It’s four years since cancer waiting times targets have been hit across Scotland. Four years of people waiting too long to start treatment. Four years of cancer charities like Macmillan criticising the missed targets and calling for action.

For the NHS it must feel like four years of being under-siege. Four years of trying to do more with less and being criticised by organisations and people who they must feel can’t possibly grasp how difficult a problem this is to solve.

The cycle goes like this: waiting times targets are missed, the critics criticise, the NHS or Scottish Government respond, the media covers the story. The same thing happens the next quarter and the next and the next.

It can’t go on like this. Something needs to change. 

People with cancer deserve to begin treatment as quickly as possible. Urgent action is needed to understand what’s going wrong and how we can create a system that works.

Severe delays can affect someone’s chances of survival and can impact on their ability to recover. Even when delays are only a few days or weeks and unlikely to impact on how well someone will respond to treatment, they still matter.

Waiting for treatment can be extremely distressing.  Macmillan research shows that nearly two thirds (64%) of people recently diagnosed with cancer in England have experienced feelings of anxiety, fear or depression whilst waiting for their treatment to start. There’s no reason to think people waiting to start treatment in Scotland are any less likely to experience the same distress.

Although we are seeing a rising tide of cancer diagnoses in Scotland and across the world – a measure largely down to an ageing population, it is not clear that we can just say that growing numbers of diagnoses are overwhelming our health services.

A look at the Information Services Division reports over the past few years shows there are months where fewer cases are diagnosed and the target is missed and months where more people are referred for tests and the target is hit. There are also some individual health boards hitting the targets while other consistently miss them.

Some health boards explain why they’ve missed targets, for example citing a lack of surgeons or radiotherapy staff being off sick. Others offer no explanation.

At Macmillan we think a starting point to understanding the problem is for the Scottish Government to make it compulsory for all boards to explain why they missed the target. And then we need to get the right people together to find a long-lasting solution.

The truth is that the missed waiting times targets are a symptom of a much wider problem. And it’s not the only one. Recently published research showed there is a cancer survival gap between those in the most and least deprived areas.

The most recently published data showing the stage at which cancer is diagnosed, reveals only 25% of people were diagnosed at the earliest stage (stage one), while 25% are diagnosed at stage four, the most advanced stage.

With so many people being referred for cancer tests when their cancer is already so advanced, it’s even more important that they are diagnosed and begin treatment as quickly as possible.

The truth is the NHS is facing a huge challenge. More people than ever before are getting cancer. That means more people are waiting for tests and treatments. At the same time more people are surviving cancer.  Currently there are 220,000 people living with cancer in Scotland and this is expected to reach almost 400,000 by 2030.

While better survival rates are very good news, the NHS is struggling to support the growing number of people who need help. Finishing treatment doesn’t mean someone has fully recovered. Many people will have physical, emotional and even financial issues as a result – problems that can last for years after treatment ends.

Let’s be honest about the challenge we’re facing. We simply cannot continue to support people with cancer in the same way we always have, with no additional resource, and somehow expect the NHS to be able to cope with the vast increase in need.

It’s time to think differently. To find new ways of achieving more. To move away from traditional approaches to care and support that are no longer fit for purpose.

Macmillan wants to help the NHS and Scottish Government do this. There are many other charities and groups who can also bring expertise and new ideas. The third sector are a valuable resource and we’re used to thinking differently and making a big impact with limited resources.

We need a national debate.  What we absolutely cannot have is another four years of missed waiting times targets.  It’s time for action.

Janice Preston, Head of Macmillan in Scotland