An oncology workforce fit for the future

To continue delivering high-quality and patient-centred care, the future oncology workforce of the NHS needs to be agile, expansive, and diverse. MSD spoke to experts to share their thoughts on what this might look like…

Remarkable progress is being made in novel areas of cancer research, which are contributing to the diagnosis and treatment of the disease. With recent reforms in UK clinical trial regulations, patients have the potential to access new cancer-targeting drugs quicker than ever before. In order for UK patients to have the best opportunity to participate in the latest commercial clinical trials, we need to see urgent implementation of the Lord O’Shaughnessy review recommendations, to address the major delays when approving new studies and recruiting patients.

Despite advancements in oncology research and development, the burden of cancer on healthcare systems continues to rise. By 2040, more than half a million people across the UK will be diagnosed with cancer each year. Record numbers of people in the UK are coming forward to have cancer checks and screenings (10,000 per day) and subsequently receiving diagnoses (around 6%). This is important progress, as it enables people to be treated at earlier stages of disease (stage 1 or 2) when survival prospects are typically higher. Although this is a step in the right direction, the challenge is to consistently deliver on screening programmes and provide timely treatment to continue improving cancer outcomes.

As the demand on the NHS continues to increase, it’s imperative that the oncology workforce in the UK is equipped with the expertise, skills, and resources to deliver high-quality, patient-centred care. Health Education England continues to invest in the education and training of the NHS’ oncology workforce, but pressures on healthcare services will continue to rise, necessitating expansion of the workforce to address both existing capacity challenges and growing demand.

To meet this growing demand, the NHS needs a workforce with capacity to support clinical research and patients in clinical practice. Building an oncology workforce fit for the future will require even greater collaboration between healthcare professionals, healthcare system decision-makers, industry leaders, policymakers, and patient communities. We spoke to experts at MSD and Prostate Cancer UK about some of the challenges that need to be addressed.

Continuing to tackle health inequalities

Every year, over 90,000 people in the UK are diagnosed with a less survivable cancer, such as lung, pancreatic, liver, oesophageal, stomach, and brain cancers. Deaths from less survivable types of cancer account for over 40% of all deaths from disease in the UK and contribute up to a quarter of all cancer diagnoses.

David Long

David Long, head of oncology at MSD, recalls a report published by MSD, with input from the Less Survivable Cancers Taskforce, on inequalities in treatment and outcomes of less survivable cancers: “In order for the recommendations of this report to be realised, we require a workforce that has the capacity to address health inequalities, be it from a workforce planning perspective or by ensuring members of the existing workforce are aware of how they can best support all patients.” The NHS recognises that people from lower socioeconomic areas have increased risk of cancer, increased risk of late-stage diagnosis, and have poorer prognosis, Long says, “It’s important the oncology workforce is fit for the future – especially when it comes to less survivable cancers.”

Chronic understaffing is widely acknowledged in disciplines such as oncology, radiology, pathology, and nursing, roles that are integral in ensuring all patients with cancer receive high-quality care. The strain on NHS cancer services is also recognised by the UK public, with 79% of surveyed people agreeing that the NHS lacks adequate staffing and resources to consult, test, and treat all patients with cancer effectively.

“The workforce shortfalls must be addressed by both additional recruitment and by supporting healthcare professionals already within the oncology workforce to work to the best of their ability,” says Long. “Reducing the administrative burden on clinical roles needs to be prioritised through expanding the number of non-clinical roles within the workforce – for example, recruiting pathway navigators. This would give the clinical staff more time to support the increasing number of newly diagnosed patients to access innovative treatments as soon as possible.”

Keeping the patient experience at the heart of oncology research, development, and healthcare

Developments in prostate cancer continually shift the demands on the workforce. But with the number of patients diagnosed only expected to grow, it’s essential that the workforce is able to deal with this increasing workload in the future, allowing them to give the personalised and consistent support that makes a huge difference for patients.

