The National Cancer Plan for England will struggle to achieve its 2029 waiting time targets and aim of bringing care into the 21st century without urgently reforming Multi-Disciplinary Team (MDT) working, a new report by The King's Fund has found.
The report represents one of the first pieces of analysis into how to deliver on the National Cancer Plan for England's aims since its publication in February. It stems from a roundtable convened by The King's Fund with clinicians, policy makers, researchers and patient advocates to explore what innovation readiness looks like in practice, and how to translate national ambition into real change for people with cancer.
Embracing innovation was a key theme of the National Cancer Plan for England with its bold ambitions: to modernise cancer services, make the most of scientific advances, and close the gap between England’s outcomes and those of the best‑performing countries.
One of the key themes of the report is that the NHS is not harnessing the full potential of innovation in cancer care due to limited workforce capacity, with clinical staff lacking the time and headspace to adopt and iterate new ways of working. There is currently a national shortfall in consultant radiologists, with all departments relying on insourcing/outsourcing to cover reporting, with a projected 39% shortfall by 2029 if trends persist. The same is true for oncology consultants where there is an expected shortfall of 19% by 2029.
The government has said that its approach to tackling these shortfalls in the 10 Year Workforce Plan will move focus away from 'ever more headcount' towards upskilling of existing staff but it is unclear if this alone will free up the time needed for the workforce to engage properly with innovation.
The King's Fund's recommendations place urgent reform of MDT meetings as a key part of the solution. In the think tank's analysis, it heard that the increasing volume of patients means the length of MDT meetings has ballooned unsustainably. One radiologist described spending hours each week preparing images in his caseload to then ‘reshow’ in three-hour long MDT meetings. MDT working that brings together different clinical professionals can be incredibly valuable, but it must be targeted where it can do most good for patients.
One solution the report recommends is a standardised triage model, where only clinically complex or uncertain cases are discussed in streamlined MDT meetings, supported by full MDT oversight for routine cases. This would directly reduce workload and release specialist time for diagnosis, reporting and pathway improvement, while maintaining quality. This approach should be considered in the government's review of MDT working being carried out by the Royal College of Radiologists which has committed to issue new guidance in spring 2027 for trusts.
Niamh Buckingham, co-author of the long read and Policy Adviser at The King's Fund, said: “The National Cancer Plan for England sets out a series of bold ambitions and if realised they would undoubtedly save and improve the lives of thousands of people. Making these aims achievable, especially within the tight timeframes ministers have set out, will require the NHS to move rapidly to embrace the innovations needed to bring cancer care into the 21st century.
“From our analysis, the historic blockers to harnessing innovation remain in place. One of the biggest constraints is the lack of headspace among staff to properly engage with new developments due to wider workforce pressures and a significant increase in patient numbers. If staff can only think of moving from one case to the next there is never the time available to them that would allow for the testing and adoption of new ways of working and building the skills needed for delivering modernised care.
“A way to rectify this would be through the urgent reform of MDT meetings. MDT working that brings together different clinical professionals can be incredibly valuable, but it must be targeted where it can do most good for patients. The present set up of discussing every case in their current format has become unsustainable. Instead, system leaders should look to adopt a streamlined model, with MDT oversight of all patients and dedicated time in MDT meetings of cases where discussion is required. This approach needs to be considered by the government’s ongoing review of MDT working.
“By significantly freeing up clinical and diagnostic capacity in this way, cancer staff can turn attention to the spread and scale of innovations needed to meet the National Cancer Plan's targets and, crucially, deliver improvements in patient outcomes.”
