Bladder cancer patients could miss out on faster, less invasive diagnosis because gaps in NHS funding and commissioning are preventing new diagnostics from moving consistently into routine care, a new report warns.
The Faster Answers report, published by Birmingham-based cancer diagnostics company Nonacus, warns that access to evidence-backed diagnostics can still depend on local funding and commissioning decisions, even where there is growing evidence of clinical and NHS benefit.
Its publication comes as the British Association of Urological Surgeons (BAUS) wrote to Health Secretary Yvette Cooper and Health Innovation Minister James Frith this week, calling for faster NHS adoption of new bladder cancer tests, fairer funding for diagnostics, and better use of real-world evidence in NHS decision-making.
GALEAS Bladder, developed by Nonacus, is a non-invasive urine test designed to help clinicians identify low-risk patients who can be safely reassured they are cancer-free without an invasive procedure, freeing up capacity for those who need it most. Patients provide a urine sample, with results typically returned within six to ten days.
The technology is already at eight NHS sites across England and Wales, including University Hospitals of Leicester (UHL), once of the UK’s largest urology sites.
Provisional pilot data from UHL shows that from 171 patients, more than four out of five patients eligible for a cystoscopy safely avoided the hospital-based procedure, based on the results from their at-home urine test. This released the equivalent of 11.6 cystoscopy sessions, with capacity used elsewhere in the urology service, including treatment.
But the Leicester pathway is supported by time-limited funding due to end in April 2027, leaving clinicians concerned about how the service can continue without a sustainable commissioning route.
Without a long-term funding settlement, hospitals would be forced to, or continue using conventional invasive diagnostic pathways, adding pressure to already stretched cystoscopy capacity and lengthening waiting times for suspected bladder cancer patients. Clinicians warn that this risks delayed diagnoses and poorer outcomes for patients, reversing the gains the pathway has delivered since its adoption.
The report sets this funding challenge against a stark clinical backdrop. Five-year survival is around 75% when bladder cancer is diagnosed at stage I, falling to around 10% at stage IV, while around 1,700 people a year in England are diagnosed at stage III or IV.
More than 27,000 people were waiting for a cystoscopy in England in May 2026. The report also notes that only 28% of bladder cancer diagnoses in England in 2019 came through in the two-week-wait pathway, while a further 14% followed an emergency admission, meaning a substantial share of patients are only diagnosed once their disease has already progressed. A non-invasive, urine-based test like GALEAS Bladder offers a way to ease pressure on cystoscopy capacity while catching cases earlier, before they escalate to emergency presentation.
The test has recently been validated in a real-world study of 964 patients with haematuria across seven NHS urology departments. It returned a 99.3% negative predictive value, correctly identifying 35 of 36 high-grade cancers and all 17 muscle-invasive cancers.
The report argues that Leicester exposes a wider problem for NHS innovation – diagnostics can build strong evidence and demonstrate value in a live NHS pathway, but still rely on local funding, short-term pilots and individual commissioning decisions before becoming part of routine care.
Jayne Douglas-Moore, Consultant Urological Surgeon at Leicester NHS Trust, said:
“Bringing GALEAS Bladder into the NHS in Leicester represents a genuine turning point in bladder cancer diagnostics. A reliable non-invasive test to risk-stratify patients with haematuria has been long awaited, and the early results are promising.
“Patients can receive answers sooner and with less anxiety, while invasive investigations and specialist resources can be focused where they’re needed most. For me, the concern now is what happens when the current funding ends. Having seen the difference this can make for patients and the service, I want to see a sustainable way to continue it.”
Joe Philip, President of BAUS and Mary Suphi, CEO of BAUS, said:
“Urology services are under real pressure, and clinicians want tools to focus cystoscopy capacity on the patients who need it most, while giving lower-risk patients faster reassurance. Implementations of this nature – as demonstrated in areas such as University Hospitals of Leicester NHS Trust – shows this kind of triage can work safely in routine NHS practice.
“BAUS would support clearer national routes to evaluation and adoption, so that high-quality diagnostics reach patients consistently rather than depending on local funding decisions.”
Jeff Bousfield, CEO of Nonacus, said:
“Leicester has done the hard bit. They’ve changed the pathway, they’re seeing patients avoid immediate cystoscopy, and they’re using that capacity elsewhere in urology.
“What shouldn’t happen now is for that progress to stop because the funding runs out. We have strong evidence and we can see what this means in a real NHS service. We now need a much clearer route to fund and adopt diagnostics like this so patients aren’t getting different care simply because of where they’re referred.”
Nonacus is calling on:
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National Institute for Health and Care Excellence (NICE) to consider the latest real-world evidence on urinary biomarkers as part of future bladder cancer guidance, and to clarify how evidence-backed risk-stratification tools can be incorporated into the pathway.
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NHS England and Getting It Right First Time (GIRFT) to support more consistent evaluation and adoption of risk-stratification approaches across haematuria pathways, reducing variation between local systems.
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Department of Health and Social Care to ensure funding, reimbursement and MedTech adoption routes allow evidence-backed diagnostics to move into routine NHS care where they demonstrate clinical and operational value.
