Recurring concern

Unreliable recognition and referral of cancer red flags

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First reported 15 Oct 2024•Latest report 5 Jun 2026

Definition

What this concern includes

Includes failures by healthcare professionals or services to recognise symptoms, history or findings as potential cancer red flags and to make or arrange the appropriate expedited specialist referral, including the two-week-wait pathway where applicable.

Not included

Excludes failures occurring after an appropriate cancer referral has been made, including delays in specialist assessment or treatment unless the referral process itself was deficient.
Excludes generic cancer-screening, diagnostic-testing or treatment deficiencies where no failure to recognise or refer a cancer red flag is identified.
Excludes non-cancer referral failures and symptoms that are not presented as potential cancer red flags.
Excludes generic clinical training, documentation or communication deficiencies unless they directly impair recognition or referral of a cancer red flag.

Reports: 2
Individual concerns: 2
Date range: 2024–2026
Stated actions: 3

Reports over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Reports about this concern sent to each recipient.

Department of Health and Social Care1

NHS Derby and Derbyshire Integrated Care Board1

NHS England1

Concerns and responses across reports

Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.

5 Jun2026
North London
Concerns raised1
1. Lack of guidance to GPs on previous cancer as a red flag requiring referral for specialist opinion without waiting for further tests
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions 1
1. Position
  Existing NICE guidance and clinicians’ recognition of previous cancer risks are considered sufficient without specific additional GP guidance.
  Stated by NHS EnglandExisting arrangements considered sufficient
AI-generated summary

Keith Richard Gandy · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Keith Richard Gandy died in hospital on 29 October 2025 after deterioration following a fall and was found to have a rare radiation-induced osteosarcoma of the pelvis. The concerns were that guidance did not clearly identify previous cancer as a red flag requiring specialist referral without waiting for further tests, and that specialist evaluation waiting times could be between six and twelve months.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Lack of guidance to GPs on previous cancer as a red flag requiring referral for specialist opinion without waiting for further tests
Wider context from the report
“There was no guidance to GPs that underlines that previous cancer is a red flag and a referral for a specialist opinion should be made without waiting for further tests. That referral waiting times for specialist evaluation in these circumstances are between 6 months to 12 months ”
Source location
Keith Richard Gandy · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Existing NICE guidance and clinicians’ recognition of previous cancer risks are considered sufficient without specific additional GP guidance.

Verbatim wording from the response
“A lack of guidance for GPs National Institute for Health and Care Excellence (NICE) guidance NG12 Suspected cancer: recognition and referral, advises that clinicians use judgement when symptoms present in people with higher baseline cancer risk. Whilst it does not specifically list previous cancer as a red flag, a history of cancer is widely recognised clinically as such a factor.”

Source location
Response from NHS England
Page 1 · response
Published 14 August 2026
Open published response
15 Oct2024
Manchester South
Concerns raised1
1. Failure to recognise persistent hoarse voice as a potential laryngeal cancer red flag
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 3
1. Action
  Record and share a head and neck cancer signs-and-symptoms webinar with primary care.
  Stated by NHS Derby and Derbyshire Integrated Care BoardStated planned
2. Action
  Deliver an educational head and neck cancer session for PCN Cancer Leads.
  Stated by NHS Derby and Derbyshire Integrated Care BoardStated planned
3. Action
  Promote head and neck cancer education through primary care, Hub Plus, and Local Medical Council communication channels.
  Stated by NHS Derby and Derbyshire Integrated Care BoardStated planned
AI-generated summary

Stephen Charles Stringer · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Stephen Charles Stringer developed a hoarse voice from January 2023, but its persistence and deterioration were not recognised as a potential cancer warning sign until October 2023. He was diagnosed in January 2024 with stage 4 squamous cell carcinoma of the glottis and treated palliatively. The report identified concerns about delayed referral, gaps in electronic patient enquiry systems, fragmented oversight of his care, and limited awareness of persistent hoarseness as a possible cancer symptom.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to recognise persistent hoarse voice as a potential laryngeal cancer red flag
Wider context from the report
“2. The evidence from the ENT consultant was that it was important that where a patient presented with a hoarse voice that all health professionals explored for how long it had been an issue and whether there was a realistic treatable cause for it .In the absence of any clear cause such as a throat infection or where there was no clear response to treatment then a hoarse voice should be seen as a red flag symptom for laryngeal cancers and result in a referral on the 2 week wait. It was clear from the evidence at the inquest that unlike other cancer red flags such as blood in urine the significance of a persistent hoarse voice was not recognised by a number of different healthcare professionals who saw him. The inquest was told that early detection of laryngeal cancers through early referrals on the 2 week wait significantly improves the outcomes for patients because far more treatment options are open to clinicians. ”
Source location
Stephen Charles Stringer · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Record and share a head and neck cancer signs-and-symptoms webinar with primary care.

Verbatim wording from the response
“The DDICB Clinical Lead for Cancer and Senior Commissioning Manager Cancer will. Promote the GatewayC module for Head and Neck (education Package) through the following channels.”

Source location
Response from Derby and Derbyshire Integrated Care Board
Page 4 · response
Published 16 October 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Deliver an educational head and neck cancer session for PCN Cancer Leads.

Verbatim wording from the response
“• LMC Record a webinar with Head & Neck Consultants and the DDICB Clinical Lead in a Q&A style to share across primary care around signs & symptoms. Raise awareness at the next PCN Cancer Leads meeting. Work with Communications to develop some public facing comms around recognising signs and symptoms.”

Source location
Response from Derby and Derbyshire Integrated Care Board
Page 4 · response
Published 16 October 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Promote head and neck cancer education through primary care, Hub Plus, and Local Medical Council communication channels.

Verbatim wording from the response
“The DDICB Clinical Lead for Cancer and Senior Commissioning Manager Cancer will. Promote the GatewayC module for Head and Neck (education Package) through the following channels.”

Source location
Response from Derby and Derbyshire Integrated Care Board
Page 4 · response
Published 16 October 2024
Open published response

Data last updated 7 September 2026

What this concern includes

Not included

Reports over time

Concerns raised1

Lack of guidance to GPs on previous cancer as a red flag requiring referral for specialist opinion without waiting for further tests

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1

Concerns raised1

Failure to recognise persistent hoarse voice as a potential laryngeal cancer red flag

Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3

Respondent positions 1

Actions described in response 3