Cancer waiting times in Northern Ireland remain under pressure as key targets missed again

Cancer services in Northern Ireland remained under intense strain at the end of 2025, with the latest Department of Health figures showing that almost all key waiting time targets continued to be missed despite an increase in the number of patients beginning treatment and a sharp rise in breast cancer assessments.

The newly published Accredited Official Statistics cover the quarter ending December 2025 and set out waiting times for patients accessing cancer services at hospitals across Northern Ireland during October, November and December.

They show a mixed picture. There was some improvement in the number of patients starting treatment within 31 days of a decision to treat, and a substantial increase in the number of people seen by a breast cancer specialist after urgent referral. But performance on the longer 62-day pathway for urgent GP referrals remained critically low, while the 14-day breast cancer standard continued to be missed on a dramatic scale.

31-day treatment target improves — but still short of standard

Under the draft cancer waiting times targets, at least 98% of patients diagnosed with cancer should begin their first definitive treatment within 31 days of a decision to treat.

In the quarter ending December 2025, 2,965 patients started their first definitive treatment following a decision to treat. That was 4.4% — or 124 patients — more than in the previous quarter, when the number stood at 2,841.

Of those, 90.1% — 2,672 patients — started treatment within the 31-day target period. That was an improvement on the previous quarter, when 88.0% — 2,499 patients — were treated within that timeframe.

Even with that rise, the system remained well short of the 98% standard.

These figures relate to all patients who received a first definitive treatment for cancer during the three months covered by the publication, regardless of their referral source or type of referral. The clock starts on the date the patient and clinician agree the planned treatment and ends when the patient receives that first definitive treatment.

The Department states that adjustments are made to completed waiting time where a patient cancels or self-defers treatment, or where treatment is suspended for medical or social reasons.

Urgent GP referral pathway remains far below the 62-day target

The picture was considerably more severe on the 62-day pathway.

The draft target states that at least 95% of patients should begin their first definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer.

In reality, the latest figures show that only 29.5% of patients met that target.

A total of 1,446 patients started their first definitive treatment following an urgent GP referral for suspected cancer during the quarter ending December 2025. That was 1.1% — or 16 patients — more than in the previous quarter, when the figure was 1,430.

But only 426 of those patients began treatment within 62 days, compared with 430 in the previous quarter. Percentage-wise, that meant a fall from 30.1% to 29.5%.

The Department’s definition of this measure is narrow and specific. It covers patients who received a first definitive treatment for cancer during the quarter following either an urgent referral for suspected cancer from a GP, or a routine GP referral that was later reclassified as urgent by a cancer specialist.

Referrals from sources other than a GP are excluded, as are routine referrals and patients who have not been given an ICD-10 diagnosis.

The waiting time runs from the date the initial urgent GP referral is received by the HSC Trust to the date the patient receives their first definitive treatment. As with the 31-day pathway, adjustments are made where there is cancellation, self-deferral, or suspension for medical or social reasons.

The Department also notes that the 62-day measurement includes cases where a patient is initially referred to one Trust for consultant assessment and later transferred to another for treatment. In those cases, responsibility is shared, with 0.5 allocated to the Trust where the patient was first assessed and 0.5 to the Trust where the first treatment took place.

Breast cancer referrals surge as 14-day standard remains badly missed

The most severe gap between target and delivery remained on the urgent breast cancer pathway.

The draft target states that all urgent breast cancer referrals should be seen within 14 days.

In the quarter ending December 2025, 3,902 patients were seen by a breast cancer specialist following an urgent referral across all five HSC Trusts. That was 44.6% — or 1,203 patients — more than in the previous quarter, when 2,699 patients were seen.

Despite that significant increase in activity, only 5.5% — 213 patients — were seen within 14 days of their urgent referral. In the previous quarter, 6.8% — 183 patients — were seen within target time.

That means the proportion of patients seen within the standard actually fell, even as the number of patients assessed rose sharply.

These figures cover urgent referrals for suspected breast cancer that were first seen during the quarter, regardless of where the referral came from. They include routine referrals later reclassified as urgent by a breast specialist, and exclude urgent referrals later reclassified as routine.

The Department measures the waiting time from the date the initial breast cancer referral is first received by the HSC Trust to the date the patient attends their first outpatient appointment with a breast cancer specialist. Adjustments are made where a patient cancels, self-defers, or fails to attend a first outpatient appointment.

Demand for suspected breast cancer services continues to rise

The pressure on the breast cancer pathway was also reflected in referral volumes.

During the quarter ending December 2025, HSC Trusts received 6,658 referrals for suspected breast cancer, up from 6,194 in the previous quarter.

Of those referrals, 86.3% — 5,748 — were classified as urgent. In the previous quarter, 85.7% — 5,309 — were classed as urgent.

