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Getting the workforce we need

8.3 Past investment in the cancer workforce has been inadequate to meet the growing demand for cancer services and the requirements of new treatments.

There have been difficulties establishing specialist training posts in some cancer specialties and there are marked regional variations in staffing levels.

8.4 Many hospitals can not recruit the staff they need. For example, therapeutic radiographers are essential to the delivery of radiotherapy to patients. As at March 2000, across the country, 103 therapeutic radiography posts had been vacant for more than three months - 7% of all therapeutic radiography posts. In Northern and Yorkshire region the vacancy rate was as high as 12%.

8.5 Inflexible demarcations between different groups of staff prevent the most effective use being made of the skill and potential of our most valuable resource. There is not enough time for adequate professional and personal development. And the NHS does not have adequate processes to capture accurate information about staff numbers, recruitment and employment trends.

8.6 Cutting waiting times for cancer patients and improving the quality of treatment depend upon the ability of the NHS to employ, develop and support the staff it needs. For example, at normal staffing rates, the additional linear accelerators to be installed will require around 160 extra therapeutic radiographers. And extending the breast screening programme to screen older women up to the age of 70 will require a 40% increase in its capacity.

8.7 The experience of the Cancer Services Collaborative shows that substantial improvements in the efficiency of services can be achieved through re-organising and streamlining care (see Chapter 5). But it has also confirmed that this approach is not sufficient in itself. A step change in the size of the cancer workforce is needed.

8.8 This will take time. It is the main rate-limiting factor in the improvements to cancer services set out in this plan. It takes a total of 15 years to train a consultant, including five or six years specialist training. Other professions involved in cancer treatment - such as nurses and radiographers - also take several years to train. In the meantime other action is necessary. This will include extending the careers of staff currently working in the NHS, recruiting staff from overseas, extending the roles of staff, introducing new assistant practitioner grades and action to retain existing staff by improving their career prospects and opportunities. Cancer will form part of strategies at national and local level to tackle recruitment and retention across the board.

8.9 The cancer workforce is diverse. Some staff, such as oncologists and therapeutic radiographers, work exclusively with cancer patients. For other staff, such as pathologists, diagnostic radiographers and surgeons, cancer care forms a greater or lesser part of their overall workload. And for some cancer patients dieticians, physiotherapists, occupational therapists and social workers provide important support.

Medical workforce

Radiologists are experts in the diagnosis and staging of cancer and in the assessment of response to treatment. Demands on clinical radiologists' time continues to grow with the increased sophistication of diagnostic and interventional techniques. Their involvement in multi-disciplinary meetings is essential if appropriate treatment regimes are to be decided.

Pathologists diagnose and stage disease, through microscopic examination of tumour specimens. Increasing numbers of pathologists are needed to meet the workload. Their involvement in multi-disciplinary team meetings and the need to review tumour specimens are adding to the pressures.

Surgeons. Surgery is the primary treatment for many cancer patients and surgeons are increasingly specialising in specific types of cancer. The consultant-based service in operating theatres both for elective work and for emergency work means surgeons' time is at a premium and insufficient theatre availability sometimes prevents optimal use of surgeons' time.

Medical and clinical oncologists specialise in the treatment of cancer using chemotherapy, radiotherapy and other non-surgical treatments. Historically this country has had fewer oncologists than other comparable countries. Demands on oncologists are rising as a result of increasing incidence of cancer, the larger number of patients being treated and the expectation that all patients have their care reviewed by oncologists working in multi-disciplinary teams.

Haematologists specialise in the treatment of leukaemia and other cancers of the blood and lymph system. They also provide support for solid tumour patients treated in local hospitals, particularly out of hours. Pressures include the increase in follow-up workload as patients live longer, the need to improve blood transfusion services and continuing support to the solid tumour service.

Palliative care specialists Many palliative care specialists work in both the voluntary and NHS sectors. There is increasing demand for specialist palliative care for cancer and for other conditions.

Other health professions

Diagnostic radiographers undertake diagnostic imaging procedures and work with radiologists and other doctors carrying out interventional procedures. There are difficulties in recruiting and retaining both trainees and qualified staff.

Scientific staff. Medical physicists, biochemists and other scientific staff provide essential input to diagnostic and therapeutic services. There are considerable difficulties in both recruiting and retaining scientific staff.

Therapeutic radiographers play a major role in the planning and delivery of radiotherapy treatment to patients with cancer. They are also involved in the care and support of patients undergoing treatment. There are difficulties in recruiting new trainees and high attrition rates from training. The proposed introduction of assistant practitioners in radiotherapy will enable the potential of therapy radiographers to be explored.

Nursing Nurses are the largest single group within the cancer workforce. There is increasing specialisation of cancer nurses as site-specific cancer teams are established. There are increasing opportunities for nurses to undertake a wider range of clinical tasks. Increasing chemotherapy workloads and the growing need for palliative care nurse specialists add to the pressures.

Oncology pharmacists Pharmacists are essential for the preparation of chemotherapy treatments and for the provision of advice on cancer medication. As chemotherapy treatments are used more widely and become more complex, the role of pharmacists who specialise in oncology becomes increasingly important.

Medical secretaries The role of medical secretaries in the cancer workforce is often neglected. They are frequently the first point of contact for patients and GPs when they phone the hospital. They have an essential role in ensuring that information about patients is communicated between clinicians and increasingly they co-ordinate multi-disciplinary team meetings.

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