RCR responds to Scottish Government’s cancer action plan

Tuesday 22 December 2020

The RCR has praised the aims of the Scottish Government’s new cancer action plan, released earlier this month, while calling for further detail on workforce and resourcing.

The cancer recovery plan, published on 9 December, promises to spend £114.5m on strengthening and redesigning Scottish cancer services up to March 2023. Commitments include a single point of contact for cancer patients throughout their care journey and a focus on “prehabilitation”, as well as the imminent creation of Early Cancer Diagnostic Centres (ECDCs) to fast-track diagnosis.  

Responding to the plan, Dr Nazia Mohammed, Chair of the RCR’s Standing Scottish Committee, said:

“Its aims are laudable, and the plan highlights a wide range of new and ongoing partnership initiatives between government, the NHS, charities and the clinical community to improve cancer pathways, early diagnoses and patient access to precision medicine and personalised care.

“However, various actions are short on detail – for example, around the creation and resourcing of ECDCs – especially given the relatively quick timescales involved.

“It also fails to paint an accurate picture of workforce constraints in hospital imaging and non-surgical oncology, as well as shortages across other medical specialties and allied health professions that are vital to cancer services.”

The cancer plan considers public awareness campaigns to increase early detection and screening uptake, ongoing oversight and reassessment of cancer pathways and metrics, and support for emerging treatments.

Commenting on various radiology and radiotherapy actions, Dr Mohammed added:   

“The RCR supports the concept of diagnostic hubs to speed up cancer detection and treatment, and it is encouraging to see clear funding earmarked for their creation. However, questions remain about how these centres will be housed and staffed – we therefore look forward to more specifics as funding bids emerge.

“The mobile scanners referenced in the plan are already in use, and while any extra equipment capacity is welcome – as COVID-19 continues to have a serious impact on scanning throughput – Scotland needs yet more scanners and they would need to be fairly distributed across the country to  realise the plan’s aim of equal access to healthcare.

“We strongly support mention of a national plan for radiotherapy and look forward to working with officials on its development. Such a plan, and commitments to embed clinical trials and radiotherapy planning tools across Scottish cancer centres, will require additional guaranteed funding for service improvement. The rolling investment to upgrade linear accelerator machines and widen access to precision radiotherapy is hugely welcome, and the RCR and the radiotherapy community would be keen to hear more detail on planned hardware and related IT procurement.”         

The plan acknowledges the pressures faced by cancer staff during the COVID-19 pandemic, and lists actions to support clinicians and plan for future workforce requirements.

However, it misses the extent of ongoing workforce issues.  

Dr Mohammed continued:

“While there is much to support in the plan, we are disappointed that the chronic shortfalls in radiology and radiotherapy staffing have been overlooked.

“New diagnostic pathways and scanners will not function without more staff. RCR figures show Scotland has just 13 more consultant radiologists now than in 2014. We need another 141 consultants to keep up with pre-covid levels of demand, outside of introducing new diagnostic models. We are grateful that recent increases in trainee numbers are now starting to show in our workforce figures, but more work is desperately needed to boost and retain the radiologist workforce in Scotland.

“The consultant clinical oncologist workforce has increased over recent years, with RCR figures showing growth of 43 per cent – Scotland has 25 more consultants than it did in 2014. However, our figures show this workforce remains short-staffed and growth is stalling. If nothing improves, Scotland will only have three more clinical oncologists in 2024, and it hard to see how we will be able to keep up with the demand for cancer care. 

“Meanwhile, the government’s cancer plan makes no reference other critical team members of imaging and cancer treatment, such as radiographic staff, who are fundamental in the scanning and treatment of cancer patients. Right now, many Scottish imaging departments are unable to extend operating hours to help tackle spiralling post-covid waiting lists because their already-stretched radiographer teams are having to shield or self-isolate.

“In summary, this document opens the door to exploring new treatment pathways, which will need to be resourced appropriately. However, we remain cautious about its realisation, given the ongoing uncertainty around the post-Brexit, post-COVID-19 financial environment which awaits us in 2021 and beyond.”