Delivering the National Cancer Plan

Key points

• Innovation is already reshaping cancer services in England, from targeted lung screening and AI-assisted imaging, to genomic testing, digital pathology and rapid diagnostic pathways. But spread and scale remain uneven. 

• System leaders and clinicians alike identify common blockers to innovation readiness: workforce capacity and headspace; variable digital infrastructure and data interoperability; complex regulatory and adoption pathways; and persistent inequalities in access. They also emphasise key accelerators: the leadership role of Cancer Alliances; increased rollout of clinical trials; and patient and public involvement. 

• National programmes provide a platform for innovation that can be leveraged: rapid diagnostic centres for people with non‑specific symptoms; community diagnostic centres expanding diagnostic capacity closer to home; modernised cancer waiting times standards; an expanding Genomic Medicine Service; and the MHRA relaunched its Innovative Licensing and Access Pathway, which facilitates more efficient and joined up routes for rapid access. 

• Systems must shift adoption of innovation from pilots and local clusters of excellence to national spread in alignment with the National Cancer Plan ambitions on earlier diagnosis and survival, the NHS 10 Year Health Plan’s shift from analogue to digital and the NHS Long Term Plan's faster diagnosis commitments. 

Introduction

The government’s National Cancer Plan for England sets out a bold ambition: 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. At its core, the plan aims to bring cancer care firmly into the 21st century – expanding screening, diagnosing earlier, tackling unwarranted variation and widening access to innovation. 

At this pivotal moment, leaders across the health and care system face the challenge of building cancer services that are not only fit for today, but ready to adopt the next wave of innovation. 

In November 2025, The King’s Fund convened a roundtable of clinical, policy, research and patient advocacy voices to explore what innovation readiness looks like in practice, and how to translate national ambition into real change for people with cancer. 

This long read sets out what we heard and suggests changes in policy and practices for commissioners, providers and clinicians to take. With the cancer plan signalling bold intent for the potential of innovation, our aim is to support policy-makers and system leaders to make the most of this opportunity for the benefit of patients. 

Why innovation readiness matters now

Cancer services are under sustained pressure: demand continues to rise, the case mix is complex and workforce shortages persist, especially across radiology, cellular pathology and specialist nursing. Clinicians repeatedly describe the lack of headspace to adopt and iterate new ways of working, even when clinical evidence is strong and consensus and motivation for change is high.

Early diagnosis and treatment are critical in extending the lives of those living with cancer and improving their quality of life. But national performance standards for diagnosis and waiting times for cancer care have not been met for several years. The government has committed to get back to meeting the NHS constitutional standards by March 2029:

• 80% of patients getting a diagnosis or all clear within 28 days of an urgent suspected cancer referral

• 96% of patients starting treatment within 31 days of a decision to treat

• 85% of patients starting treatment within 62 days of referral.

With just over three years to close the gap, this ambition will prove exceptionally challenging.

Innovation has always been central to progress in cancer. Advances in surgery, radiotherapy, chemotherapy, immunotherapy and targeted medicines have contributed to improved survival rates over decades. In recent years, however, the pace, complexity and breadth of innovation have accelerated at a time when demand is rising and there are huge operational pressures. Adopting new diagnostics and treatments can require extra clinical input, pathway redesign and new data processes, so they do not initially free up time for clinicians. As a result, prioritising innovation can feel at odds with the strong national direction to restore performance standards, which demands urgent capacity gains. Acknowledging and managing this tension is essential if cancer services are to support the innovations of tomorrow while also meeting the operational pressures of today. 

Overall, we heard that innovation is coming thick and fast, but without adequate planning and capacity building, there is the risk that proven innovations stall or spread unevenly, entrenching variation and inequity in access to care. 

What are the ambitions for innovation in the new National Cancer Plan? 

In February 2026, the government published the first national cancer strategy in 10 years, shaped by more than 11,000 responses to its call for evidence from patients, carers and the wider cancer community. The plan sets out a clear ambition to improve five‑year survival and bring outcomes closer to international peers. Central to this is ending the postcode lottery in access to timely diagnosis, cutting‑edge treatments and new technologies. 

