Ready to Lead, Ready to Change: Transforming Cancer MDTs for the National Cancer Plan
The MDT Leadership & Improvement Readiness Programme, in partnership with West Midlands Cancer Alliance (WMCA)
Early insights from the WMCA MDT Leadership & Improvement Readiness Programme
The National Cancer Plan for England, published in February 2026, sets out an ambitious goal: to save 320,000 more lives by 2035 and make England a global leader in cancer outcomes. It is clear that incremental change will not be enough. For the multidisciplinary teams at the heart of every cancer pathway, this is both a challenge and an opportunity.
MDT working has been the gold standard of cancer care since the Calman-Hine report, and the Plan recognises the strong evidence that MDTs improve the quality and effectiveness of treatment. But it is also candid that some MDT meetings have become unwieldy and rigid. For core members, the question is no longer whether MDTs need to change, but how.
The changes MDTs need to make
The Plan sets out a clear direction of travel for MDT working:
A national review of MDT working (Action 9). Led by the Royal College of Radiologists, with new guidance expected in spring 2027, the review will focus on practical steps to increase efficiency, streamline decision-making and help patients get treatment faster.
Streamlining and Standards of Care. Non-complex, guideline-aligned cases should follow agreed Standards of Care, freeing MDT time for patients whose care genuinely needs multidisciplinary discussion.
New quality standards. A new generation of cancer manuals, published by tumour type from 2027, will set standards for clinical effectiveness, safety, and experience of care.
Specialist review where it matters. More patients with complex needs will have their treatment plans discussed and reviewed by a specialist MDT.
Faster pathways. Effective MDTs are essential to meeting the Faster Diagnosis Standard and the 62-day treatment standard.
Many of the building blocks already exist. The ten national MDT streamlining recommendations have been in place for some time, yet implementation remains variable. Nationally we still see proformas that miss patient preferences and social context, Standards of Care that exist on paper but are not used in practice, inconsistent quoracy and audit, and core members, including Clinical Nurse Specialists, who are unsure of their authority to contribute.
What MDT core members said at the launch of the WMCA MDT Leadership & Improvement Readiness Programme
MDT members joining the launch of the programme described this gap between guidance and practice in their own words. The barriers they identified map closely onto the national streamlining recommendations:
Triage and preparation time: there is not enough job-planned time to triage cases or prepare them for discussion, so pre-meeting triage, a cornerstone of streamlining, is hard to sustain.
Case volume: MDT lists remain long even after pre-triage, with late additions and a reluctance to accept that not every case needs full discussion, which limits the time available for complex patients.
Information and presentation: presenting clinicians do not always have all the information to hand, and sometimes no one is available to present, leading to longer discussions and repeated deferrals while waiting for results.
Standards of Care: participants want to streamline appropriately using Standards of Care, but need colleagues, including surgeons and consultants, to engage with referral criteria and agreed pathways.
Participation and engagement: not everyone is fully present, particularly in virtual meetings, and workload often falls on the lead rather than being shared across the team.
Support roles: MDT coordinators need the knowledge and skills to support the meeting, especially when cross-covering for colleagues.
Crucially, participants also wanted to know how to improve without compromising the clinical governance of the MDT. That is the balance the national review is seeking too.
None of these are purely technical problems. Using Standards of Care safely requires trust, shared accountability, and permission to change long-standing habits. Streamlining without strong leadership risks missed complexity and more unwarranted variation. Research consistently shows that inclusive, collective leadership across the whole team, not the chair alone, is one of the strongest predictors of MDT decision quality. The Plan makes the same point about the workforce: the answer is not simply more staff, but people equipped with the skills, motivation, permission, and support to deliver reform.
Supporting the review of how MDTs work using leadership as enabler to improvement
In the West Midlands, (WMCA) the Leadership & Improvement Readiness Programme is part of a wider focus on MDT optimisation and improvement. This includes, a refresh of MDT best practice documentation, implementing Standards of Care consistently across MDTs, and a multi-year MDT quality assurance programme which is formed of a self-assessment and panel review of MDT function and quality.
Reviewing how MDTs work will only lead to lasting improvement if the people in them are ready to lead change. The programme is designed to do exactly that: to give MDT core members the leadership capability, tools, and confidence to act on what the review identifies, and to make improvements stick.
