Cancer care in peril as workforce crisis escalates, warns Royal College of Radiologists
The stark reality of the workforce crisis laid bare in two new reports
The Royal College of Radiologists (RCR) issues an urgent call to action to the next government, as two new reports underscore the dire state of cancer care in the UK due to escalating workforce shortages. The findings reveal a stark reality: delays in diagnosis and treatment are putting patients' lives at risk.
The reports are based on 100% response-rate surveys of cancer centre heads and clinical directors of radiology departments and therefore represent some of the most authoritative reports into the current state of diagnosis and cancer care in the UK.
Key findings from the reports include:
Worsening delays
Delays in cancer treatment have become routine, with nearly half of cancer centres experiencing weekly delays. leading doctors are increasingly concerned, with almost all (97%) clinical directors saying that workforce shortages were causing backlogs and delays at their trust/health board. Any delay is critical for cancer patients, as every month delay in cancer treatment raises the risk of death by around 10%.
Impending crisis
The UK is deep in a workforce crisis, with a staggering 30% shortfall in clinical radiologists and a 15% shortfall in clinical oncologists. The medium age of consultants leaving the workforce has plummeted, from 57 in 2021 to 54 in 2023. One third of consultants leaving the workforce were under 45. If immediate action is not taken, these shortfalls are projected to rise to 40% and 21%, respectively, by 2028.
Cancer demand outstripping workforce
In 2023, the demand for systemic anti-cancer therapy (SACT), including chemotherapy, surged by 6-8%, while the consultant workforce expanded by only 3.5%. This glaring imbalance has created a crisis where demand vastly outstrips the capacity of the cancer workforce. As a result, despite advancements in cancer treatments, workforce shortages are impeding delivery, depriving patients of potentially life-saving therapies.
Number of cancer centres experiencing severe delays has doubled over the past year
Nearly half of cancer centres (47%) now face weekly delays in administering SACT, a staggering increase from 28% the previous year. The situation is similarly dire for radiotherapy, with weekly treatment delays nearly doubling from 22% in 2022 to 43% in 2023.
Government inaction
Despite being one year into the Government’s NHS workforce plan, the reports highlight a critical failure to address the worsening workforce crisis. Insufficient training and retention efforts have exacerbated shortages, leaving hospitals struggling to meet patient demand. This is one of the most pressing challenges the new government must address, and it is imperative that they get it right.
Regional inequalities
Inequities in access to cancer specialists persist across the country, with rural areas disproportionately affected. Disparities in workforce distribution exacerbate these inequalities, leaving some regions with significantly fewer doctors per patient. For example, the West Midlands has only 4.9 clinical oncologists per 100,000 population aged 50 plus, while London has almost 3 times that number at 11. There are double the number of radiologists per 100,000 people in London than in North and West Wales. This introduces clear inequalities whereby people living in certain regions are likely to receive results of their imaging test or start cancer treatment more quickly than those in other regions.
Worsening delays
Delays in cancer treatment have become routine, with nearly half of cancer centres experiencing weekly delays. leading doctors are increasingly concerned, with almost all (97%) clinical directors saying that workforce shortages were causing backlogs and delays at their trust/health board. Any delay is critical for cancer patients, as every month delay in cancer treatment raises the risk of death by around 10%.
Impending crisis
The UK is deep in a workforce crisis, with a staggering 30% shortfall in clinical radiologists and a 15% shortfall in clinical oncologists. The medium age of consultants leaving the workforce has plummeted, from 57 in 2021 to 54 in 2023. One third of consultants leaving the workforce were under 45. If immediate action is not taken, these shortfalls are projected to rise to 40% and 21%, respectively, by 2028.
Cancer demand outstripping workforce
In 2023, the demand for systemic anti-cancer therapy (SACT), including chemotherapy, surged by 6-8%, while the consultant workforce expanded by only 3.5%. This glaring imbalance has created a crisis where demand vastly outstrips the capacity of the cancer workforce. As a result, despite advancements in cancer treatments, workforce shortages are impeding delivery, depriving patients of potentially life-saving therapies.
