Transforming urgent cancer care

Cheshire and Merseyside Cancer Alliance

Urgent Cancer Care (UCC) is a critical yet often under-recognised aspect of the cancer journey, marked by fragmented accountability across the healthcare system.

Although cancer accounts for 5% of UK emergency department (ED) attendances, patients are four times more likely to be admitted than non-cancer patients. Half of these admissions last under 3 days, revealing missed opportunities for same-day care. Presentations range from suspected new cancers (19%), treatment complications (14-20%), to issues related to comorbidities and end-of-life care.

Despite national efforts to improve both Urgent and Emergency Care (UEC) and cancer outcomes, their separation has led to gaps in UCC provision: limited ED alternatives, underdeveloped Acute Oncology services, poor governance for malignancy of unknown origin, and fragmented communication between care teams.

In response, Cheshire and Merseyside Cancer Alliance (CMCA) became the UK’s first to prioritise UCC, developing and aligning its strategy with the NHS UEC recovery plan and the Darzi report. A unique collaboration was formed across oncology, UEC, and community services, guided by patient stories and data.

Five transformational projects were launched: Acute Oncology, Cancer Triage Hotline, Metastatic Spinal Cord Compression (MSCC), Emergency Brain Pathways, and Same-Day Emergency Care (SDEC). These are underpinned by four strategic themes: training and education, integrated care, governance, and innovation.

Key enablers to the success of the programme constitute a multi-system partnership with robust governance, accountability, and a combined commitment to improvement.

Strategic objectives include increasing cancer referrals to SDEC and Urgent Community Response (UCR), reducing ED visits, avoiding short-stay admissions, and implementing service standards and governance frameworks. Innovative workstreams include implementing new software to align with NHS 111 and clinical assessment services, new ambulatory MSCC pathways, and cancer nurse placement within UCR.

Early results have shown a 7% weekday and 12.5% weekend reduction in ED referrals, a survival increase from 30 days to seven months for MSCC patients, and a 68% rise in monthly SDEC referrals. Standardised pathways for emergency brain and MUO presentations improved diagnostic speed and patient experience.

Although the full impact will not be seen before 2028, these models are now informing national guidance and are transferable across the NHS, offering a scalable solution for improving urgent cancer care nationally.