NHS hospital bicycle Credit: Flickr/CC BY-NC-SA 2.0
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%.
The 7 key professions:
- Histopathologist: A doctor who examines tumour or blood samples under a microscope to help diagnose cancer.
- Clinical radiologist: A doctor who interprets scans – like MRI and CT scans – to diagnose, treat and manage cancer.
- Diagnostic radiographer: A specialist who takes scans – like MRI and CT scans – that can be used to diagnose cancer. They’re the people you see when you go for an ultrasound or MRI appointment.
- Oncologist: A doctor who treats cancer.
- Specialist cancer nurse: A nurse who helps to ensure that people with cancer are supported through their treatment and care and have the information they need. They can also play a vital role in delivering cancer treatments.
- Therapeutic radiographer: A specialist who plans and delivers radiotherapy treatment.
- Gastroenterologist: A doctor who investigate, diagnose and treat disease related to the stomach, bowel, liver and pancreas.
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.
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.
Estimating the cost of growing the NHS cancer workforce in England by 2029 (2020) Cancer Research UK
Avril Pridmore October 25, 2020
I am interested to know how many staff you have allowed for producing the slides for the histopathologists to look at. Histopathologists do not make their own slides and there is also shortage of biomedical scientists and laboratory support staff.
Katie Roberts October 29, 2020
Thank you for your comment. Our report aims to create an overall picture of how much money is need for the key cancer professions. While we recognise the importance of all support staff across the NHS, it was necessary to place limits on the scope of our modelling and therefore we decided to focus on only the 7 professions in the cancer workforce as previously set out by HEE.
Katie, Cancer Research UK
Kath Simpson October 12, 2020
Having had an unexpected Ovarian Cancer diagnosis in March this year at the age if 64, I feel extremely thankful that I was in the care of the experts of The Royal Derby Hospital, I cannot praise the Dept enough. I had several visits to 2 GP’s who completly missed my symptoms. Having received 6 chemo’s (2 still to go shortly) plus Ultraradical surgery I am doing well and feel very positive. However had there been a bigger campaign highlighting the issues of Ovarian Cancer plus a blanket annual CA125 blood test from the age of 55?? for everyone (similar to the programme for diabetese) surely Cancer issues could be investigated much earlier before symptoms get to the stage of major treatments being required