The Department warns that when totals are added across all HSC Trusts, the regional figure may overstate the true level of demand because referrals transferred from one Trust to another create duplicate referrals.

It states that referrals for suspected breast cancer can be for advice, assessment, or both, and that all new referrals are included regardless of source or urgency.

Encompass rollout continues to affect data picture

The latest figures were published against the backdrop of the ongoing regional rollout of encompass, the new electronic patient record system.

The South Eastern Health and Social Care Trust launched encompass on 9 November 2023. It later went live in Belfast Trust on 6 June 2024, in Northern Trust on 7 November 2024, and in Southern and Western Trusts on 8 May 2025.

Because of that rollout, the Department said validated data for Belfast Trust for the quarter ending June 2024, and breast cancer referrals data for that Trust for the quarter ending September 2024, are not available. Validated breast cancer referrals data for Southern and Western Trusts for the quarter ending June 2025 are also not available.

Figures sourced from encompass are classed as “official statistics in development”, a subset of Official Statistics under the Code of Practice for Statistics.

The Department said caution should be exercised when using those figures and they are not directly comparable with legacy pre-encompass data, but added that they are still a meaningful representation of what they measure and are of sufficient quality for publication and use.

Northern Trust performs above regional average in key areas

For the Northern Health and Social Care Trust, the quarter produced a stronger performance than the regional average on both the 31-day and 62-day cancer pathways, although both targets still remained well out of reach.

On the 31-day pathway, Northern Trust recorded 94.7% performance, with 303 out of 320 patients starting treatment within 31 days of a decision to treat.

That was an improvement on the previous quarter, when the Trust achieved 93.8%, and placed it above the Northern Ireland regional average of 90.1%. It was also the second-highest performing Trust on this measure, behind only Southern Trust.

Even so, it remained short of the 98% target.

On the 62-day pathway, Northern Trust recorded 32.3% performance, with 68 out of 210.5 patients starting treatment within 62 days following an urgent GP referral.

That was still far below the 95% target, but slightly better than both its previous quarter figure of 30.1% and the Northern Ireland average of 29.5%.

The volume of patients waiting longer than 62 days remained substantial, with 142.5 patients in that category.

For urgent breast cancer referrals, Trust-level percentages are no longer published. Since 8 May 2025, breast cancer services have been managed as a regional service across five hospital sites in an effort to equalise waiting times, meaning the Department no longer provides an individual Trust breakdown for the 14-day target.

However, the Northern Trust received 954 urgent breast cancer referrals during the quarter, compared with 663 in the previous quarter — a rise of around 44%.

Long waits remain buried inside the wider figures

Alongside the headline percentages, the wider performance picture remained stark.

For the 31-day target, the median wait was 6 days. However, the 95th percentile stood at 42 days, meaning 5% of patients waited six weeks or more to begin treatment after a decision to treat.

For the 62-day urgent GP referral pathway, the median wait was 42 days, but the 95th percentile reached 247 days. That points to a much longer tail of patients facing the most serious delays, with some waiting more than eight months to begin treatment.

On the breast cancer pathway, the median wait for a specialist appointment was 53 days — around seven and a half weeks — far beyond the 14-day target.

The regional breakdown also showed variation by tumour site on the 62-day pathway. Performance was highest for upper gastrointestinal cancer at 45.1%, and lowest for head and neck cancer at 19.4%.

On the 31-day pathway, Southern Trust recorded the highest performance at 96.0%, while Belfast Trust had the lowest at 83.8%.

Regional breast service central to latest reforms

The Department linked part of the current breast assessment picture to the move towards a regional service.

A new regional breast assessment service launched in May 2025 in an effort to equalise waiting times across Northern Ireland and remove the stark variation that had existed between local Trust areas.

Under the regional model, patients are offered the earliest available appointment anywhere in Northern Ireland rather than waiting only within their home Trust area.

The Department said this approach is intended to ensure access is based on availability rather than postcode, and the latest figures were presented as reflecting a transitional period of reform.

The system has also been supported by additional weekend and evening clinics.

According to the latest performance information cited by the Department, the current waiting time for a breast assessment has now fallen to 5 weeks and 2 days, compared with a peak of 12 weeks in September 2025.

Mike Nesbitt says regional model is “delivering positive results”

Health Minister Mike Nesbitt welcomed the latest figures, particularly the increase in breast cancer assessments, and said the new regional model was beginning to show results.

He said:

“While my department continues to strive to build on these improvements, I would like to assure the public that the implementation of the regional breast assessment system is delivering positive results for patients. 

