More Could Be Spent on Recruiting and Training Cancer Staff if the NHS Is to Provide a World-Class Cancer Service


(The RAND Blog)

A nurse checks the dosage on his digital tablet supervised by his staff nurse, photo by sturti/Getty Images

Photo by sturti/Getty Images

by Jenny George

December 10, 2020

The nation's eyes have been focused on the NHS during the COVID-19 pandemic and on the efforts of NHS staff to help those affected. But while tackling COVID-19 is paramount, the NHS continues to face other critical healthcare needs. Research carried out by the Cambridge Centre for Health Services Research (CCHSR), a collaboration between RAND Europe and the University of Cambridge, suggests that action is needed now to recruit and train more NHS staff in certain key cancer-related roles if it is to meet its ambitions for improving cancer services over the next 10 years.

Cancer is a leading cause of death in the UK. Approximately one in every two people will develop cancer at some point in their lifetime and over 400 people die from the disease every day. As England's population has increases and people live longer on average, more and more people each year are being diagnosed with cancer and are being treated and supported by NHS staff across a wide range of specialisms.

Against this background, both the government and the NHS have placed a strong emphasis on cancer in their plans and commitments. For example, one of the key aims of the NHS Long Term Plan, published in 2019, was to improve early diagnosis of cancer and cancer survival rates. But the diagnosis, treatment, and support of people living with cancer relies on a range of skilled NHS staff performing and reporting on diagnostic tests and providing different forms of treatment and support. Many of these key cancer-related professions have been under pressure, with high numbers of vacant posts and staff shortages.

Staff shortages have a real impact on people who are living with cancer. The government has acknowledged that too many people are still currently being diagnosed too late. And capacity constraints, particularly due to staff shortages in diagnostic services, are one of the factors influencing the waiting times for cancer treatment, which were growing even before large scale disruption caused by the current pandemic. The long-term effects on NHS staffing of the COVID-19 pandemic, as well as the UK's exit from the European Union, are yet to be seen but are likely to be significant.

The long-term effects on NHS staffing of the COVID-19 pandemic, as well as the UK's exit from the European Union, are yet to be seen but are likely to be significant.

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Ensuring that there are enough staff in key cancer-related professions is a vital part of improving cancer services and their outcomes for patients. Health Education England (HEE) plays a crucial role in this, as it is responsible for workforce planning, education, and training.

In 2018, HEE published a cancer workforce plan which looked at whether the cancer workforce would be able to cope with increasing demand for cancer care. The plan raised concerns about potential NHS staff shortages in seven key specialisms that were closely related to cancer diagnosis and treatment: clinical and medical oncology, gastroenterology, histopathology, clinical radiology, diagnostic radiography, therapeutic radiography, and specialist cancer nursing. The plan estimated that, to deliver world-class cancer services by 2029, staff numbers would need to grow by 45 per cent in these professions.

The aim of the CCHSR study, which was conducted on behalf of Cancer Research UK, was to develop a model to estimate how many more staff would be needed to expand the workforce to reach the 45 per cent target, and what the additional cost to HEE would be. We did this by modelling what might happen to staff numbers for each of the seven professions, if recent trends in recruitment, leavers, and retirement continued.

There was some good news for the NHS. Our modelling found that if current investment levels are retained, most of the seven key cancer workforces are estimated to increase to some degree between now and 2029. We estimated that by 2029, there would be 8,000 more NHS staff, working in one of those seven key professions, bringing the total to almost 37,000. However, this increase would not be enough. Without additional action, we estimated that the number of NHS staff in these professions would fall almost 5,000 short of the hoped-for 45 per cent overall increase in numbers.

Securing 5,000 more staff over the next decade may not immediately sound too stretching. But acting to recruit and train more staff could only be successful in getting sufficient numbers in post by 2029 if it were to happen without delay. These are specialist posts. Training to be an oncologist, for example, may take about nine years, so any additional funding to recruit specialists to benefit cancer patients in 10 years' time may need to be significantly frontloaded.

We estimated how much more it might cost HEE to grow the cancer workforce by 5,000 staff through training alone. The costs vary across the different cancer professions. It costs HEE more to train medical doctors than radiographers or nurses, even though the numbers required for the latter are larger. But overall, we estimated that growing the workforce by the additional 5,000 staff solely by increasing training opportunities within the NHS would cost HEE about £260 million (approximately six per cent of its annual budget).

In July 2020, the NHS published its NHS People Plan 2020–21, which took some important steps in the right direction. The plan recognised staff shortages in cancer services and included some targets to tackle this. For example, it committed to train 450 radiographers, and provide training grants for 350 nurses to become cancer nurse specialists and chemotherapy nurses in 2021. It also set out short-term actions to increase staff numbers such as promoting international recruitment.

But while these are very welcome commitments, our modelling estimates that these commitments will not be enough to provide the world class cancer service that Health Education envisaged.

Cancer is just one sector where the NHS needs staff—but given the high and increasing incidence of cancer, and the importance of early diagnosis for improving chances of survival, it is a critical one for healthcare. We are still yet to see the full impact of the current pandemic or of leaving the European Union on our NHS staff. But it is extremely clear that decisions made now on funding NHS staffing increases will doubtless affect people diagnosed with cancer in the decades to come.

Jenny George is a senior research leader at RAND Europe.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.