A major strand of the plan focuses on scaling innovation. This includes expanding genetic and genomic testing to identify cancers earlier, widening access to AI‑supported imaging and robotic technology, and applying emerging tools such as circulating tumour DNA and liquid biopsy tests across more tumour types. These developments are intended to make personalised and earlier-stage treatment a reality for far more patients. 

The plan also emphasises reducing inequalities and creating a more digital, personalised service. Commitments include strengthening access to clinical trials, improving provision in rural and coastal areas and using the NHS App to give patients clearer information and better visibility of research opportunities. Expanding community diagnostic centres to operate for longer hours aims to boost diagnostic capacity and shift more care closer to home. 

Importantly, the plan recognises the conditions required for innovation to succeed. It reaffirms the central role of Cancer Alliances in translating national ambitions into pathway-level improvement, and highlights the need for a resilient workforce, modern equipment and coordinated capital investment. Partnership across the system, including the research sector, charities and industry, is presented as essential to sustained progress. 

Like the 10 Year Health Plan, the cancer plan backs data, AI, robotics and genomics to deliver considerable productivity savings. But alongside this promise sits a familiar challenge – NHS readiness. As we heard repeatedly in our roundtable, scientific advances are moving faster than service capacity. This tension between the pace of innovation and operational reality is acknowledged in the plan. Delivering its ambitions will require disciplined implementation and investment in the fundamentals so that new technologies can be harnessed to their full potential. 

Where is innovation already happening in cancer services? 

Medicines continue to play a crucial role in improving cancer outcomes, but innovation readiness involves more than adopting new drugs. It means having the right diagnostics, clinical pathways, data and digital tools, genomics capability, workforce roles and trial infrastructure in place so that new developments, whether clinical or technological, can be used safely and effectively. 

Across the country, Cancer Alliances, commissioners and providers are already taking steps in this direction. They are expanding diagnostic capacity through rapid and community diagnostic centres, simplifying and standardising genomics consent and reporting, and building clinical trial ‘launchpads’ so more patients can access cutting-edge trials closer to home. Together, these efforts show where innovation is already happening in cancer services. 

Rapid diagnostic centres (RDCs) 

RDCs provide a co-ordinated, one-stop route for people with concerning but non-specific symptoms for example unexplained weight loss, abdominal pain or fatigue. RDCs ‘bundle’ diagnostic tests together, reducing unnecessary waits and visits. Evaluations of this approach show it can be highly effective in identifying cancers and serious benign conditions faster. 

Community diagnostic centres (CDCs) 

CDCs bring imaging, endoscopy and other diagnostic tests into community locations such as shopping centres, university campuses and sports grounds. They bring care closer to home, expanding access to patients, and reducing pressure on other parts of the system. As of the end of March 2025, 14.7 million tests had been carried out since the programme started in July 2021. The aim is for all CDCs to run out-of-hours services, 12 hours a day, 7 days a week, and deliver same-day tests where possible. Integrating CDC slots with ‘best practice timed diagnostic pathways’ helps to shorten diagnosis pathways, reduce variation, improve experience of care, and meet the faster diagnosis standard. 

Genomic Medicine Service  

Genomic testing can accelerate diagnosis, guide targeted treatments and connect patients to relevant clinical trials. The Genomic Medicine Service is a national service that standardises access to genomic testing through genomic laboratory hubs and a national genomic test directory with agreed turnaround times. Progress so far includes a major increase in genomic tests across cancer, improved equitable access to personalised care and increased clinical trial matching. Workforce readiness, particularly for bioinformatics and biomedical scientists, will be critical for making this testing and reporting mainstream, and significant upskilling, particularly in the practical application of genomic medicine, will be required. 

Cancer Vaccine Launch Pad  

The Cancer Vaccine Launch Pad is a national platform matching eligible patients to join a personalised mRNA vaccine or other immunotherapy clinical trial. The model aims to provide up to 10,000 patients with personalised cancer treatments by 2030, but this will require targeted investment, pathology and genomics readiness and operational planning. 

Innovative Licensing and Access Pathway  

The Innovative Licensing and Access Pathway is a relaunched end-to-end pathway that brings the MHRA (the medicines and health technology regulator), NICE (which assesses medicines and health technology) and the NHS together earlier to help promising medicines reach patients faster. Products that qualify get an Innovation Passport and a joint Target Development Profile – a plan that aligns evidence needs and system preparedness before launch. This joined up route offers a clearer, streamlined and pragmatic approach but more can be done to align regulatory processes for innovative technology products with ‘traditional’ health technology products. 