The programme launch and early thoughts
The programme launched in July 2026 and is running until Autumn 2027, this is our fourth cohort in WMCA, building on more than five years of partnership with WMCA. The programme has four interconnected elements:
Practical webinars covering why MDT meetings go off track, Standards of Care and national guidance, MDT reform and the National Cancer Plan, AI and digital tools, and designing the future MDT.
Leadership workshops on influencing change, getting every voice heard, managing disagreement and conflict, leading change when teams are resistant, and advanced tools for clinical leaders.
Improvement Readiness Action Learning Sets, jointly facilitated by 360 Degree Society, WMCA and Expert Advisory Group clinical leads, offering a confidential space to work through real MDT leadership challenges.
A blended, flexible design that respects clinical workloads, with recorded sessions, CPD accreditation, and mapping to the ACCEND framework.
What MDT members told us
At the launch, we asked participants to describe their MDT in one word. Their answers were honest: long, time pressured, friendly but not succinct, and not always a quality discussion. When asked what they wanted from the programme, they talked about improving efficiency and engagement, sharing the workload more evenly, and help to make change stick. Many saw the conflict management workshop as a key need.
At the first practical webinar, we used the 5 Ps framework (Purpose, Preparation, Process, People, Product) to ask each group to identify the weakest area in their own MDT. Preparation came out on top, followed closely by Process. Not one participant identified Purpose as the problem. MDT members know why their meeting matters; what they need is support with the practical and behavioural changes that make it work.
How the first sessions have gone.
Practical Webinar 1: Why MDT Meetings Go Off Track was delivered twice in September 2026 to fit around clinical commitments. It explored root causes using the 5 Ps, streamlining techniques such as pre-meeting triage, referral standards, and structured presentations, and how to manage hybrid and virtual meetings so that everyone contributes.
Leadership Workshop 1: Influencing Change Across Clinical Teams explored power, principles of influence, stakeholder mapping, push and pull strategies and understanding resistance, with participants applying these to real MDT scenarios and building a personal action plan.
The most striking result came from the leadership workshop. Participants rated their confidence to influence change within their MDT at the start and end of the session. At the start, 60% rated their confidence as low, very low or none. By the end, nobody did: 60% rated themselves moderate and 40% high, up from just 13% high at the start.
From learning to improvement
What matters most is what happens back in the MDT. Participants left each session with a specific commitment, and these link directly to the improvements the Cancer Plan asks for:
Streamlining and preparation: introducing pre-MDT triage using a traffic light system, making sure investigations are complete before discussion, and triaging their own patients so they are presented effectively.
Standards of Care and national guidance: one participant committed to routinely asking whether there is a reason to depart from national guidance, a simple question that supports safe streamlining.
Inclusive decision-making: asking everyone at the end of each case whether they want to add a view and being more proactive in involving colleagues who join remotely.
Leading change: stakeholder mapping, using pull as well as push strategies, and exploring the reasons behind resistance rather than taking it personally.
In their own words:
“For me it is understanding that resistance is not personal and requires a deeper discussion.”
“I’m the chair so I have to act by example and demonstrate these skills.”
“I would like our MDT to set up a face-to-face meeting so as a group we can sign up to new ground rules as a starting position.”
One participant also noted the value of learning that other MDTs face the same issues, even where tools are already in place. This shared learning across teams is one of the programme’s greatest strengths.
Building on proven results
These early findings are consistent with the evaluation of the previous cohort, which showed 99–100% satisfaction, MDT meetings 20–30% shorter, around 50% improvement in discussion effectiveness, and confidence in chairing MDT meetings rising from 4/10 to 9/10.
Leadership is not optional
The National Cancer Plan is clear about the scale of change required. MDTs remain the right structure for modern cancer care, but their value depends on process, ownership and culture keeping pace with clinical best practice. Reviewing how MDTs work is the first step; having leaders across the whole team who can act on what that review finds is what turns it into improvement. The first sessions of this programme show that when MDT core members are given practical tools, time to reflect and permission to lead, they leave ready to act.
If you wish to discuss how we can support your cancer MDTs – we would love to offer you a free confidential chat and share our work and experiences. We would love a chat over a virtual cuppa.