Cancer innovation meets NHS reality (2025)

What actually changed

  • ctDNA goes mainstream in lung and advanced breast: a blood-test-first route designed to shave weeks off treatment starts and reduce invasive biopsies.

  • NICE keeps the cadence: adjuvant/ peri-op updates in lung reset standards; myeloma options re-enter routine use; CDF list churn continues to smooth the pipeline between promising and proven.

  • Knock-on effect: diagnostics, theatres, and MDTs get pulled forward. Precision isn’t “add-on”; it’s the new backbone.

Where it’s sticking

  • Diagnostics are the bottleneck. GLH capacity, logistics, and reporting into MDTs remain patchy. “Test available, result late” is still a thing.

  • Variation risk (aka postcode oncology). Blueteq criteria, contracting, and pathway rewires create go-live gaps between providers.

  • Workforce bandwidth. Peri-op IO shifts demand upstream—imaging, interventional diagnostics, pre-hab, anaesthetics, surgery lists.

  • Data plumbing. LIMS → EMR → MDT → registry still isn’t seamless. We can’t improve what we can’t see.

  • Commissioning complexity. CDF transitions, specialised vs system levers, and capital for diagnostics collide at the bedside.

So, how many therapies “funded” in 2025? Enough to matter. Multiple new/updated TAs hit routine baseline, and CDF updates kept the door open for promising indications. The exact count matters less than the implementation load: every change means new criteria, diagnostics dependencies, MDT scripts, and first-patient-treated timelines.

The Alliance moment

This is where Cancer Alliances earn their stripes. “Good” in 2025 looks like:

  • Make ctDNA boring (in a good way). One-page SOP from phlebotomy → GLH courier → LIMS → MDT in ≤5 working days. Build the contingency triggers (insufficient plasma? reflex tissue).

  • Publish a quarterly “NICE/CDF → clinic” tracker. Criteria, diagnostics required, Blueteq go-live, sites live, first patient treated. No surprises.

  • Re-stage capacity. Protect imaging and pre-hab; rebalance theatres and SACT for peri-op/adjuvant volumes.

  • Close the equity gap. Alliance dashboards to spot lagging providers; deploy targeted help (CNS time, admin, courier fixes) before the headlines do.

  • Own the data. TATs, mutation rates, stage migration, conversion-to-treatment. If it isn’t measured, it isn’t managed.

The nzyme market access take:

  • Diagnostics are the new access bottleneck.

  • TA volume is steady and impactful—implementation is the job.

  • Variation is the reputational risk. The gap between “approved” and “available” is admin, logistics, and bandwidth. Targeted activity supporting Cancer Alliances to plan, implement and close the gap is critical to patient access.

Let us know what do you think or get in touch to find out how you can ensure you are accessing all the levers to ensure patient access in 2026?