New reports show staff shortages continue to hold back cancer care

Image of an MRI scanner and a radiographer

Two new reports by the Royal College of Radiologists (RCR) have found that the UK had a 17% shortfall of clinical oncologists, and a 29% shortfall of consultant radiologists, last year.

The latest findings have highlighted the impact of workforce issues on the ongoing patient backlog and patient outcomes across UK nations.

These reports further highlight the Government’s persistent failure to offer a long-term solution to the chronic shortages in the cancer workforce. We need a plan that works for all, and this must include concrete steps to grow the specialist cancer workforce we so desperately need.

Michelle Mitchell, chief executive of Cancer Research UK.

What does the data show?

The new reports are based on 100% response-rate surveys of Cancer Centre Heads and Clinical Directors within clinical radiology.

The reports revealed that the UK is 189 trained clinical oncologists short of what the country needs to deliver improved cancer care, while there are currently 1,621 fewer radiologists than required.

This 17% shortfall in clinical oncologists was the same percent reported in 2020, despite an increase in activity since then. Considering an aging population and associated increase in cancer incidence, this figure is expected to increase to 26% by 2026, based on current projections.

The reports have also predicted that based on current projections, the existing 29% shortfall of clinical radiologists – healthcare professionals who use medical imaging to diagnose, treat and manage disease – will grow to 39% by 2026.

While on the surface, this looks like an improvement on 2020’s 33% shortfall, when we factor in the reduced demand for radiology services during the pandemic, it’s a minimal improvement and without further investment, the gap will continue to rise when factoring in rising demand of these services.

At the same time, vacancy rates for clinical radiologists have remained worryingly unchanged, varying between 9 and 11%, over the last 5 years. It is extremely concerning there are still over 200 vacancies across the UK that have been unfilled for a year or more.

“Whenever I speak to consultant radiologists and consultant oncologists, the number one issue is workforce,” says RCR President, Jeanette Dickson. “The situation we’re in is simply unsustainable, and as these reports show, the impact of doctor shortages is being felt across the country and affecting our ability to diagnose devastating illnesses such as heart disease and stroke, but also our ability to diagnose and treat cancer in a timely manner.”

Regional disparity

The latest reports also showed regional disparities in the delivery of cancer care across the UK.

While in London the census does not show any shortfall of clinical oncologists, North and West Wales has a devastating 54% shortfall, and the East Midlands has a 34% shortfall with 75% of vacancies in the region vacant for over a year.

Similarly, workforce growth amongst clinical radiologists in Scotland is at an all time low at only 3% per year, with 67% of vacancies unfilled for a year or more.

This unequal playing field means there are patients in some regions who may not be receiving the same access to the health services they require which can, in turn, directly impact patient outcomes and mortality rates.

“UK cancer survival currently lags behind comparable countries, and despite the tireless work of the NHS, there is unacceptable variation across the country in the ability to deliver timely cancer care,” says Mitchell.

Reports of low morale

The survey also gathered data on workforce morale and staff burnout across the NHS and reported that staff burnout is a key contributor to staff shortages.

Of the clinical directors that completed the survey, 98% say they are concerned about workforce morale, stress and burnout in their radiology departments, while 100% of of Cancer Centre Heads of Service cited the same concern within oncology departments.

Last year, a British Medical Association (BMA) report found that 25% of surveyed members were considering a career break and 21% were considering leaving the NHS altogether.

The impact of stress and fatigue is linked to decreased productivity, medical errors, early retirement, reduced staff retention and system failure. And, as the clinical radiology report highlighted, the key driver of stress and burnout is issues with workforce.

The impact on patients

As well as having significant financial implications, with radiology departments becoming reliant on expensive locums, the reports find that failure to address these critical workforce shortages will ‘severely impact backlog and patient outcomes.’

The pandemic has been a devasting time for people affected by cancer with many experiencing unacceptably long waits for vital tests and treatment once they’re in the system and one of the lasting impacts of COVID-19 has been increased imaging waiting times for patients.

In fact, in England, December 2021 figures showed that the 62-day treatment target was still being regularly missed, with only 67% of patients treated within 2 months of urgent GP referral. Significantly, every month that cancer treatment is delayed can increase the risk of death by 10% – a number that continues to increase the longer treatment is delayed.

This latest radiology census found that 97% of clinical directors said that they are concerned about the backlogs and delays patients are facing on a daily basis, while 81% note concerns about patient safety in their trust or health board, primarily due to workforce shortfalls.

In addition, 63% of clinical directors believe they do not have sufficient clinical radiologists in their departments to be able to deliver safe and effective levels of patient care

To tackle the workforce shortages outlined in these reports, and deliver the care people affected by cancer deserve, Cancer Research UK are calling on the Government’s upcoming 10-year cancer plan to be followed by an additional plan for the healthcare professions key to diagnosing and treating cancer – including clinical radiology and oncology.

This should include projections of the future skills and staffing numbers needed to deliver the strategy and, crucially, must be underpinned with the long-term investment needed to deliver it.

“Sajid Javid’s upcoming 10-year cancer plan is a vital opportunity to deliver a cancer plan for all,” adds Mitchell.

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