Two new reports by the Royal College of Radiologists (RCR) demonstrate the scale of workforce shortages in diagnostic and cancer departments across the country and the impacts on cancer patients.
NHS cancer leaders have growing concern that workforce shortages are leading to delays in cancer diagnosis and treatment and putting patients at risk.
The research
The reports by the RCR are based on 100% response-rate surveys of cancer centre heads and clinical directors of radiology departments. They represent some of the most authoritative reports into the current state of diagnosis and cancer care in the UK.
Censuses found that in 97% of UK cancer centres, patients’ treatment had been delayed because of staff shortages over the past year. In about half of centres, shortages were causing delays almost every month which are impacting chemotherapy or radiotherapy treatment in about half of cancer centres, and weekly delays in about a quarter of centres, compromising patient care.
88% of cancer leaders are concerned that staff shortages are impacting the quality of patient care. Delays are potentially harmful to patients: every month that cancer treatment is delayed can raise the risk of death by 10%.
The RCR argues that a ticking timebomb is putting patients at risk – more doctors are retiring early, and the growing reliance on outsourcing/locums is unsustainable and expensive. A 29% shortfall in radiologists is being faced, which will rise to 40% by 2027 if action is not taken – at a time when demand for healthcare will be rising.
While the pandemic had a major impact on cancer services, this situation has been worsening for years – the main cancer target has been missed since 2014. Doctors are now having to make difficult decisions about how to prioritise patients, with some cancer centres even considering limiting access to new chemotherapy treatments or sending patients to other hospitals for treatment.
Staff shortages
The report argues that delays in patient care are not new but the current serious situation is the direct result of severe shortages in the professions critical to diagnosing and treating cancer patients. The RCR argues that the Government has failed to tackle this worsening workforce crisis, by not training enough doctors over recent years and failing to retain doctors — only one in four (24%) clinical directors said that their radiology department had sufficient consultant clinical radiologists to deliver safe and effective levels of patient care, compared to 30% in 2021 – challenging departments’ ability to diagnose cancer and other diseases swiftly.
Moreover, staff are apparently leaving due to stress and burnout, and more than 75% of clinical oncologists and radiologists who left the NHS in 2022 were under 60.
Hospitals are increasingly relying on expensive and ineffective strategies to plug the gaps – with 8% of the oncology consultant workforce made up of locums, compared to just 4% in 2020. Three in five locums have been working in oncology departments for over a year. The NHS spent £223m on managing excess radiology reporting in 2022, which is £45m more than the year before. £223m is a startling figure which could be used instead to pay for over 2,000 full-time positions.
“Demand grows and expectations grow but workforce does not match this. The result is longer waiting times for scans/reports and increased unhappiness from clinicians and patients. We are expected to do more in the same time and this can only lead to fatigue, errors and burn-out”. – consultant radiologist
The report argues the data paints an alarming picture for the future of the UK, with rising demand for healthcare and rising cancer incidence, driven largely by our ageing population. “If the Government does not act, we will have a 40% shortfall of radiologists by 2027 – up from 29% today. We will also face a 25% shortfall in clinical oncologists, up from 15% today”.
Regional disparities
The report highlights the inequalities that exist across the country. There are fewer doctors per patient in rural areas compared to urban areas, and more long-term unfilled vacancies. London has 10.5 oncologists for every 100,000 older people (55+), compared to just 4.7 in the Midlands and 2.1 in North/West Wales.
Additionally, forecast retirement rates are very high in Wales. One in four (24%) is expected to retire in the next five years. This rises to nearly 1 in 2 in the next 10 years.
Moreover, last year, the North of Scotland’s Clinical Radiologist workforce shrank. The vacancy rate for Clinical Oncologists in Scotland is 9%, above the national UK average. This has been gradually increasing since 2019. 57% of these vacancies have been open for 12 months or more.
In England, the South East (38%), East of England (36%) and East Midlands (35%) have the greatest shortfalls in Clinical Radiologists, compared to 13% in London.
For all four nations the data shows a stark urban-rural split whereby people living in rural communities may receive second-tier care. This unlevel playing field means there are patients in some regions who may not be receiving the same access to the health services they need – directly risking patient outcomes.
The vacancy data for clinical oncologists supports these inequalities:
• London has a 2% vacancy rate. 33% of vacancies have been open for 12+ months.
• The South West has an 11% vacancy rate. 82% of vacancies have been open for 12+ months.
Responses
Dr Katharine Halliday, RCR President, said:
‘All doctors want to give patients the best possible care, but workforce shortages are hampering our ability to do that. There are simply not enough doctors to safely treat the volume of patients needed, and this will only worsen as demand rises and more doctors leave the NHS. We face moral injury from dealing with the impossible balancing act of an overstretched service, burned out staff and ever-rising demand for care”.
Michelle Mitchell, Chief Executive of Cancer Research UK, said:
“These reports lay bare the scale of the workforce issues gripping the NHS and impacting the care of people affected by cancer. Due to under-funding and poor planning from governments across the UK, there isn’t enough staff or equipment to diagnose and treat cancer in a timely way.”
“We urge political leaders in all UK nations to act now to address chronic staffing issues and unacceptable waiting times across the NHS. Without long-term and strategic planning matched with sufficient investment, it will continue to be difficult for people to benefit quickly from life-saving cancer checks and treatment.”
Minesh Patel, Head of Policy at Macmillan Cancer Support, said:
‘NHS professionals are working tirelessly to provide people with vital cancer care, but chronic staff shortages are leaving them stretched to breaking point. Macmillan and The Royal College of Radiologists have been sounding the alarm about the devastating impact of staffing shortages on delays to diagnosis and treatment for years now, but the crisis continues to be brushed aside by governments.
“At the heart of this crisis is a failure to recruit and retain enough specialist cancer professionals. This census provides a real-time snapshot of the harsh reality facing people living with cancer and specialist NHS staff”.
Baroness Delyth Morgan, Chief Executive of Breast Cancer Now, said:
“Today’s report is the starkest warning yet that the government’s failure to tackle the crisis facing the cancer workforce, risks pushing cancer diagnosis and treatment to the brink of disaster. Despite the tireless work of the NHS, chronic staff shortages are denying people with breast cancer the best chance of early diagnosis and timely access to life-changing treatments”.
Final thought
The Government must act to protect the running of the NHS. Our healthcare system is in crisis and there are hopes that this report will act as a wake-up-call that a commitment to constructing strategies for investment, retainment and support are vital. There is no luxury of time as healthcare workers are overworked and scared for their patients.