A common thread across these examples is that innovation is taking root where core enabling conditions already exist: national leadership with clear mandates, dedicated infrastructure and workforce capacity, defined data and reporting standards, and early alignment across regulatory, commissioning and provider functions. These enablers align with the themes raised in the roundtable: that innovation spreads most successfully when systems create the time, clarity and co-ordination needed for change. 

Cross-cutting themes from the discussion 

Stakeholders at our roundtable made a compelling case for building innovation capability into the fabric of cancer services – not just for pilot sites, but across pathways and geographies. Participants were candid about both the promise of innovation in cancer care and the practical implications for systems. The following crosscutting themes stood out: workforce capacity, digital infrastructure and data sharing, regulatory pathways, commissioning and adoption, and expanding access. 

Workforce capacity 

Workforce capacity and headspace is considered the biggest constraint on innovation. A persistent shortage of radiologists and pathologists, rising patient volumes and treatment complexity, and overstretched nursing teams mean innovation is often done on the side rather than through organised change. 

Even with investment in capital and equipment, capacity cannot increase until staffing shortfalls are met. For example, radiology departments may not be able to staff an increase in scanners at present. Similarly, CDCs have delivered millions of tests, yet rely on radiographers, radiologists and endoscopists to translate capacity into timely results. 

However, while the government acknowledges that the oncology workforce needs to grow, it is clear ‘this growth will not be at the unsustainable rate implied by the 2023 Long Term Workforce Plan’. It has said that that the forthcoming 10 Year Workforce Plan will move beyond ‘ever more headcount’ to developing a workforce with the right ‘skills, education, training, motivation, permission, support and equipment’ to deliver modernised care. While upskilling of the workforce is welcome and necessary, it remains to be seen whether this approach will free up sufficient time for the workforce to engage with development. 

There was broad agreement at our roundtable on the need for protected time and redesigned processes that free up capacity to test and adopt new ways of working and build skills in genomic medicine. This includes more clinical time to be dedicated to research, especially in under-represented profession such as nurses. Protected time would have a secondary benefit of boosting professional development and morale. 

Linked to workforce capacity is reform of multi-disciplinary team (MDT) working. MDT meetings were introduced to ensure consistency in diagnosis and treatment, ensuring joint review of all patients. However, we heard increasing volumes of patients have meant that discussing every case has become unsustainable. There was widespread agreement among participants that reform is needed to streamline meetings while maintaining quality. There was also strong support for triage to prioritise complex cases, with scheduled regular benchmarking and review. This has the potential to strengthen MDT meetings as a driver of improvement and adoption rather than as a constraint on staff time. 

A radiologist described spending hours each week preparing images to ‘reshow’ in three-hour meetings where most patients do not need discussion. Reforming MDT meetings would release clinical capacity, reduce duplication and enable the headspace required to accelerate adoption of proven innovations. 

Digital infrastructure and data sharing 

Currently, data sharing across diagnostics is fragmented, limiting reporting and slowing decision-making and evaluation. Clinicians see value in integrated diagnostic reports that synthesise imaging, pathology and genomics, and in triage tools that help improve GP referral quality. But they warned that without allotting time and resource for clinicians to act on this information, the potential will not be realised. Participants called for a short-term focus on optimising existing digital tools (eg, virtual MDTs) to create immediate efficiency and quality gains, rather than overloading services with too many novel pilots at once. 

The appetite for digital integration between radiology and cellular pathology is strong but currently systems do not interoperate even within a single organisation, which is a major barrier that organisations will need to overcome to spread and scale innovation successfully.

Participants supported mandated interoperability standards and collaborative expert networks to ensure strict quality control across sites. 

In addition, without consistent, shareable data on patient flow, treatment volumes and outcomes, integrated care boards (ICBs) struggle to understand whether pathways are working and whether innovations are improving productivity or widening variation. A fully integrated, interoperable dataset is crucial for future strategic commissioning, particularly as ICBs assume responsibility for specialised services. 

The Cancer 360 dashboard within the Federated Data Platform (FDP) is being rolled out nationally, integrating tests, appointments and treatments into a single tracking view to identify pathway delays and support personalised planning. The NHS is also developing a secure data environment network and expanding NHS DigiTrials for clinical trial recruitment in an attempt to improve data access for researchers to drive advances in cancer diagnosis and treatment. 

