PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

53 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceFrance’s sophisticated health information infrastructure paradoxically lacks integrated tracking from referral through specialist assessment to treatment initiation. Spain’s regional autonomy compounds the problem, with each autonomous community maintaining incompatible data systems that prevent national recognition of dramatic variations in specialist access (UOC, 2022). Most critically, the inability to track cumulative delays across complete pathways means health systems systematically underestimate the true burden on patients. Current monitoring systems, where they exist, typically capture isolated metrics – initial referral time, diagnostic wait, treatment delay – without recognising that patients experience these sequentially. The measurement challenges and monitoring gaps documented throughout this report (see Chapter 6 on governance) mean that a patient’s journey involving multiple weeks at each stage can accumulate to months of total delay, yet no indicator captures this complete pathway time. Without comprehensive pathway monitoring, health systems remain unable to learn from their failures or demonstrate whether reforms actually improve the patient experience of accessing specialist care. POLICY LEVERS: REFERRAL AND ACCESS TO SPECIALIST CARE The patient journey through specialist care pathways reveals multiple failure points that compound into significant delays. Countries lack standardised referral criteria, comprehensive pathway monitoring, and coordination mechanisms between primary and specialist care. With a large proportion of cancers diagnosed through emergency presentations in some countries, and regional variations in specialist access exceeding 100 days, the evidence demonstrates that poorly coordinated pathways undermine the benefits of early detection. The absence of integrated tracking systems means health systems remain blind to cumulative delays that can transform treatable conditions into advanced disease. Based on the evidence examined, countries should consider the following integrated approaches to strengthen referral and specialist access: ■ Establish clear referral criteria with supporting infrastructure Countries need evidence-based guidelines specifying when specialist referral adds value versus when primary care management is appropriate. These criteria should be embedded in clinical decision support systems and regularly updated based on emerging evidence. Critically, primary care must have the resources and authority to manage conditions within their scope, avoiding unnecessary referrals that fragment care. ■ Implement target maximum waiting times for specialist access Countries need explicit timeframes for specialist consultation following referral, with enforcement mechanisms and consequences for non-compliance. These must cover the complete pathway from referral to initial specialist assessment, with operational capacity developed to meet standards consistently. ■ Create unified information systems for seamless coordination between sectors Interoperable electronic systems must enable information sharing between primary and specialist care, eliminating the current reality where patients carry paper documents between providers. This requires not just technical standards but governance frameworks that mandate data sharing whilst protecting privacy, enabling specialists to access comprehensive patient histories and primary care to receive timely feedback.