full team ahead

103 Pages·2017·2.21 MB·English

by  Camilla Pallesen

F
ULL TEAM AHEAD:
UNDERSTANDING THE
UK NON-SURGICAL
CANCER TREATMENTS
WORKFORCE
DECEMBER 2017
Full team ahead: understanding the UK non-surgical cancer treatments workforce

CONTENTS

LIST OF FIGURES AND TABLES .............................................................................. 4

EXECUTIVE SUMMARY ......................................................................................... 5

1 INTRODUCTION ............................................................................................... 11
2 MODEL FOR TREATMENT WORKFORCE PLANNING ......................................... 15
3 THE CURRENT WORKFORCE ............................................................................ 17
4 HORIZON SCANNING ....................................................................................... 28
5 TEAMWORK AND SKILL MIX ............................................................................ 33

IMPLICATIONS FOR WORKFORCE GROUPS
6 CLINICAL SCIENTISTS ....................................................................................... 45
7 CLINICAL TECHNOLOGISTS .............................................................................. 47
8 NURSES ........................................................................................................... 53
9 ONCOLOGISTS ................................................................................................. 58
10 PHARMACISTS ............................................................................................... 66
11 THERAPEUTIC RADIOGRAPHERS .................................................................... 68

12 CONCLUSIONS ............................................................................................... 73

APPENDICES ....................................................................................................... 74
1. AREAS OUT OF SCOPE ............................................................................... 74
2. DATA COLLECTION ISSUES ........................................................................ 74
3. AVAILABLE DATA FROM PROFESSIONAL BODIES AND CHARITIES ............. 75
4. SITE VISITS ................................................................................................ 78
5. FULL SURVEY ............................................................................................. 78
6. BEST PRACTICE MODELLING METHODOLOGY ........................................... 83
7. SKILLS MIX CASE STUDIES ......................................................................... 92
REFERENCES…………………………………………………………………………………………………102

2
Full team ahead: understanding the UK non-surgical cancer treatments workforce

REFERENCE
This report should be referenced: ‘Cancer Research UK (2017) Full team ahead: understanding the UK
non-surgical cancer treatments workforce’.
AUTHORS
Katie Burns 2020 Delivery

Mike Meredith 2020 Delivery

Matthew Williams Institute of Employment Studies

Clare Huxley Institute of Employment Studies

Camilla Pallesen Cancer Research UK

ACKNOWLEDGEMENTS
Cancer Research UK commissioned 2020 Delivery and Institute of Employment Studies to carry out
this research study.

We are grateful for the valuable input of our advisory group. This group was comprised of Diane
Gagnon, Liz McSheehy, Jane Barrett, Harriet Adams, Fiona Ingleby, Karen Darley, Fiona Dennehy,
Maggie Kemmner, Helen Beck and Camilla Pallesen.

It is particularly worth highlighting the contributions of Diane Gagnon and Liz McSheehy, who ensured
that the views of people affected by cancer were represented throughout this research.

We are also very grateful for the contributions of our clinical panel: Andy Beavis, Andrew Goddard,
Charlotte Beardmore, David Bloomfield, David Cunningham, Jeanette Dickson, Helena Earl, Jemimah
Eve, Harriet Gordon, Spencer Goodman, Simon Grumett, Johnathan Joffe, Alison Norton and Peter
Selby.

We are grateful to all health professionals who participated in our survey and interviews.

ABOUT CANCER RESEARCH UK
Cancer Research UK is the world’s largest independent cancer charity dedicated to saving lives
through research. It supports research into all aspects of cancer and this is achieved through the work
of over 4,000 scientists, doctors and nurses. In 2016/17, we spent £432 million on research institutes,
hospitals and universities across the UK. We receive no funding from the Government for our research
and are dependent on fundraising with the public. Cancer Research UK wants to accelerate progress
so that three in four people survive their cancer for 10 years or more by 2034.

