(Post-Diagnosis / Post-Risk Identification)
Rachel’s Pathway (Interim)
Preventing fragmented surveillance after diagnosis
The missing part of the conversation
The NHS 10-Year Plan sets out an important ambition: to integrate data and improve prevention through a single patient record, risk profiling, and predictive care.
But hereditary risk is not only about identification.
Even when a person is diagnosed with cancer, or later found to have a hereditary risk condition, outcomes can still be harmed by fragmented surveillance, unclear responsibility, and disjointed follow-up across hospitals and specialties.
This is where Rachel’s Pathway sits.
What Rachel’s Pathway addresses
Rachel’s Pathway focuses on what happens after:
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a cancer diagnosis
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a high-risk clinical picture
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or a confirmed hereditary risk finding
It is designed to ensure that the patient receives coordinated, consistent surveillance and follow-up, rather than care being split across multiple services with no single overview.
Focus
NHS 10-Year Plan (Fit for the Future)
Long-term prevention and risk prediction.
Rachel’s Pathway
Immediate safety and coordination once risk is known.
Record
NHS 10-Year Plan
Single Patient Record to support joined-up care.
Rachel’s Pathway
A record alone does not coordinate appointments, surveillance, or accountability.
Ownership
NHS 10-Year Plan
Does not specify who owns surveillance coordination for hereditary risk patients.
Rachel’s Pathway
Requires a named coordinator / accountable role to ensure follow-up is not fragmented.
Surveillance
NHS 10-Year Plan
No defined national surveillance coordination model described.
Rachel’s Pathway
Structured follow-up plan agreed across specialties.
Cross-Hospital Care
NHS 10-Year Plan
Not addressed in operational detail.
Rachel’s Pathway
Designed specifically to prevent gaps when care spans multiple trusts or services.
Timelines
NHS 10-Year Plan
Long-term ambition (years).
Rachel’s Pathway
Practical and implementable now using existing pathways.
Patient Experience
NHS 10-Year Plan
More access to records and risk information.
Rachel’s Pathway
A coordinated plan so patients are not left navigating complex systems alone.
Side-by-side: NHS 10-Year Plan vs Rachel’s Pathway
Focus
NHS 10-Year Plan: Long-term prevention and risk prediction
Rachel’s Pathway: Immediate safety and coordination once risk is known
Record
NHS 10-Year Plan: Single Patient Record to support joined-up care
Rachel’s Pathway: A record alone does not coordinate surveillance or accountability
Ownership
NHS 10-Year Plan: No named model specified for long-term coordination
Rachel’s Pathway: Requires a named coordinator or accountable role
Surveillance model
NHS 10-Year Plan: Operational surveillance model not specified
Rachel’s Pathway: Structured surveillance plan agreed across services
Cross-hospital care
NHS 10-Year Plan: Cross-trust coordination not described in operational detail
Rachel’s Pathway: Designed to prevent gaps when care spans multiple trusts
Timelines
NHS 10-Year Plan: Long-term ambition over several years
Rachel’s Pathway: Implementable now using existing pathways
Patient experience
NHS 10-Year Plan: Greater access to records and risk information
Rachel’s Pathway: A single coordinated plan so patients are not left navigating complex systems alone
Feature
Focus
Record
Ownership
Surveillance
Cross-hospital care
Timelines
Patient experience
NHS 10-Year Plan (Fit for the Future)
Long-term prevention and risk prediction
Single Patient Record to support joined-up care
Does not specify who owns surveillance coordination for hereditary risk patients
No defined national surveillance coordination model described
Not addressed in operational detail
Long-term ambition (years)
More access to records and risk information
Rachel’s Pathway (post-diagnosis / post-risk identification)
Immediate safety and coordination once risk is known
A record alone doesn’t coordinate appointments, surveillance, or accountability
Requires a named coordinator / accountable role to ensure follow-up is not fragmented
Structured follow-up plan, agreed across specialties
Designed specifically to prevent gaps when care spans multiple trusts/services
Practical and implementable now using existing pathways
A coordinated plan so patients aren’t left navigating complex systems alone
Why this matters: Rachel’s experience
Rachel’s case shows why identification alone is not enough.
Rachel was diagnosed with breast cancer and received treatment. At the time, it was believed the cancer had been dealt with. However, the cancer later returned and she died six years after her original diagnosis.
In the years between, care and surveillance can become fragmented across hospitals, services, and appointments — especially when hereditary risk is not clearly owned by one accountable pathway.
Rachel’s Pathway exists because patients should not be left in a system where the burden of coordination falls on them — or where each service assumes another service is responsible.
The urgent point
Even if the NHS successfully delivers long-term ambitions by 2035, this will not automatically prevent harm for patients who:
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are diagnosed during the next decade
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have complex clinical histories
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move between services
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or require long-term surveillance and coordinated follow-up
That is why interim safety standards are needed now — both before diagnosis (Rachel’s Rule) and after diagnosis (Rachel’s Pathway).
What is being asked for
Rachel’s Rule and Rachel’s Pathway together call for two practical interim safety standards:
1) Before diagnosis
A minimum, accountable process for hereditary risk recognition using clinical history and red flags — not family history alone.
2) After diagnosis / after risk identification
A minimum standard for coordinated surveillance and follow-up, with a named responsible role to prevent fragmentation across services.
Full policy proposals
A comprehensive full Rachel’s Pathway policy proposal is available to read in the Proposal & Policy section of this website.