Failure to tackle workforce shortages threatens cancer survival progress in England.

Abstract

The absence of any serious plan to tackle workforce shortages is threatening efforts towards improving early cancer diagnosis and overall survival rates in England, a crucial report from the Health and Social Care Committee has warned. Members of Parliament warned there was a real risk that gains made in cancer survival would be reversed as pressured health care services continue to grapple with the ongoing impact of the COVID-19 pandemic. The NHS is not on track to meet its 2028 target to diagnose 75% of cancers by stage 1 or 2, which means 340 000 people will not have their cancer diagnosed at an early stage, the committee concluded. The report follows a decision by the Committee's independent expert panel to rate the Government on progress made against cancer targets as inadequate. Although the panel welcomed the announcement of a £2·3 billion investment in community diagnostic centres, it called for commensurate scaling up of treatment pathways. None of the ambitions to tackle the pandemic backlog, improve early diagnosis, or ensure the provision of prompt treatment will be possible without addressing gaps in the numbers of clinical oncologists, consultant pathologists, radiologists, and specialist cancer nurses, according to the Committee's independent expert panel. There was little evidence of a serious effort to tackle workforce gaps, the inquiry found, and although the cancer workforce grew by 3–4% a year between 2016 and 2021, it is insufficient to address ongoing shortages amidst a cancer incidence that is increasing by more than 2% per year. According to the report, the Committee has frequently recommended the overhaul of workforce planning with independent projections of need, but the Government has failed to implement this strategy. The report calls on the Government to develop a specific plan to address gaps in diagnostic workforce and invest in sustainable long-term increases. Other recommendations included a better understanding of how deprivation drives gaps in outcomes, differential adoption of best practice around the country, and reducing red tape in clinical research, as well as faster adoption of new innovations. Jeanette Dickson (Royal College of Radiologists, London, UK), who provided evidence to the committee, agreed that workforce was the biggest issue affecting the ability to build on progress made so far. “Diagnostic images reviewed by radiologists feature in the vast majority of cancer diagnoses; yet, we have a shortfall of nearly 2000 doctors in those posts. Similarly, we are short of nearly 200 clinical oncologists who treat patients using radiotherapy,” she told The Lancet Oncology. “If we want to diagnose patients earlier, giving them the best chance of successful treatment, we have to do more scans at an earlier stage—but we do not have capacity for that.” Charles Swanton (Cancer Research UK, London, UK) said those working in cancer services had been raising these concerns for a long time. “There is going to be a huge rise in the number of cancer diagnoses over the next decade and we need to be preparing for that onslaught right now.” He added that a lot of proposals for faster and easier access to diagnostic tests were workforce dependent, from running CT scanners to histology and endoscopy services. “It really does take a multidisciplinary team.” Shortages in workforce also affect the ability to do research, he added, despite clinical trials often being very much part of a patients' treatment and not an optional extra. “We need innovation and that is only going to come about if there is access to research and that needs protected time for doctors and nurses and allied health professionals to be able to engage in research.” But, he added, with 20 years to train a consultant and 10 years for a specialist nurse, you cannot suddenly create the jobs overnight. “2028 is not that far down the road; we need to train doctors and nurses now and recruit them into these specialities.” A Department of Health and Social Care spokesperson said: “We are supporting the NHS to prioritise reducing cancer waiting times, giving people the treatment they need and tackling the COVID-19 backlog. To deliver long-term recovery and reform, our record investment in the NHS included an extra £2 billion in 2021 and £8 billion over the next 3 years to cut waiting times, including delivering an extra nine million checks, scans, and operations.”