Cancer Research UK is a registered charity in England and Wales (1089464), Scotland (SC041666) and
the Isle of Man (1103)
3
Full team ahead: understanding the UK non-surgical cancer treatments workforce
LIST OF FIGURES AND TABLES
Figure 1 Site visit locations
Figure 2 Representation of modelling methodology
Figure 3 Best practice model for breast cancer
Figure 4 Proportion of staff in UK nations
Figure 5 Number of staff per million people
Figure 6 Annual UK change in numbers
Figure 7 Clinical technologists compared to best practice model
Figure 8 Time spent by clinical technologists
Figure 9 Future workforce projections for clinical technologists
Figure 10 Skill mix impact for demand of clinical technologists
Figure 11 Time spent by surveyed chemotherapy nurses
Figure 12 Time spent by surveyed clinical nurse specialists
Figure 13 Oncologists compared to best practice model
Figure 14 Oncology workforce projections
Figure 15 Potential of skill mix for oncologists in 2022
Figure 16 Therapeutic radiographers compared to best practice
Figure 17 Time spent by surveyed therapeutic radiographers
Figure 18 Therapeutic radiography workforce projections
Figure 19 Skill mix impact for therapeutic radiographers
Figure 20 High-level breast pathway representation
Figure 21 Radiotherapy delivery pathway
Figure 22 Chemotherapy delivery pathway
Figure 23 High-level breast cancer treatment pathway
Figure 24 High-level lung cancer treatment pathway
Figure 25 High-level prostate cancer treatment pathway
Figure 26 High-level bowel cancer treatment pathway
Figure 27 Head and neck cancer treatment pathway – local
Figure 28 Head and neck cancer treatment pathway – local/regional
Figure 29 Head and neck cancer treatment pathway – metastatic
Figure 30 Non-Hodgkin lymphoma treatment pathway

Table 1 Survey responses – compared to total workforce
Table 2 Size of UK workforce, 2015
Table 3 Trends in headcount numbers by nation
Table 4 Additional hours spent by staff
Table 5 Non-UK nationals in workforce, England
Table 6 Skill mix opportunities in Systemic Anti-Cancer Therapy
Table 7 Skill mix opportunities in radiotherapy
Table 8 Workforce projections for clinical oncologists
Table 9 Workforce projections for medical oncologists
Table 10 Aggregation of cancer sites
4
Full team ahead: understanding the UK non-surgical cancer treatments workforce
EXECUTIVE SUMMARY
More than 360,000 people in the UK are
diagnosed with cancer each year1. By 2022
it is projected that this figure will reach
422,000 people2,3. Yet while more people
WE MUST IMPROVE
will develop cancer, survival is improving.
HOW WE USE THE SKILLS
Currently half of all cancer patients survive
their disease for 10 years or more. Cancer AND EXPERIENCE OF THE
Research UK wants to accelerate progress WORKFORCE, ESPECIALLY
so that 3 in 4 people survive by 2034. Early
IN LIGHT OF FUTURE
diagnosis followed by access to the best,
TREATMENT DEMANDS
evidence-based treatment is critical to
achieve this.

As we strive towards earlier diagnosis of
cancer, treatments will change.
current workforce data; a survey of the
Increasingly, treatments are tailored to an
workforce across the UK (> 2500
individual’s cancer; combinations of
responses); in-depth interviews with
treatment types are being used to target
workforce staff; and expert advice from
cancers differently and there are more
health professionals.
treatment options than ever before.

Additionally, an ageing population, often
We knew at the start of the research that
with comorbodities, means the treatment
data on staffing levels is limited across the
of cancer has become more complex.
UK. This makes it difficult for health bodies

to make well-informed decisions about
As such, ensuring better access to workforce planning7,8. For example, in
treatments is rightly a priority in the
England healthcare providers report
cancer strategies for England4, Scotland5,
staffing requirements based on projected
and Wales6. Northern Ireland does not
budgets rather than what is needed to
have an up-to-date cancer strategy at the
deliver best practice care to patients.
point of publishing this report. Having the

optimal workforce is fundamental to
Therefore, we have developed a ‘best
ensuring treatment can be provided to
practice treatment model’. This model was
meet the needs of patients.
developed through extensive clinical

consultation, to understand how patients
OUR APPROACH should ideally be treated, and the
workforce needed to do that.
Cancer Research UK commissioned this

research study to investigate the current
This gives us a picture of actual patient
and future needs, capacity, and skills of
need in cancer services, highlighting the
the non-surgical oncology workforce to
difference between the modest vacancy
provide optimal treatment to the UK
rates in the sector and the widely reported
population.
pressures and worsening performance in

