Supporting cancer performance improvements at the Royal Free London
The Royal Free London NHS Foundation Trust (RFL) met the 62-day standard target for cancer patients for the first time in January 2026. They were one of only eight trusts in the country to achieve this and continued to make significant moves forward in their overall cancer waiting times performance. It is a step change from January 2025 when only 55% of patients started their treatment on time.
Over the last two years North Central London Cancer Alliance supported this improvement challenge by providing two cancer programme improvement managers, embedded at the trust to work alongside the staff teams. They played a key role in collaborating with operational and clinical team members across the Royal Free London group to reduce cancer waiting times. They supported the trust in meeting NHS England performance targets, as well as improving patient outcomes and patient experience across cancer services.
Mapping out cancer pathways and examining the data dashboards to identify the backlogs were critical in obtaining better results.
Examples of key initiatives:
Renal service
A six-week wait for a first appointment has been reduced to one week.
Consultant appointments were reduced and nurses see appropriate patients instead.
A business case was made for an additional advanced nurse practitioner role in this clinic.
Non-cancer results are now given by letter, instead of by appointment.
Finding additional capacity reduced the waiting time for renal biopsies from six to four weeks.
Future plans include:
improving biopsy recovery time from six to four hours. This will allow more than one patient to be seen on each bed per day.
Introduction of a nurse-led discharge process so that there is no need to wait for a doctor to become available to sign off a patient leaving hospital.
Colorectal imaging and endoscopy
Targeted interventions at North Middlesex University Hospital (part of the Royal Free London group) led to its highest ever 28-day Faster Diagnosis Standard for colorectal cancer diagnosis performance – 71.3% in February 2026. The biggest pathway bottleneck to making improvements was capacity in the imaging and endoscopy clinics.
- A new protocol was implemented to ensure that at the earliest possible point, a patient is told about either a diagnosis or exclusion of cancer.
- This reduced the number of patients who are unnecessarily brought back for follow up clinic appointments. This can add days to the process and affects capacity and performance.
- Patients who have an endoscopy, and no cancer is found, are informed of that by the endoscopist on the day. They are therefore removed from the cancer pathway on the same day.
- For patients whose endoscopy shows a suspected cancer, they are informed on the day and they have a conversation with a clinical nurse specialist in the unit
This allows more patients to receive their diagnosis within 28 days of being referred – which contributes to meeting the Faster Diagnosis Standard (FDS).
Introducing the straight to test pathway
An NCL Cancer Alliance embedded manager also supported the team to implement the colorectal straight to test pathway at NMUH. This meant that there was a standardised approach across the Royal Free London for diagnostic investigation requests based on presenting symptoms, which reduced unwarranted variation.
An overreliance on CT colonography (CTC) instead of colonoscopy, which is the gold standard diagnostic investigation for patients on a colorectal cancer pathway, increased the pressure on an already stretched radiology service.
Some patients were waiting up to five weeks for a CTC scan, meaning delays to cancer diagnosis or confirmation of no cancer.
A task and finish group of both clinical and operational colleagues across the trust, focused on strengthening clinically led counselling to promote colonoscopy as the gold standard investigation.