Now that half of us will get cancer at some point in our lives why can’t we all have the best chance of beating it? Figures from Cancer Research UK this week illuminate how government inaction on NHS staffing is denying patients early access to diagnosis and treatment – writes Paul Evans. 

Every year around 115,000 cancer patients in England are diagnosed too late to have the best chance at survival, according to a fresh analysis from the cancer charity.

All the evidence points to the fact that catching cancer early provides a much better chance of successful treatment, but Cancer Research UK believe a lack of capacity is the biggest impediment.

Criticising the government’s progress in increasing the NHS workforce in critical areas like diagnosis they highlighted that 1 in 10 of these posts are currently unfilled.

“there’s no plan to increase the number of NHS staff to cope with demand now or the growing numbers in the future” says Emma Greenwood, Cancer Research UK’s director of policy.”

Bold promises

Last year the government pledged to catch 75% of stage 1 and 11 cancers by 2028. That would mean a big step up in activity – with an extra 100,000 patients diagnosed early each year, but how realistic is this when currently cancer services are struggling to tread water.

Hospitals are continuing to miss their targets to start treatment quickly according to the latest NHS data for cancer waiting times. The current commitment is a maximum wait of 62 days from the time of referral by a GP, in fact nearly a quarter of patients wait longer

A dossier of evidence collected by the Hospital Consultants and Specialists Association (HCSA) confirms the problems with understaffing. A consultant radiologist reported that “Scan report turnaround time has gone from one week to over a month. Unexpected and critical findings are going unreported for weeks. We are now just firefighting.”

The HCSA report that delays of five to six weeks for scans are common and patients are turning up to outpatient appointments but leaving without their results because scans are not available.

Despite a shortage of over 100,000 staff across the NHS and dire warnings that this is projected to rise to 250,000 by 2030 without the proper action, the government response has been painfully slow.

Missing plans

NHS England omitted any substantial workforce strategy from its 10-year plan for the NHS, launched in January. When the plan finally arrived, it was an interim plan, widely welcomed for its intentions and analysis, but stymied by a lack of the essential funding that NHS leaders need to press on with training and recruitment.

Crucial treasury spending decisions were due this Autumn but have once again been delayed, probably until next year. The government is mired in political crisis and have lost all impetus on this crucial element in the NHS recovery.

Meanwhile services are crying out for decisive support. NHS leaders, eyeing up another tough winter are left to struggle with growing demand, a flagging workforce and compromised services.

Just this week a BMA survey warned that Nine in 10 doctors fear a ‘toxic combination’ of rising workload and understaffing will force them into making mistakes. The unified call being made from across the service is “give us more staff!”

The Government was told about severe staff shortages in NHS cancer care back In July 2015, according to the chair of the Independent Cancer Taskforce, Sir Harpal Kumar,

“It’s totally unacceptable that these shortages could now lead to delays in patients getting treatment.”

The Government defence is that they have already committed an extra £20.5 billion to the NHS over five years, but economists – including their own, have concluded that this investment is not enough to expand capacity and does not include the funding to train and hire new staff.

The Chancellor, Sajid Javid announced that the government will invest £250 million on new artificial intelligence technologies to help relieve the workload of doctors and nurses, but health experts remind us that new technology would need time to become proven and this that would not fill the gaping hole in the workforce.

Capacity shortfall

Right now, staff shortages are affecting every part of cancer care according to work commissioned by Cancer Research UK. It is estimated that by 2027, the NHS needs:

  • An additional 1,700 radiologists – people who report on imaging scans – increasing the total number to nearly 4,800
  • To nearly triple its number of oncologists – doctors specialising in treating patients with cancer – a jump from 1,155 to 3,000
  • Nearly 2,000 additional therapeutic radiographers – people who give radiotherapy to cancer patients – increasing the total to almost 4,800

The staffing crisis is double edged. There is not enough money to train the specialists of the future, but also many existing posts cannot be filled.

The Royal college of Radiologists says that One-in-six UK cancer centres now operates with fewer clinical oncology consultants than five years ago.

Vacancies for clinical oncology posts are now double what they were in 2013 – with more than half of vacant posts empty for a year or more.

Good and bad

Despite all the pressures, important progress has been made with improving services over the last 20 years. Cancer networks have adopted and shared the most effective techniques and survival rates have risen across many of the common cancers.

However, the UK lags still behind other countries, performing worse than Australia, Canada, Denmark, Ireland, New Zealand and Norway, a study in Lancet Oncology found. Although based on data between 1995-2014 it backs up that case that the NHS needs a step-change in early treatment to catch up.

Sara Hyam who helped launch Cancer Research’s campaign for more staff is confident that the problem does not lie in clinical approaches and believes the NHS has staff and treatments to match the best available anywhere in the world. The primary issue is that we are not treating patients early enough to give them the best chance at full recovery.

Shortages of staff are not the only factor: patients can be reluctant to acknowledge their symptoms and visit GP and in the past GPs have not always picked up on warning signs, but both of these factors are showing signs of improvement.

Broken promises cost lives

Healthcare is complex, but the keystone to building a service that can meet our needs is a resolute plan to put trained staff in the right posts to raise capacity.

Our government have been given this message loud and clear. Staff surveys, academic studies and the emotional experience of patients all echo the same themes.

Faith in politicians is at its lowest, but on the NHS and cancer specifically, they have lain out a string of powerful promises and asked to be judged on them. With an election shortly upon us we will no doubt have to listen to more earnest pledges, but further inaction in the face of these basic health needs should rightly be regarded as a crime of neglect.

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Paul Evans
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director of the NHS Support Federation

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