Regulatory pathways 

The current regulatory landscape for innovative technologies remains complex and difficult to navigate. While the regulatory route for medicines is well established, the pathways for approving non-medical technologies are far less clear. There is a patchwork of pathways to approval for innovations including the Innovative Licensing and Access Pathway, the Innovation Devices Access Pathway, Early Access to Medicines Scheme and NICE’s Early Value Assessment for technologies, each with different purposes, criteria and evidence expectations. 

As Cancer Research UK sets out, for industry and researchers developing new technologies, clarity and certainty in regulation and adoption are essential. Without a clear line of sight from pre‑market development to commissioning and use in the NHS, industry may be deterred from bringing emerging innovations to market in the UK. A unified, end-to-end regulatory and adoption framework for emerging innovations and the steps required for transition into routine commissioning is a prerequisite for future readiness. A streamlined, coherent system would enable the NHS to adopt promising technologies with greater confidence and pace. 

Commissioning and adoption 

Commissioning and procurement remain significant stumbling blocks in the spread of innovation. The lack of consistent, standardised routes for adopting innovative technologies creates uncertainty for industry, commissioners and providers alike. There can be weaker evidence bases for clinical and cost effectiveness of emerging technologies which hinders evaluation and the business case for commissioning. 

Because of these uncertainties, many innovative technologies are first piloted on a small scale, sometimes within a single hospital or trust. While pilots can be valuable, they are frequently under‑funded and short‑lived, leaving insufficient time to collect the evidence needed for long‑term commissioning decisions. Data generated through these pilots is rarely shared across regions, even when multiple areas are testing the same innovation. Fragmented procurement slows spread and contributes to variation in the uptake of innovations across the country. 

Short-term financial pressures and a widespread culture of risk aversion among commissioners often make matters worse. Services may be able to fund a new drug, but not the workforce, digital infrastructure or equipment required to deliver it safely and at scale. Many ICBs also lack the capacity to develop robust business cases, particularly when whole pathway costing is required. 

One way to address this is through social finance mechanisms that support ‘double running’ during the transition to new models of care, giving organisations time to prove the benefit before core budgets must absorb the cost. Several innovation networks and support organisations already operate in this space, but their reach is patchy and often dependent on local enthusiasm. 

The shift to ICBs and more strategic commissioning offers opportunities but also exposes gaps. Historically, specialised services were commissioned nationally, while local elements of cancer care were commissioned separately. This has contributed to a lack of accountability, with no-one owning the whole pathway. Innovations often sit at provider level, with strategic commissioners brought in too late to shape how they should be adopted or evaluated. This limits the ability to scale promising models or align them to population needs. 

Local systems also struggle to prioritise among the many promising technologies emerging each year, with horizon scanning capacity limited or underused. Without clearer signals about which innovations the NHS intends to back, and without coordinated commissioning and procurement support, adopting and spreading innovation in the NHS will remain a complex, resource intensive and lengthy process, even when the innovation itself is relatively simple to implement. 

Expanding access 

Without paying enough attention to spread, many patients risk missing out on advances in diagnosis, treatment and personalised care. NHS England therefore emphasises the importance of designing innovations that can operate in a range of contexts, from small pilots in a single integrated care system (ICS) to multi‑site adoption across regions and national deployment. Ensuring that innovations are inherently scalable helps avoid the familiar pattern of promising pilots that fail to translate into widespread practice. 

Neighbourhood-based delivery models and targeted community outreach have an important role to play, particularly in reducing inequalities in stage at diagnosis and improving access to research. When paired with robust monitoring, these approaches can bring services closer to underserved populations and reveal where gaps persist. 

However, risk aversion within acute providers means many commissioning decisions still reinforce a hospital-centric model, despite opportunities to deliver more care closer to home. For example, we heard from a strategic commissioner that robotic surgery in specialist centres may deliver excellent outcomes for some cancers, but not all patients necessarily stand to benefit and instead may be more appropriately treated in a local setting. 

