These tools have reduced the time to review significant findings from three weeks to just three days
• Community and diagnostic capacity expansion, including projects such as additional imaging services and diagnostic centres that increase access to tests and reduce delays across pathways.
• Colon Capsule Endoscopy – offering a less invasive diagnostic test for suitable lower gastrointestinal referrals, helping streamline investigation pathways.
• Cytosponge Programme – enabling earlier detection of oesophageal cancer through a minimally invasive diagnostic test.
• Teledermatology – supporting faster assessment and triage of suspected skin cancer referrals using digital imaging.
• MRI Optimisation – improving scan quality and consistency across providers to reduce repeat imaging and delays.
• Signatera - evaluating the real-world impact in an NHS setting of circulating tumour DNA (ctDNA) testing using Signatera™ to inform follow-on treatment decisions of early stage urothelial and gastro-intestinal cancer patients.

The work has been clinically led and delivered through strong partnership working and shared accountability across organisations. Investment in workforce and joint planning has also helped create consistent standards across all providers so patients receive timely access to diagnosis and treatment wherever they enter the system.

NELCA has delivered sustained high performance against the national cancer waiting time standards despite rising demand, covering an area with some of the most diverse communities in England, and in areas of high deprivation.

The latest figures for 2025-2026 show that North East London ranked 1st nationally for Faster Diagnosis Standard and 2nd nationally for 62-day performance.

In the first quarter of this year, North East London Cancer Alliance was ranked number one nationally for the 62-day combined standard, achieving 75.5%, demonstrating strong pathway management from referral through to treatment.

During Q2, North East London was the best performing ICB in London across all three standards, including the 28-day Faster Diagnosis Standard. In Q3, Faster Diagnosis Standard performance reached 82.2%, again ranking first in London.

NELCA is currently the only Cancer Alliance without any provider in the lowest quartile for any cancer standard, demonstrating consistent improvement across the system.

Provider performance has improved significantly, including a 14-percentage-point increase in 62-day performance at Barts Health, with further gains at Homerton and BHRUT.

For patients, this has meant quicker diagnosis or reassurance, shorter waits to start treatment and a more consistent experience across north east London.

Investment in workforce growth, technology, diagnostic capacity and pathway redesign has been essential to sustaining these improvements. Across the system, teams have worked together to address historic backlogs, rising referrals and operational pressures while maintaining patient safety and experience.

Redesigned pathways, shared performance oversight and collaborative working are now embedded across the system to maintain consistent standards. We will continue to reduce inequalities in access, diagnosis and treatment, particularly for communities that experience poorer outcomes.

We will do this through expanding the use of proven innovation, including AI-supported diagnostics and community-based testing, to increase capacity and support earlier diagnosis at scale. Workforce development remains a priority to ensure services can respond safely to increasing referrals.

Some of our innovative projects, which will help sustain future improvement in cancer care and outcomes, include:

• A 24/7 chatbot for colorectal patients to help them to prepare for their colonoscopy
• Launch of a virtual hospital tour of St Bartholomew’s Hospital to reassure patients ahead of their appointments
• Increased use of clinical animations in multiple languages to help explain different cancer tests
• Online training modules for MDT coordinators and trackers
• Use of HIPEC – a heated chemotherapy solution involving a highly skilled and complex process which takes 7-8 hours of continuous surgery - to treat not only colorectal cancer patients but also ovarian cancer patients, increasing survival rates and improving quality of life

We are also sharing learning across London and nationally so that other systems can adopt similar approaches to reducing variation and improving cancer waiting times.

By maintaining strong partnership working and consistent standards, we aim to continue delivering faster diagnosis, earlier treatment and better outcomes for the population of north east London.