Joe

Joseph Woollcott, policy & health influencing manager at Prostate Cancer UK, says, “We know that clinical nurse specialists (CNSs) are key to patient experience and outcomes, and men who have access to a CNS consistently report a better experience. To maintain this high standard of care, we need a systematic, proactive approach to recruitment, training, development, and retention of nurses and other staff. To support this, we offer a range of health education and are aiming to publish a new professional framework later this year to make the career path for junior nurses more transparent and accessible, while reducing variation in services across regions.”

“But without a comprehensive strategy to address shortages and future-proof the entire cancer workforce, frameworks like this won’t be enough. That’s why we’re working closely with other charities as part of One Cancer Voice to call on the government to take concrete steps to address this issue, so cancer patients get the care and support they need now and in the future.”

Prioritising collaborative relationships between the NHS and pharmaceutical industry in the here and now

Partnerships between pharmaceutical companies and the NHS can streamline the patient pathway to help enable patients to access treatment sooner.

Rachel

MSD is working closely with the healthcare system to improve the time between diagnosis and treatment of cancer. Rachel Houlding, national healthcare lead for oncology at MSD, says, “Better planning ahead and support for healthcare staff is required to enable the NHS to adopt innovations of the future.”

MSD continues to work with Cancer Alliances and NHS Trusts by mapping out cancer care pathway challenges and solutions. For example, MSD hosted a capacity workshop with a Trust and Cancer Alliance, which helped 140 patients. This demonstrates the profound benefits of bringing together the NHS and industry to improve patient care.

Diversifying clinical trials to ensure cutting-edge medicine reaches patients sooner

Patient access and recruitment into clinical trials in the UK has been slowly declining. Participation in phase 3 clinical trials in the UK, between 2017–2021, decreased by 48% and the number of cancer clinical trials initiated in the UK per year has also decreased, by 41%. Research from 2020 in the UK indicated that 63% of patients with cancer would consider receiving treatment as part of a clinical trial, yet many are missing out on enrolment due to lack of awareness.

christoph

Christoph Hartmann, director for medical affairs at MSD, says, “We need to improve the accessibility of clinical trials for patients with cancer and ensure that clinical trial designs comprise a diverse population, including people with different protected characteristics.” Hartmann added, “With great progress being made in oncology therapeutics research and advancements in technology, the existing systems and structures used for data collection are increasingly inadequate.”

For example, the time and cost implications of enrolling patients into some clinical trials could be reduced if the biomarker status of patients was accessible in a centralised database. These possibilities emphasise the need for accurate, standardised national data on cancer patients.

“To deliver both diverse and efficient clinical trials, we require a skilful workforce that is trained in conducting high-quality trials with a culture in the NHS that values them,” says Hartmann. Lord O’Shaughnessy’s recent review of commercial clinical trials recommended that the NHS should use the upcoming NHS Long Term Workforce Plan and UK Recovery, Resilience, and Growth (RRG) Research Workforce Strategy to establish a Clinical Trials Career Path for training critical research roles – realising this recommendation is essential to create an oncology workforce that is fit for the future.

Investing to expand the NHS workforce

Critical shortages in key staff and resources could be mitigated by implementing long-term strategic plans across cancer care pathways.The Royal College of Radiologists found there is currently a 15% shortfall in clinical oncologists, which is projected to increase to 25% by 2027, and a 29% shortfall in radiologists. As a result of shortages, treatment is being delayed.

Harriet

Harriet Adams, director of oncology policy and communications at MSD, says, “MSD recognises the acute need for an NHS Long-Term Workforce Plan, alongside the funding required to implement its recommendations. Not only is this critical for outlining the needs of the future oncology workforce, but also in enabling capacity building within the existing workforce.”

“While there is more to do, we will continue to work with others in the cancer community to address the challenges the NHS workforce faces because we know we are stronger together. Ultimately, through our work at MSD and collaborations with healthcare services and cancer charities, we believe we can help to redefine what survival means for cancer patients – finding ways to give people not only more time, but better quality of life in the time they have.”

David Long is head of oncology at MSD

Joseph Woollcott is policy & health influencing manager at Prostate Cancer UK

Rachel Houlding is national healthcare lead for oncology at MSD

Christoph Hartmann is director for medical affairs at MSD

Harriet Adams is director of oncology policy and communications at MSD

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