While specialist centres are essential for complex care and trials, commissioners argued strongly that patients should not have to travel unnecessarily for treatments that could be delivered locally. This aligns with what patients consistently say matter most to them – accessing testing close to home with rapid communication of results. Co-production at the earliest stage of innovation design would ensure new technologies meet these expectations, improving both patient experience and uptake. 

Cancer Alliances are well positioned to lead this work: they can coordinate horizon scanning, support implementation across diverse providers, and tailor delivery approaches such as mobile lung screening to reflect local needs. However, participants were clear that national archetypes for scale and spread of innovations are needed to prevent regional variation while still allowing local flexibility in how models are delivered. 

Access to clinical trials has long been recognised to be inequitable. Currently, most patients access trials through their clinician, leading to ad hoc recruitment. Many clinicians lack the time and headspace to engage fully in research, and data driven approaches to recruitment are still far from routine. Outside major centres of excellence, trial infrastructure is patchy, leaving patients in many parts of the country with limited opportunities to participate in cutting‑edge research, particularly those for whom cost, time or access to transport is an issue. 

The 2023 Lord O’Shaughnessy review into commercial clinical trials made a series of recommendations adopted by the previous government. Progress is underway in many of these areas, but success will depend on systems having the infrastructure in place to extend trial access and accelerate readiness for complex therapies. 

From plan to pathway

What do policy-makers and system leaders need to put in place now to deliver future-ready cancer services? 

1. Double down on delivery 

Delivering innovation-ready cancer services requires a sharper national and local focus on implementation than has been shown to date. Clarity of accountability at each level of the system, and discipline in delivery are priorities. The National Cancer Plan is ambitious, but without a costed, timebound plan that sets out what must be achieved and by when, and who is responsible, frontline teams will continue juggling competing priorities and urgent operational demands. 

A single, coherent delivery roadmap aligned across national bodies, Cancer Alliances and ICSs would allow local leaders to prepare for the future. This helps staff concentrate on the basics that unlock transformation: enough trained people in the right places, equipment that works reliably, and information that flows so teams can spot and fix delays quickly. 

The new generation of cancer manuals committed to in the National Cancer Plan will be a key tool for strengthening accountability by setting out what ‘good’ looks like across each stage of the pathway and clear quality standards. Used well, they can function as a bridge between national ambition and local implementation and drive continuous improvement.

2. Protect time for innovation 

Creating space for staff to innovate is equally critical. Across radiology, pathology, oncology, nursing and genomics, clinicians at our roundtable described being unable to engage in improvement because they have no protected time to do so. Innovation cannot be something carried out ‘on the side’ – it needs to be built into job plans and team workflows. Protected innovation time, supported with funding to backfill clinical duties, would allow staff to participate in research, embed new technologies and redesign pathways. This should be supported by peer learning networks and improvement collaboratives. 

Reforming MDT meetings is one of the most urgent changes required, as recognised in the National Cancer Plan. The government has asked the Royal College of Radiologists to formally review opportunities to modernise MDT working and committed to issue new guidance in spring 2027 for trusts to increase efficiency, streamline decision making, and help patients get treatment faster. This aligns closely with what we heard at the roundtable: that MDTs have become overwhelmed by volume and complexity, and clinical time is not being used where it adds most value. 

A nationally mandated triage model, where only clinically complex or uncertain cases are discussed in full MDT meetings, supported by streamlined MDT meetings for routine cases, would drastically reduce workload and release specialist time for diagnosis, reporting and pathway improvement. 

3. Invest in people, not just technology 

Innovation only shortens waits if there are enough trained people to read scans, report biopsies and plan treatment. Training numbers need to expand across radiology, oncology, histopathology, genomics and specialist digital roles. The forthcoming 10-year workforce plan must address underpinning workforce shortages to realise the government’s ambition for innovation. 

At the same time, the NHS should upskill roles in the MDT to match the changing nature of diagnosis and treatment. Genomics should be embedded into undergraduate and postgraduate curricula for nurses, GPs, pharmacists and oncologists. 

Retaining staff must also be a priority, with more flexible working patterns, portfolio careers that combine research and clinical practice, and wellbeing support. All of this could be strengthened by national innovation deployment teams able to support local implementation when needed. 

4. Keep early and timely diagnosis a north star 

Early and timely diagnosis remains one of the most powerful levers for improving outcomes, and the National Cancer Plan reinforces this by placing earlier detection at the heart of its ambitions. Rolling out national screening programmes and engaging with underserved communities is essential to bring about progress. To enable services to identify and close gaps, stage at diagnosis should be routinely measured by deprivation and ethnicity. 