“The regional model now ensures patients are offered the earliest available appointment anywhere in Northern Ireland, which is the right approach for cancer care. I acknowledge that we are still some way short of the ambitious 14-day target, but I fully expect the long-term position to continue to improve as waiting times fall and the number of patients assessed increases.

“We are seeing positive results from additional weekend and evening clinics.  Latest performance information shows the current waiting time for a breast assessment is now 5 weeks and 2 days, a substantial improvement from the peak waiting time of 12 weeks in September 2025.

“There is more to be done, and I recognise that too many women are still waiting too long for this essential service.  I am determined to support this work and, earlier this year, announced £5 million recurrent funding under the Elective Care Framework to reform the breast assessment service, implementing a modern consultant-led model supported by skilled practitioners.

“While today’s figures cover a transitional period of reform, they indicate a downward trajectory in waiting times, a sign we are heading in the right direction. I commend the collective efforts of healthcare staff in their determination to deliver real results for patients.”

Alan Chambers backs minister’s approach and points to stress faced by patients

Ulster Unionist health spokesperson Alan Chambers MLA also welcomed the increase in breast assessments and said the waiting list problem remained one of the most difficult issues facing the health service.

He said:

“Treatment and consultation waiting lists have been one of the toughest challenges faced by Health Minister, Mike Nesbitt MLA, during his time in post.

“One area that has been concerning women with a referral to a specialist for a breast assessment is the potential of a breast cancer diagnosis. This results in severe stress for both the patient and their family. Given the messaging around early detection of any cancer, it is understandable that the patient wants the reassurance that only a detailed and timely specialist assessment offers.

“The Minister introduced a regional breast assessment scheme last year to remove the postcode inequalities around referral times. The new approach gives patients the choice of attending the earliest available appointment anywhere in Northern Ireland.

“The positive outworking of this system has seen a major 46% improvement in the number of patients being seen by a breast cancer specialist following an urgent referral in the quarter ending in December 2025. A total of 3902 patients were assessed against 2699 in the previous quarter.

“The Minister has not shirked from conceding that his Department is still some way from achieving his desired 14-day target. However, he states that he is confident that the position will continue to improve. The latest figures provide evidence that even more improvements can and will be achieved.

“Current waiting time for a breast assessment is a worrying 5 weeks and 2 days, but is a vast improvement on the peak waiting time of 12 weeks in September 2025.

“The Ulster Unionist Party welcomes the Minister’s earlier announcement of £5m recurrent funding under the Elective Care Framework to reform the breast assessment service.

“The latest improved figures of patients being offered a breast assessment are a welcome step in the right direction, and the Minister has correctly praised the efforts of healthcare staff who have delivered this improvement.

“We look forward to further improvements in waiting times for those women facing the stress of a breast assessment referral. The regional model is delivering results and points towards how other waiting lists can be reduced.

“The Ulster Unionist Party will continue to give our full support to the Minister and our wonderful healthcare staff as they strive to continue to provide first-class outcomes for their patients.”

System treating more patients, but major delays remain entrenched

Taken together, the latest quarter points to a service that is doing more, but still falling well short of where it needs to be.

The number of patients beginning treatment on the 31-day pathway increased. The number of patients seen by breast specialists also rose sharply. Northern Trust, in particular, performed above the Northern Ireland average in the two main treatment pathways.

But the scale of the delays remained severe.

Less than a third of patients referred urgently by a GP for suspected cancer began treatment within 62 days. On the urgent breast cancer pathway, only around one in 20 patients were seen within the 14-day target.

The Department’s latest publication captures a period of reform, service reorganisation and continuing pressure on capacity.

For patients entering the system, however, the headline reality at the end of 2025 remained the same: treatment was reaching more people, but long waits were still deeply embedded across key parts of Northern Ireland’s cancer care pathway.

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At a glance:

• The Department of Health has published Accredited Official Statistics on cancer waiting times for Northern Ireland for October to December 2025.

• The 31-day treatment target showed some improvement, with 90.1% of patients beginning treatment within 31 days of a decision to treat, up from 88.0% in the previous quarter.

• The 62-day target remained far below standard, with only 29.5% of patients starting treatment within 62 days of an urgent GP referral for suspected cancer.

• Urgent breast cancer performance remained especially weak, with only 5.5% of patients seen by a specialist within 14 days.

• Across all five HSC Trusts, 3,902 patients were seen by a breast cancer specialist after an urgent referral, up 44.6% on the previous quarter.

• Referrals for suspected breast cancer rose again, reaching 6,658 in the quarter, with 86.3% classed as urgent.

• Northern Trust performed above the regional average on the 31-day and 62-day cancer pathways, though still missed both targets by a wide margin.

• The latest figures were published against the backdrop of the regional rollout of the new encompass electronic patient record system, with some data classed as official statistics in development.