first published on healthandcare.scot

Attendees at this week’s Scotland Policy Conference on priorities for cancer provision heard that challenges across the workforce must be addressed to ensure good cancer care – and work needs to extend beyond the central belt.

Professor David Morrison, Director of the Scottish Cancer Registry at Public Health Scotland explained that despite improved research and development for the treatment of cancers, Scotland’s ageing population will require more staff and resources in cancer services:

“The capacity to benefit from treatment is increasing all the time as we get more and more sophisticated methods of treating cancers.

“There are an increasing number of survivors. And the demographics of the country mean that we're going to get more and more people at that older age where the risks of cancer increase.

“In short, the numbers – if not the risks – of cancer will continue to increase. And going along with that, therefore, so will the resources required for both health services and other support services for cancer.”

Professor Morrison added that improved training, mentorship and better using the Cancer Registry, which contains information on all new cancer diagnoses across the country, are needed to boost Scotland’s primary prevention agenda.

He said, staff can be empowered in their clinical and research work through this high quality information on cancer occurrence, risks, treatments, and outcomes.

However, Dr Frances Yuille, the Medical Director of Education for the Royal College of Radiologists, said the latest figures reveal that meeting staff shortfalls alone remains a challenge.

Drawing on the 2022 oncology workforce census, Dr Yuille pointed to a 14% shortfall of clinical oncologists – noting that “it’s going to get worse” over the next few years, adding:

“It’s not going in the right trajectory at all. There’s not a lot of us but we are important in leading these teams but already, we need 15 more consultants to begin to deliver effective care.”

She said that the vacancy rates are “never good”, leading to an overreliance on existing staff to cover the need where possible, which does not help wellbeing or mental health:

“I'm afraid as a group of clinical oncologists that we are not coping very well. We are stressed, burned out – I don't think COVID has helped – but I think you can see just from those numbers, that we're working as hard as we possibly can.

“And some of us can't work any harder than we are. What's being asked of us is probably too much.”

In fact, half of the clinical oncologists responding to the census said they are burned out.

Around 90% of clinical directors across the UK said they have insufficient numbers of oncology radiologists to provide safe and effective care. Dr Yuille said this rings true for Scotland too, where many vacancies remain unfilled for up to a year.

Scotland’s cancer strategy

Published a year ago, Scotland’s cancer strategy focuses on strengthening the workforce through good planning, training and nurturing of staff.

Dr Yuille said NHS Education for Scotland and the Scottish government have been cooperative with this work but have so far failed to “pull through” young professionals into specialising in oncology:

“You can’t just create an oncologist overnight. A big part of the strategy was trying to improve numbers and training for staff and not only doctors, but the whole workforce pathway.

“From the prevention, the GP, primary care involvement, to radiographers, nurses, pharmacists and then the palliative care and third sector are all involved – as well as the oncology clinical role.

She highlighted the need to incorporate flexibility into the structure of the workforce, and ensuring professionals have time for development and research alongside their clinical work.

Regional differences

Dr Yuille said that there are areas of Scotland where attracting and retaining staff is more difficult, meaning “significant regional inequalities” exist in Scotland’s oncology workforce:

“The North of Scotland has half the number of oncology consultants per head of population compared to the South East.

“Recruitment is not going very well either – we were a little bit worse than the rest of the UK but the whole of the UK had poor rates.

“It’s quite worrying as while the central belt was fine – Edinburgh and Glasgow both filled their recent posts – there were only six of them.

“There were four posts in Dundee and only two of them were filled and five posts in Aberdeen – none were filled.”

She said this will also ring true for nurses and radiographers, and that training programmes currently concentrated in the central belt should be expanded to encourage applicants to train and stay in remote and rural regions.

To effectively address such gaps and inequalities, Dr Yuille said NHS Scotland and government leaders must do better in prospective workforce planning and “try to fill places before there’s a crisis”.

Currently, she adds, senior cancer clinicians across Scotland are doing their best to support each other when acute recruitment challenges arise:

“I can tell you, the training programme director who’s in Glasgow is very aware of the issues in Aberdeen and Dundee and travels up there regularly to try and help them recruit.

“So, we do have a Scotland-wide view and more recently we’ve had to work to provide services to the North and actually, the only centre that hasn’t needed extra support has been Edinburgh. We’ve had consultants to help in Glasgow, Dundee, Aberdeen, and Inverness.”

Dr Yuille says there’s currently “not enough people in the system” so they are not receiving enough trainee applicants overall, but incentives are clearly needed for people to work in the North.

Retention vs retirement

Beyond recruitment, Dr Yuille says the NHS is losing out on experience and time from consultant as despite the national retirement age being 67, the median retirement age for consultant oncologists is 54 years old.

Basic things, like flexible working patterns and working computers, as well as childcare issues for younger consultants, she explained are driving some of this early exodus.

Dr Yuille highlights these, as well as delivering a dedicated NHS Scotland recruitment campaign and improved training programmes, as key to addressing some of these gaps:

“We to be supported by those at higher levels to be more prospective and less reactive in the way we plan services.

“We just need time to lead and time to deliver change – we can do it; we just have to be more supported in this.”