NHS staff shortages: What’s needed to build a sustainable cancer workforce?

For a few months this year, Thursday evening in the UK meant just one thing. Not the latest episode of a lockdown favourite or another virtual pub quiz, but a chance for people across the country to clap our carers.

It was a rowdy 5 minutes where people came together to recognise the herculean efforts of healthcare staff across the country. But our love affair with the NHS and the staff who make it began long before COVID-19 and it’s an appreciation that will outlast the pandemic.

But the NHS needs more than our colourful banners to keep it going, it also needs government support.

In the 2019 General Election, the Conservative party pledged to ‘increase cancer survival rates’ and ‘boost early cancer diagnosis across 78 hospital trusts’. Ambitions that will be impossible without a sustainable, future-proofed workforce.

A ‘make or break’ issue

NHS staff shortages is not a new issue. In 2015, workforce was identified as a ‘make or break’ issue in the Cancer Strategy for England. But nearly 5 years later, it remains unresolved.

And the longer it’s left, the worse the problem will get. Before the COVID-19 pandemic, more than 1 in 10 diagnostic posts were vacant. Earlier this month, Professor Sir Mike Richards published a review of diagnostic services, which described services as approaching a ‘tipping point’ and calls for major expansion to the workforce.

Diagnostic services in all 4 UK nations are struggling to meet waiting times. And while many things contribute to missed waiting time targets, the biggest barrier is staff shortages.

As the vacancies pile up and the demand for cancer services increases, the Government’s ambition to diagnose 3 in 4 cancer early by 2028 is becoming less and less likely.

Whilst training NHS staff to take on new roles and responsibilities and improving ways of working is important, it’s not a replacement for a well-resourced workforce. So the big question is: what would it take to build a vibrant and sustainable cancer workforce? It’s not an easy figure to estimate, but we ran some numbers.

As there is more data available in England, the estimates look at staff numbers in England alone. But many of the findings will apply across all 4 nations.

Growing the cancer workforce

To ensure the NHS has enough staff to diagnose, treat and care for people with cancer over the next decade, they’ll need some new recruits.

Which is where Health Education England (HEE) – the organisation responsible for workforce planning, education and training – comes in. In 2018, they identified 7 professions that are key to diagnosing and treating cancer and estimated that, to deliver world-class cancer services by 2029, staff numbers would need to grow by 45%.

Thanks to existing investment in education and training from HEE, staff numbers are already on course to increase by 2029 in most of these professions – but not by enough. In fact, we’ve estimated it will cost HEE between £142 million and £260 million more than it already invests to grow the key cancer professions by 45%.

As one-off figures, they sound big. But this investment in the future of cancer workforce can be spread out over the next few years. And with Health Education England spending around £4.3 billion last year, it would be a fairly small annual investment.

To put it in context: if HEE’s budget remains the same, £260 million spread over 3 years would be approximately 2% of their annual budget. Not too big an investment in the grand scheme of things, but one that could help transform cancer services. And not just cancer services – some of the 7 professions identified also diagnose and treat other diseases, so the benefits could extend to those too.

Here’s what it would be paying for.

Seven key professions

Based on our modelling, each of the 7 cancer professions are growing or declining on their own trajectory at the minute depending on how many staff are being trained and recruited, as well as the number of staff retiring, leaving early or rejoining the workforce.

The good news is that numbers of people joining 6 of the 7 professions are on the rise. But only one – gastroenterology – is on track to meet HEE’s ambition of 45% growth by 2029.

And numbers in one key profession – histopathology – look set to decline in the coming years. If nothing is done to change the forecast, the number of histopathologists in England is estimated to drop by 2% by 2029. A far cry from the 45% growth that HEE aspires to.

Copy this link and share our graphic. Credit: Cancer Research UK

There are a number of ways for HEE to increase the cancer workforce – which is why our cost estimates in fact range from £142 million to £260 million.

The lower cost option of £142 million would involve a combination of increasing training opportunities, recruiting more specialists from other countries, encouraging existing NHS staff to move into these specialist areas and encouraging specialists to come back to the NHS – including those who have recently retired.

Growing the cancer workforce solely by increasing training opportunities within the NHS would cost a bit more. £260 million according to our estimates.

And it’s possible that more might be needed. Our modelling did not take into account that several posts in the NHS – more than 1 in 10 – are currently vacant. These need to be filled too.

UK Government must act

As with all estimates, these figures were calculated with several assumptions. But it is the first complete look at what’s needed across the cancer pathway and should form an important part of the conversation about what’s needed to transform cancer services in England.

It’s a conversation that’s been going on for many years. And with the number of people being diagnosed with cancer estimated to increase in the coming years, it’s time to move beyond words. The UK Government must act now.

In a few weeks the UK Government will decide how much money Health Education England will have to spend in the coming years. Which will in turn determine how much money they put aside for the cancer workforce.

Put simply, how the UK Government responds to NHS staff shortages now will determine what the future holds for people with cancer in the decades to come.

And with 1 in 2 of us getting cancer in our lifetime, an additional £260 million seems like a small price to pay for a cancer workforce that’s large enough to give everyone the diagnosis, treatment and care they deserve.

Katie