Could a review of cancer and diagnostics staffing and career pathways reverse waiting times?

10–12 MINS

By Skills for Health | 14 June 2022

NHS waiting times for cancer treatment and diagnosis in England are now the longest on record, with the Health and Social Care Committee publishing a report urging the government to take action or risk jeopardising patient care. 

At the core of the issue is staffing. 

The national shortage of nurses, including cancer nurses, is well known – a problem seemingly exacerbated by the pandemic, with a reported 170,000 NHS staff leaving the service in the last two years. 

Despite being brought into sharp focus most recently, there has, for some time, been mounting concern among healthcare leaders regarding staffing and cancer care, which is why Health Education England South East has been collaborating on scalable strategies and solutions to overcome these workforce challenges of the NHS organisations across the geography it covers. 

In partnership with Skills for Health, Health Education England South East, local NHS trusts and Cancer Alliances are blazing a trail when it comes to opening up career pathways, finding smarter ways of working and streamlining patient journeys, with the aim of transforming cancer care and diagnostic services. Ten case studies have been developed to showcase the excellent work being undertaken in the HEE South East region based on examples of forward-thinking new roles and approaches to skills mix and workforce planning. 

East Sussex Healthcare (ESHT) is one of the NHS Trusts in question and has been a pioneer in the creation of a range of new roles to support consultants, doctors, nurses and allied health professionals caring for patients on the cancer and diagnostics pathway. 

Building upon their award-winning rollout of band 3 Doctors’ Assistants across the Trust, which cut the administrative burden of doctors in half, EHST have also developed other new roles to support cancer and diagnostic services. This includes the new Endoscopy Assistant. 

With the Trust experiencing difficulties recruiting Endoscopy Nurses for its two endoscopy sites in Eastbourne and Hastings, ESHT took the decision to develop the band 3 Endoscopy Assistant role to work alongside an Endoscopist, thus reducing the need for two endoscopy nurses. 

Also embracing new roles and routes into supporting cancer care and diagnostics is University Hospital Southampton NHS Foundation Trust, whose pathology departments handle over 6 million clinical laboratory requests a year and have adopted a series of different apprenticeship standards to enable career progression, which it is hoped, in time, will reap rewards in terms of staff recruitment and retention. This includes the new level 6 Healthcare Science Practitioner apprenticeship standard which will enable staff to achieve the BSC in Biomedical Science degree which is required to undertake the role of a band 5 Biomedical Scientist, supporting harder to recruit to services. 

The threat of a mass shortage of cancer nurses including Cancer Nurse Specialists has similarly prompted a rethink of career progression routes by Thames Valley Cancer Alliance (TVCA). 

Bringing together cancer leaders, commissioners, service providers and third sector organisations, TVCA takes a whole population approach to improving cancer services across the three Integrated Care Systems of Frimley, Buckinghamshire, Oxfordshire, West Berkshire, Bath & North East Somerset, Swindon and Wiltshire. 

Key to the approach of TVCA has been to raise the visibility and awareness of careers in cancer. This includes the roles of band 5 nurses as well as of Cancer Nurse Specialist and the Nurse Consultant. Catherine Bailey, Macmillan Nurse Consultant, in Breast Cancer works at the Royal Berkshire Breast Cancer Service in Reading which has seen the number of patients increase over the last five years with 555 patients diagnosed with new primary breast cancer in 2021 as well as having approximately 211 patients with metastatic breast cancer in the overall workload and 1339 breast cancer patients being monitored by the centre’s follow-up pathway. This has led to the Centre reviewing the breast cancer pathway and the cancer nursing and other staffing to support this demand. The Nurse Consultant role is key in the cancer pathway and this advanced role embedded in practice enables care of the patient at an independent autonomous level, with an advanced clinical decision–making and a non-medical prescribing role running independent chemotherapy and follow-up clinics, giving patients results and discussing treatment options. As there is a national shortage of Oncologist Consultants the Cancer Nurse Consultant role importantly supports the Trust and the workforce to provide these essential skills. 

Better use of resources coupled with clearer career progression routes has provided a platform for Great Western Hospitals NHS Foundation Trust (part of TVCA) to set up a new ‘Personalised Care Service’ with the help of Macmillan Cancer Support to expand patient support. 

The Service, launched in 2021, is designed to look holistically at the needs of cancer patients, enabling them to self-manage their illness better. The Service received 60 referrals in its first three months alone and is proving highly beneficial in streamlining patient pathways. 

Staffing capacity to undertake diagnostic imaging such as x-rays and scans is essential for patients on the cancer pathway and to meet the demand for routine imaging. With the challenges of an ageing workforce and being able to recruit both diagnostic and therapeutic radiographers Surrey and Sussex Cancer Alliance (SSCA) has taken a fresh approach to workforce planning. The approach is at a strategic level, and it was recognised that existing roles were limited with a lack of career progression opportunities. As a result, a Sussex Imaging Transformation Workforce Group representing services across the region supported by Health Education England South East, facilitated a patient pathway-mapping workshop, which identified a shortfall in the workforce required to undertake routine, elective computerised tomography (CT) examinations and took steps to explore alternative options as a collaborative. 

As a result of this exercise, a competence map was developed with the aim to increase skill mix and promote consistency of roles to meet service needs, identifying the need for a career framework across the CT pathway and to support new roles across the diagnostic workforce such as the Radiography Department Assistant as an entry point. 

Dawn Probert is a Senior Consultant at Skills for Health and is leading on the project along with Health Education England South East. She comments: 

“Workforce planning is crucial to identifying and alleviating blockages in the system that delay diagnosis and treatment of cancer patients. 

“Now more than ever, detailed skills analysis and robust workforce planning is required if cancer and diagnostic services as a whole are to meet patient demand in the medium to long-term. 

“What this regional project approach has demonstrated is that there are many positive and transformational approaches and roles which have been developed and utilised to finding solutions to the recruitment, retention and training of the workforce to improve cancer patient journeys and diagnostic services. 

“The development of these 10 cancer and diagnostics case studies and accompanying Resource Guide are hoped to demonstrate to other NHS trusts and cancer alliances the innovative work which is already happening in the South East with workforce solutions which can be adopted by others. Designed to be scalable, they offer trusts nationwide the tools and strategies to get to grips with recruiting, retaining and developing staff and to meet the increasing demand for cancer and diagnostic services and improve patient care into the future.” 

Click here to view all 10 case studies.

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