UK cancer services. Our work was also
The research combined data analysis of
informed by the workforce planning
5
Full team ahead: understanding the UK non-surgical cancer treatments workforce
framework developed by the Health nurses working in cancer care.
Foundation9.
The workforce (in absolute terms) has
We consulted people affected by cancer been growing over recent years, although
throughout the report (on its scope, not to the same degree as demand for
methods and recommendations) to ensure treatment. Treatment demand has
that the views of those being treated are increased due to the growing number of
represented in this research. patients diagnosed with cancer (incidence)
or living with the disease, and the
This report presents the findings for the complexity of the treatments they need.
workforce providing systemic anti-cancer Trend data is available for medical and
therapy (such as chemotherapy and clinicial oncologists and therapeutic
immunotherapy); hormone therapy; stem radiographers. This shows that staff
cell therapy; and radiotherapy. Surgical numbers in these three roles combined
services for cancer have been explored in have grown by nearly 4% per year on
a previous report10. average over the last 3 years. However,
cancer incidence (new cancer diagnoses)
Teamwork is fundamental to the delivery alone is increasing by 2% per year. The
of these cancer treatments. The non- combination of cancer incidence with
surgical cancer treatments workforce those already diagnosed and continuing to
delivers treatments through shared have cancer treatment would mean that
responsibility and expertise. This report’s this increase in staff would not meet the
findings and recommendations are patient demand for cancer treatment.
therefore focused on how these teams
can continue to deliver excellent The current vacancy figures seem
treatment and patient care and use each relatively low. For example, the vacancy
of their skills and expertise to benefit levels for clinical and medical oncologists
other members of their team. are 3.3% and 5.3% respectively. But our
research suggests that these are
underestimates of the true workforce
FINDINGS
gaps, because:
• Many posts have been vacant for up to
CURRENT STAFF
two years.
SHORTAGES • Vacancy rates only reflect current
vacancies – services often remove a
Based on available data, there were more
job advert if they fail to fill the post
than 9,000 health professionals working in
and redesign the team structure to
non-surgical oncology treatments services
deliver the service instead.
in 2015. We were unable to develop
During our site visits, it was also widely
comprehensive workforce figures in the
recognised that there are not enough
UK due to the incomplete data sets and
health professionals trained to fill all
lack of systematic collection of these
vacant posts.
workforce groups, particularly for nurses

and pharmacists. This includes
Nearly 3 in 4 (73%) of our survey
inconsistency of job titles and variations
respondents identified staff shortages as a
between roles, as well as lack of
barrier to providing efficient cancer
accurately identified work areas, such as
6
Full team ahead: understanding the UK non-surgical cancer treatments workforce
treatments and excellent patient with other cancer treatment
experience. This results in: providers
Neighbouring centres often find
• Insufficient capacity to undertake themselves competing for scarce staff
clinical research numbers in the local labour market, and in
Staff do not feel they have capacity to some cases this means competition is
undertake clinical research. This included more likely than collaboration.
not having enough staff to deliver the
clinical trials as well as lack of time to plan • Short- vs. long-term job planning
and set up the research. Workforce shortages limit the capacity of
the services to plan for the future,
“Without time to research and develop
focusing more on reacting to current
treatments, it will feel like the early 90s
issues than long-term planning. Despite
again, when we were really behind the
rest of Europe and our techniques were treatments becoming more complex and
out of date. [In those days] our the volume of patients increasing, staffing
outcomes were right at the bottom of patterns have therefore rarely adapted to
the table” reflect this.
Head of Radiotherapy Physics
• Downgrading of patient experience • Inefficient use of the workforce’s
Whilst most staff felt able to deliver skills and experience
cancer treatments in line with standard During our site visits, many health
protocols, 43% of survey respondents did professionals highlighted the problems
not feel they had enough patient-facing with lack of administrative staff. In some
time to deliver best practice care to instances, therapeutic radiographers had
patients, including providing emotional been asked to man the reception. This is
support or comprehensive information an ineffective use of highly qualified staff.
about the treatments.
• Decreased staff wellbeing and morale
• Missed opportunities for service and increased working hours
improvement All workforce groups reported that they
Interviews and survey respondents from were working more than their contracted
all workforce groups mentioned that they hours. 43% of medical oncologists in our
sacrifice time which should be set aside survey worked more than 8 additional
for service improvement, implementing hours per week.
innovation, and training and development,
to deal with increased demand for Discussions with our panel of experts also
treatment. highlighted concerns that these shortages
would be exacerbated in the future due to
“My job is purely trying to keep the changes occurring at the moment.
wheel turning. I would love to develop Changes to funding for nurses, therapeutic
my service which is suffering from a radiographers, and clinical scientists
severe lack of research trials and heighten the importance of understanding
opportunities for patients” how changes to training pathways will
Skin medical oncologist impact the workforce supply in the future.

