The Royal College of Radiologists’ latest census of clinical oncologists has found:
- The NHS needs at least another 189 clinical oncologists to meet demand
- More than half of UK cancer centre clinical directors (52%) say oncologist shortages are negatively impacting patient care
- This year’s newly trained consultants will only fill 55% of vacancies
- If nothing is done to retain exhausted staff and expand the workforce, by 2025 the shortfall of clinical oncology consultants in the NHS will be between 21–29%
The RCR collected data from the UK’s 62 cancer centres in December 2020 to find out staff numbers and issues among clinical oncologists – the expert doctors who treat cancer with all non-surgical means, including radiotherapy, chemotherapy and immunotherapy.
The survey report, released today, found consultant numbers have barely risen outside of England and are nowhere near close to meeting demand, let alone able to roll out improvements to cancer care.
Clinical oncology directors responding to the RCR census said staff shortages are leading to treatment delays, long waits and “increases in sub-optimal care and complaints”.
At the end of 2020 there was the equivalent of 913 full-time clinical oncology consultants working across the UK NHS.
An extra 46 full-time consultants joined the workforce last year – with 41 of those based in England.
Meanwhile, the number of newly diagnosed cancer patients needing non-surgical treatment across the UK was rising by an estimated 168,000 every year before coronavirus hit1.
Now, understaffed cancer teams are having to manage a return to pre-coronavirus levels of demand – but working at a slower rate due to social distancing and extra hospital cleaning – alongside a looming backlog of tens of thousands of cancer patients who missed out on diagnoses and treatment last year2.
The new RCR report shows there are now 87 vacant posts for clinical oncology consultants across the NHS – with an estimated 48 new UK recruits due to finish training to fill those jobs this year.
By factoring in doctors’ overtime as well as vacancies, the RCR calculates the real shortfall of NHS clinical oncology consultants is at least 189, or 17% of the UK workforce.
Staffing trends and shortages are also varied across the home nations.
England gained 41 clinical oncology consultants last year, but the report shows it still has a shortfall of 17%, needing at least another 154 to meet basic demand. Some English regions are more understaffed than others, with the East Midlands, North East and South West all facing a 22% shortfall of oncologists.
Wales and Northern Ireland now have above average consultant shortages, with shortfalls of 20% and 27% respectively. Scotland’s workforce is comparatively better off, with an ongoing shortfall of 15%.
Non-surgical cancer care has carried on and adapted throughout the COVID-19 pandemic, however, RCR data demonstrates how shortages are stopping consultants finding time to improve services.
Full-time consultants are recommended to spend at least 10 hours a week on training, teaching and service improvement. However, consultants only managed seven on average last year, an amount that is going down year-on-year.
As well as assessing the current state of the clinical oncologist workforce, the RCR report predicts doctor numbers and shortages up to 2025, giving two different forecasts – how many consultants will be needed to keep up with the ongoing baseline rise in cancer cases, and how many extra would be needed to roll out gold standard treatments.
If workforce trends continue, the report predicts that by 2025 the NHS will be 21% – or 272 full-time consultants – short of the number it needs to meet basic cancer care demands. It will be 29% – or 405 consultants – short of the number required to transform and level up cancer services.
The UK and devolved governments are beginning to invest more in clinical oncology and have promised rises in consultant training numbers3. However, as it takes six years to train a clinical oncology consultant, the workforce crises shows no sign of abating soon.
The RCR is urging health leaders and NHS trusts to do much more over the short-term to retain exhausted staff, especially after a poll of clinical oncologists earlier this year found that 70% were considering reducing their hours or leaving the NHS4.
Dr Tom Roques, the RCR’s oncology workforce lead and main author of the census report, said:
“The chronic, crushing pressure on the clinical oncology workforce has been emphasised yet again in our latest staffing statistics. Despite growth in consultant numbers over the past year – predominantly in England – shortages continue. To meet basic demand, right now the NHS needs nearly 200 extra clinical oncology consultants.
“Our annual census returned hugely worrying reports from cancer service leads, who told us shortages are draining staff and directly causing treatment delays and inconsistent and sub-optimal cancer care.
“Meanwhile, there are some really exciting developments in non-surgical cancer care, from fast-track stereotactic radiotherapy for prostate cancer patients, to using artificial intelligence programmes to speed up planning. But it’s hard to see how we can implement these new treatments and improve outcomes for our patients when the workforce is exhausted and facing massive patient backlogs, with no time to rest or roll out advances.
“We have seen some encouraging progress around extra training places across the UK, and it is absolutely vital that these promised uplifts are realised for the long-term.
“In the short-to-medium term, we cannot guarantee gold standard care for all patients and we have to do as much as possible to support, motivate and retain the consultants we already have. This means Government continuing to invest in cancer IT and technology and remove pension disincentives, and NHS trusts and health boards getting serious about flexible working, wellbeing support and retaining senior consultants.”
References
- The estimate for new non-surgical cancer workload is an extrapolation based on official Public Health England statistics which show 46% of new cancer patients are treated with chemotherapy and/or radiotherapy. Cancer Research UK estimates 367,000 new patients are diagnosed with cancer each year, so the RCR estimates that approximately 168,820 (46 per cent) of those new cases will have non-surgical treatment.
- Macmillan Cancer Support has estimated 38,500 fewer people started cancer treatment in England alone between March 2020 and February 2021 than over the same period the previous year
- Earlier this year, UK Government allocated funding for 50 new clinical oncology training places in England. In 2019 the Scottish Government promised the creation of two additional clinical oncology training placements, and last year the Welsh Government promised an additional four placements over future years.
- An RCR poll of 312 UK clinical oncologists conducted in April 2021 found that 20% were considering imminently leaving the NHS and 50% were planning to reduce their working hours.