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The Progressive Policy Think Tank

It could take until 2033 to clear cancer treatment backlog in England, finds IPPR and CF

Pandemic toll on cancer services revealed in new analysis, with an estimated 19,500 missing cancer diagnoses due to missed referrals

Ambitious cancer services recovery plan needed to clear backlog and improve services and survival rates beyond 2019 level, urges think tank

New research from IPPR and CF – the health consultancy and data analytics company – has found that even if stretched hospitals can maintain activity levels 5 per cent above pre-pandemic levels, it will still take until 2033 to clear the cancer treatment ‘missing patients backlog’ caused by the pandemic. However, if activity levels can be increased further and maintained at 15 per cent above pre-pandemic levels, backlogs across the cancer care pathway could be cleared by next year.

While the number of people who need cancer treatment has not changed, the research shows that during the pandemic:

·     369,000 fewer people than expected were referred to a specialist for a suspected new cancer diagnosis (15 per cent lower than expected),

·     187,000 fewer episodes of chemotherapy (7 per cent lower than expected),

·     and 15,000 fewer episodes of radiotherapy were performed (13 per cent lower than expected).

IPPR and CF analysis shows the backlog has been starkest in diagnostics, where the pandemic has led to 37 per cent fewer endoscopies, 25 per cent fewer MRI scans and 10 per cent fewer CT scans being performed than expected.

IPPR warns that due to the ‘missing patient backlog’ there will be thousands of people for whom it will now be too late to cure their cancer. The think tank recently estimated that the number of cancers diagnosed while they are still highly curable (stage one and two) fell from 44 per cent before to pandemic to 41 per cent last year.

Assuming that nine in 10 of these ‘missing’ patients eventually presents to cancer services for treatment (including palliative treatment), the analysis suggests the backlog in chemotherapy and radiotherapy could take until 2028 and 2033 respectively.

However, if cancer care activity levels can be increased, then the backlog can be cleared much more quickly, and many cancer-related deaths can be prevented. Increasing activity levels to 115 per cent of pre-pandemic levels would clear the backlog across most of the cancer care pathway by next year. The researchers argue that this uplift in cancer care activity could only be achieved with new policy to increase the cancer workforce and investment in diagnostic equipment beyond the new funding announced this month.

Recovery alone is not enough

IPPR makes the case that returning to pre-pandemic standards of cancer care should not be the limit of ministers’ ambition. Pre-pandemic the UK had poor cancer outcomes compared to similar countries, the lowest numbers of CT and MRI scanners per head in the OECD and workforce shortages across all cancer-related services. Cuts to public health services across the country have also played a role in the UK’s poor population health and cancer survival rates, according to IPPR.

To ‘build back better’ in cancer care, the think tank calls on the government to enact a three-part cancer pledge to:

·     Build capacity – A workforce plan to support and reward healthcare workers and a revision of pension tax rules to increase the number of oncology consultants will immediately boost the size of the cancer workforce. There must also be investment to bring in more diagnostic machines as well as establishing more mobile and community diagnostic units. Expanding MRI scan capacity by 10 per cent could clear the full MRI backlog in the NHS by 2024 instead of 2040.

·     Harness innovation – Improving the uptake of innovations – including new technologies and genomics - and re-thinking service design will both improve survival outcomes and improve productivity. Without innovation, it could take several decades to clear the backlogs in diagnostic endoscopy. A new transformation fund will help to get diagnostic innovations into practice.

·     Better prevent - The government should scale up its ambitions on prevention to improve cancer outcomes and reduce demand on cancer services. This should include a new tobacco levy and a fruit and vegetable subsidy funded by a junk food tax.

Dr Parth Patel, IPPR research fellow and an NHS Doctor, said:

“The pandemic has severely disrupted cancer services in England, undoing years of progress in improving cancer survival rates. Now the health service faces an enormous backlog of care that threatens to disrupt services for well over a decade. We know every delay poses risks to patients' chances of survival.

“Clearing the cancer care backlog before the next general election looks unlikely with the way the NHS is currently resourced, staffed and organised. The funding announced this month is just about enough to keep the health service afloat, but does not provide the funds needed to bring down pandemic backlogs as quickly as possible or transform service quality. The government has pledged to improve cancer survival in this country, which lags far behind most similar countries. That will take investment in diagnostic kit, immediate and long-term plans to expand the workforce and much bolder policy on prevention.”

Chris Thomas, IPPR senior research fellow, said:

“The impact of the pandemic on cancer services cannot be disassociated from the political and policy decisions that came before it. Years of austerity ripped the resilience out of cancer care, limiting our diagnostic capacity and reducing our ability to prevent people getting cancer in the first place. The government must not repeat the same mistakes and try to run an already burnt out NHS even hotter – with nothing like the right capacity, tools and resource.

“Returning cancer care to its pre-pandemic state is not sufficiently ambitious and will not deliver the rapidly improvement in cancer outcomes we need. The government must live up to their ‘build back better’ rhetoric and not just return us to the stagnating cancer survival rates seen pre-pandemic.”


Dr Parth Patel and Chris Thomas are available for interview


David Wastell, Head of News and Communications: 07921 403651 [email protected]

Robin Harvey, Digital and Media Officer: 07779 204798 [email protected]


·     The IPPR paper, Building back cancer services in England by Parth Patel and Chris Thomas, will be published at 0001 on Friday 24 September. It will be available for download at:

·     Advance copies of the report are available under embargo on request

·     Estimates on how long it will take to address pandemic-related backlogs across the cancer care pathway

Projected future activity





‘2 week wait’ referrals for suspected cancer


January 2023

April 2022


CT scans


May 2022

December 2021

MRI scans


September 2024

April 2023



May 2026

February 2024


Chemotherapy treatment episodes


August 2022

February 2022

Radiotherapy treatment episodes


June 2023

July 2022

Source: CF 2021

·     Methodology - This model has assumed that 75 per cent of the ‘missing patients’ will eventually present to cancer services for a referral or diagnostic investigation, and that 90 per cent of those who have missed cancer treatment will eventually present for some form of a cancer therapy (including palliative cancer therapy). The model also assumed demographic change will lead to a 4 per cent increase in demand on services. Based on these assumptions, we have modelled how long it will take to address ‘missing patient backlogs’ across the cancer care pathway.

·     IPPR is the UK’s pre-eminent progressive think tank. With more than 40 staff in offices in London, Manchester, Newcastle and Edinburgh, IPPR is Britain’s only national think tank with a truly national presence.