Staff shortages, broken equipment, and rising referrals have been blamed as Scotland experienced its worst year on record for cancer waiting times.

Campaigners warned that frontline staff are "working in crisis conditions" as statistics revealed that the NHS in Scotland has now missed the 31-day target for patients starting cancer treatment in five out of the past six quarters.

The 62-day target - the maximum time patients should wait between an urgent referral for cancer tests and starting treatment - has not been met since 2012.


Kate Seymour, head of advocacy at Macmillan Cancer Support, said Scotland's cancer waiting times saw "the worst year on record in 2023 and are still worsening".

She said: "Hundreds of people each month continue to face anxiously long waits for cancer treatment and the cancer workforce in Scotland is exhausted, working in crisis conditions. It’s unsustainable.

“In September 2023’s Programme for Government, the First Minister committed the Health Secretary to deliver ‘demonstrable improvement’ in cancer waiting times by April 2024.

"Today's figures show this will clearly not be achieved. This can’t go on.

"It is crucial that the Scottish Government takes action to ensure their own targets can be met and people living with cancer can get the care they need and deserve, now and in the future.”

The Herald: The 31-day standard was achieved in only one quarter last yearThe 31-day standard was achieved in only one quarter last year (Image: PHS)

In 2023 almost 1,500 people with cancer in Scotland waited more than a month to start treatment following the clinical decision to do so, and just over 5,000 waited more than two months to start treatment following an urgent referral for suspected cancer.

Overall, 94.1% of patients who started cancer treatment between October and December last year had done so within 31 days of a decision to treat, against a target of 95%.

On the 62-day standard, the figure was 71.1%.

However, performance is particularly concerning for certain cancer types, such as urological cancer, with fewer than half (46%) of these patients starting treatment within two months of an urgent referral for tests last year.

Health boards responding to Public Health Scotland described a litany of problems ranging from faulty scanners resulting in imaging backlogs to consultant vacancies and bed shortages.

The Herald: Broken or faulty scanning equipment was a recurrent complaint from boardsBroken or faulty scanning equipment was a recurrent complaint from boards (Image: PA)

NHS Ayrshire and Arran reported that vacancies in pathology and radiology and "MRI scanner breakdowns" were leading to backlogs and delays in cancer patients being diagnosed, with bed capacity also "very challenged" - though cancer patients continue to be prioritised for admission and surgery.

NHS Borders said it is struggling to meet demand using its single CT scanner and has submitted a business case for a second machine.

In Fife, a "sustained increase" in patients being urgently referred with a suspicion of cancer is "impacting prostate and colorectal pathways in particular", while a breakdown of its PET scanner has "created long delays within the lung pathway".

NHS Forth Valley said it is experiencing "workforce challenges across all specialties" along with equipment issues, including a "transient failure of one of our scanners" and huge demand on its two CT scanners. It is also seeking a third machine.

NHS Grampian describes "staff vacancies in multiple areas" as well as issues with "bed capacity, theatre capacity, and delayed discharges" holding up treatment.

Along with a high levels of cancer referrals, it also noted that its A&E departments are seeing "continued high numbers of emergency presentations" among patients with cancer.

Tayside said "equipment faults requiring repair and downtime" had affected its PET-CT scanner, while both Highland and Lothian said they are struggling to fill radiology vacancies in particular.

In Greater Glasgow and Clyde - Scotland's largest health board - "significant pressure on pre-diagnosis steps, such as outpatient appointments and diagnostic procedures" were blamed for waiting times difficulties, along with higher numbers of cancer referrals compared to the pre-Covid period.

Across Scotland as a whole, cancer referral rates have increased by 17% between December 2019 and December 2023, from 82 to 97 eligible referrals per 100,000 population.

However, these figures only cover people referred for tests who are subsequently diagnosed with cancer.

It does not include, for example, people sent for investigations as a result of worrying symptoms or a suspected cancer picked up during routine screening where it turned out to be a false alarm.

The Herald: Several boards reported issues with bed and theatre capacity, but say cancer patients remain a prioritySeveral boards reported issues with bed and theatre capacity, but say cancer patients remain a priority (Image: PA)

Cancer incidence in Scotland is projected to rise by 22% by 2040, largely driven by an ageing population, meaning that demand for diagnosis and treatment will inevitably grow.

Dr Sandesh Gulhane, a GP and shadow health secretary for the Scottish Conservatives, said Scotland faces "a terrifying ticking timebomb of cancer cases" as he urged Scotland's new Health Secretary, Neil Gray, to "get a grip on cancer waiting times".

He added: “It should be a source of shame for [the SNP] that well over a quarter of cancer patients are waiting over two months to begin treatment.

“Everyone knows someone who has been diagnosed with this awful disease and how critical it is to start treatment quickly to boost their chances of survival."

Scottish Labour health spokeswoman, Dame Jackie Baillie, said: “We know the pandemic led to an increase of undiagnosed cancer cases but the government’s promises on recovery in cancer services are meaningless as far too many patients are not seen within the performance standard."

Health Secretary Neil Gray said that cancer "remains a national priority for the NHS and Scottish Government".

He added: "We're treating more patients on 62 and 31-day pathways than before the Covid-19 pandemic - over 700 more and over 400 more respectively in this latest quarter.

"The 31-day standard was narrowly missed this quarter, and the median wait for treatment was just five days.

"Nevertheless, we remain absolutely committed to reducing waiting times and a further £10 million of funding has been given in 2023-24 to support this improvement."