• Less frequent sharing of best practice
7
Full team ahead: understanding the UK non-surgical cancer treatments workforce
The Royal College of Nursing report that PREPARING FOR THE
nursing applications have decreased by a
FUTURE
quarter following the removal of the
student bursaries in England. The Institute
More staff will also be needed to deliver
for Physics and Engineering in Medicine
non-surgical cancer treatments in the
(IPEM) also highlight concerns around lack
future. We were not able to account for
of uptake of clinical technology posts in
the impact of shifting diagnosis to an
England and Wales.
earlier stage, but this should be further
RECOMMENDATIONS
examined. With treatment demand
1. Health Education England, and its increasing and a patient population who
equivalents in the devolved nations, will have more complex needs, particular
should use our ‘best practice attention needs to be paid to the
treatment model’ to project required following changes.
workforce numbers based on patient
demand, not on affordability. • Dramatic changes in treatments
The workforce will need to be equipped
2. Health Boards and Cancer Alliances for the rapid growth in the use of
should report staff shortages to health immunotherapy, and novel combinations
workforce bodies, such as Health such as radiotherapy with
Education England, based on staff immunotherapy.
needed to meet patient demand not
vacancy figures. • Development of new technologies
New software will help automate some
3. Health Education England must work. However, some new technology
address current and future staff makes the treatment techniques more
shortages by: complex and time-consuming to plan.
a. Increasing training places for clinical
and medical oncology; • Changes to treatment delivery
b. Reviewing training pipelines for clinical Some treatments, such as chemotherapy,
technology with IPEM and the will be provided closer to the patient’s
Department of Health; home. This will affect the recruitment
c. Reviewing how the removal of student practices and ways of working.
bursaries for nurses and therapeutic
radiographers is affecting workforce RECOMMENDATIONS
projections in 2018/19.
5. The UK Radiotherapy Board and the

UK Chemotherapy Board should
4. NHS Digital, and its equivalents in the
review how future changes to cancer
devolved nations, should work with
treatments will impact staff numbers
relevant professional bodies to
and skills required.
develop more standardised role
6. Further research is needed to
descriptions and codes, particularly in
understand the impact of early
nursing and pharmacy.
diagnosis initiatives and improvements

in technology on when and how

patients are treated, and the
workforce implications of this.
8
Full team ahead: understanding the UK non-surgical cancer treatments workforce
SKILLS MIX CAN HELP mix approaches are:
• Pharmacists – more pharmacists
ALLEVIATE PRESSURE
trained in non-medical prescribing
would enable prescribing to be shared,
Teamwork is fundamental to the
freeing up time for oncologists.
successful delivery of cancer treatment.
• Therapeutic radiographers – more
The non-surgical cancer treatment
therapeutic radiographers would
workforce already share their workload
enable more clinical research in
and responsibilities. Teams develop new
radiotherapy and better
ways of safely providing these treatments
implementation of complex treatment
to patients using different team members’
techniques.
skills and experiences.
• Clinical technologists – more clinical
The importance of implementing technologists would enable more
innovative ways to better utilise the mix of specialisation in dosimetry and
skills within the team – known as skills mix complex planning.
approaches – was a key finding of this
research. Better use of skills mix Further changes that would facilitate skills
approaches will require changes to the mix include:
size and skills of different workforce • Professional bodies providing more
groups. guidance on skills mix approaches.
• Cancer services exploring further
We identified 3 key skills mix implementation of open access,
opportunities: stratified and telephone follow-ups.
• Ensuring future health service
• Training more advanced clinical
contracts for the workforce groups in
practitioners;
scope reflect current and increasing
• Increasing implementation of non-
future workload.
medical prescribing; and
• Increased professional and senior buy-
• Non-medical professionals taking on
in at cancer treatment service level,
responsibility for:
facilitating implementation of skills-
o Treatment review;
mix approaches.
o Radiotherapy treatment planning; and

o Radiotherapy plan checking.
RECOMMENDATIONS
However, more capacity is needed in the
7. NHS England should share the 3 key
current workforce to adopt these changes.
skills mix opportunities identified in
For example, increasing non-medical
this research with Cancer Alliances to
prescribing will require more training for
spread innovation and encourage best
pharmacists. The knock-on effect of this is
practice.
that oncologists will need more time to

train pharmacists. Pharmacists will also
8. The UK Radiotherapy Board and UK
need additional time in their schedule to
Chemotherapy Board should work
learn new skills. As a result, the service
with the Department for Education
delivery model needs to adapt to this.
and equivalent bodies in the devolved

nations to understand how
The professions that will benefit most
apprenticeship standards can be used
from increased capacity and use of skills
9
Full team ahead: understanding the UK non-surgical cancer treatments workforce
to improve skills mix implementation. Cancer services across the UK must
address workforce challenges to optimise
9. The UK Radiotherapy Board and UK treatment delivery. This research
Chemotherapy Board should agree the demonstrates the importance of
standards needed for skills mix workforce planning driven by patient
approaches and how to implement demand, not what is affordable according
follow-up and open access to hospitals’ budgets.
approaches.
Cancer Research UK believes that
10. The Department of Health and workforce planning for providing cancer
equivalent bodies in the devolved treatment should be based on our ‘best
nations should ensure that contracts practice’ treatment model and the Health
for health professionals covered in this Foundation’s framework. This will enable
research include protected time for an improved understanding of true patient
Supporting Professional Activities such demand and the development of
as service improvement, training, and comprehensive UK workforce strategies.
clinical research.

10