Early and timely diagnosis relies on cancer pathways meeting performance standards with acceptable turnaround times. This requires RDCs and CDCs to be more fully integrated into cancer pathways so that patients experience seamless referral, testing and follow up, supported by real time pathway tracking across each step of the journey. 

In the longer term, adoption of the personalised and early-stage treatments of the future, will require genomic and biomarker testing to be scaled and embedded routinely in cancer pathways. 

5. Join up digital infrastructure 

Underpinning all these improvements is the need for interoperable digital infrastructure. Participants were clear that fragmented systems remain one of the biggest obstacles to innovation. Nationally mandated minimum interoperability standards would ensure that diagnostic systems can speak to one another, enabling innovations like integrated diagnostic reports that combine imaging, pathology and genomic information. This must be backed by investment where legacy systems are not capable of meeting those standards. 

6. Harness the power of data 

Better data flow is urgently needed. Teams should be able to see a single, up-to-date view of a patient’s tests, appointments and treatment milestones, with tools codesigned by clinicians and patients. Linking operational and outcomes data will also allow services to assess the real-world impact of pathway improvements. 

The National Cancer Plan emphasises the importance of transparency, including public reporting of performance metrics and outcomes. Publishing meaningful, comparable data helps drive improvement by sharing learning, spreading best practice, inviting scrutiny and supporting equitable adoption of innovation. 

7. Create a clear route for adoption 

A clear, consistent adoption pathway is essential for new innovations. Industry, commissioners and providers all described the confusion caused by ill-defined regulatory routes, unclear evidence requirements and inconsistent local decisions. The NHS needs a single, nationally defined route for approving and commissioning innovative technologies. The centre should send clearer signals to ICBs about which devices, diagnostics and digital tools will be backed for spread, on what timetable and with what support for implementation. 

Commissioning capability must also be strengthened. Many ICBs and Cancer Alliances lack the specialist expertise and capacity to develop robust business cases, particularly when innovations require whole pathway investment in workforce, equipment and digital systems. Regional support hubs, template business cases and wider use of social finance mechanisms could help systems overcome financial risk aversion, which participants identified as one of the most enduring barriers to adoption. 

8. Close the gaps in access 

Improving access to clinical trials is another priority. Equity must be at the centre of this effort. Regional trial launchpads can link spoke hospitals with centres of excellence, while NHS DigiTrials and secure data environments can support automatic trial matching. Expanding trial workforce capacity, particularly research nurses and navigators, will help ensure new therapies reach more patients, not only those living near specialist centres. 

9. Invest in the basics 

Capital and estates modernisation remains essential. Outdated radiotherapy machines, constrained endoscopy units and insufficient digital pathology infrastructure were repeatedly cited as limiting capacity. Replacement and upgrade programmes should continue, with transparent reporting on their impact on treatment timeliness and safety. Similar attention should be given to theatres and chemotherapy day units where bottlenecks hold up the pathway after diagnosis. 

10. Be open about trade-offs and do not overlook cultural change 

There will be trade-offs to make about where to prioritise stretched staff, how to pace the introduction of new technologies and how to balance national consistency with local flexibility. Those choices should be explained, evaluated and, where needed, adjusted. The goal is not blanket adoption, but realistic planning and a clearer understanding of who stands to benefit from each innovation, ensuring cancer services work better for all people who rely on them. 

Alongside these operational decisions, leaders must not overlook the cultural conditions that enable innovation to take root. Leadership that models openness, transparency and collective responsibility inspires trust and collaboration, helping create a climate that enables staff to focus on improvement and quality. A culture of shared accountability must underpin future cancer pathway design and delivery. Innovation-readiness depends on providers being willing to collaborate across boundaries, supported by commissioning frameworks that encourage shared ownership.

The King’s Fund view 

Acknowledgements 

We are grateful to everyone who shared their insights and ideas with us, and to those who contributed through scoping conversations and workshops. This work has benefited from the perspectives of people across health and care services and the life sciences sector, including clinicians, researchers, industry, system leaders, commissioners, providers, policy experts, and charities advocating for and supporting people with cancer.