Number of cancer centres experiencing severe delays has doubled over the past year
Nearly half of cancer centres (47%) now face weekly delays in administering SACT, a staggering increase from 28% the previous year. The situation is similarly dire for radiotherapy, with weekly treatment delays nearly doubling from 22% in 2022 to 43% in 2023.
Government inaction
Despite being one year into the Government’s NHS workforce plan, the reports highlight a critical failure to address the worsening workforce crisis. Insufficient training and retention efforts have exacerbated shortages, leaving hospitals struggling to meet patient demand. This is one of the most pressing challenges the new government must address, and it is imperative that they get it right.
Regional inequalities
Inequities in access to cancer specialists persist across the country, with rural areas disproportionately affected. Disparities in workforce distribution exacerbate these inequalities, leaving some regions with significantly fewer doctors per patient. For example, the West Midlands has only 4.9 clinical oncologists per 100,000 population aged 50 plus, while London has almost 3 times that number at 11. There are double the number of radiologists per 100,000 people in London than in North and West Wales. This introduces clear inequalities whereby people living in certain regions are likely to receive results of their imaging test or start cancer treatment more quickly than those in other regions.
“I can no longer defend the NHS as an exemplary healthcare system. We are all failing and in so doing failing our patients”
Anonymous Consultant
Outsourcing creates additional challenges
To cope with the soaring demand for imaging. In 2023 the NHS spent £276 million on outsourcing, insourcing and ad hoc locums; the highest on record. Analysis from the RCR shows this would have been enough to fund 2,690 yearly consultant salaries, higher than the current shortfall. The current approach, which includes outsourcing, has also raised concerns about patient safety. One doctor highlights the risks of "incorrect advice about local pathways" and "variable quality," leading to discrepancies, especially in acute cases. This underscores the urgent need to invest in strengthening our workforce.
A call to action
The RCR has written to major political party leaders warning that without immediate intervention, the UK risks undoing decades of progress in cancer care. They are demanding urgent investment in workforce development to ensure patients aren't left waiting for a diagnosis and can begin lifesaving treatment as soon as possible. Furthermore, they are calling on whoever forms the next government to work with the NHS to spell out how they intend to Recruit, Train and Retain clinical oncologists and radiologists ensuring the stability and strength of the workforce for future generations.
Dr Katharine Halliday, President of the Royal College of Radiologists, said:
“Today's reports reveal a stark reality: the crisis in the radiology and oncology workforce is jeopardising patients' health. Despite our dedication to providing the best possible care, severe workforce shortages are significantly hindering our efforts. We simply do not have enough doctors to manage the increasing number of patients safely, and this problem will only worsen as demand continues to rise and more doctors leave the NHS. The immense strain on an overburdened system, coupled with exhausted staff and increasing demand, creates a toxic cocktail for our NHS.
“Action from the new Government is essential. Time is critical. Doctors are working under extreme stress and are deeply concerned for their patients. We urge the new Government to heed the advice of doctors and implement a forward-thinking strategy to recruit, train, and retain staff. Only this approach can help reset the system, safeguard the NHS, and guarantee patients receive the quality care they deserve.”
Cancer Research UK's chief executive, Michelle Mitchell, said:
"These reports demonstrate that worsening shortages of radiologists and oncologists are directly impacting cancer patients, with some facing worrying delays in receiving vital treatment. Cancer services are struggling to see people as quickly as they should, and the last time all cancer wait time targets were met in England was as far back as 2015. Demand will increase too. By 2040, there are projected to be around half a million cancer cases a year across the UK.
"To address these issues it is imperative that all political parties commit to making this general election a turning point for cancer. Post-election, any UK government must invest in the staff and equipment that are desperately needed to ensure patients have access to the best cancer care. Cancer patients expect nothing less.”
Mairaid McMahon, Policy Manager at Macmillan Cancer Support said:
“The latest census from the Royal College of Radiologists once again highlights the significant shortages that remain within the cancer workforce. These shortages impact negatively on patient care, cause delays to diagnosis and treatment, and could potentially to lead to worsening outcomes for people with cancer.
“The incoming government needs to do more to address recruitment and retention, not just in generalist roles, but also specialist roles that are key to cancer treatment. We need to see targeted funding to increase the size of the cancer workforce, ensuring that everyone receives the timely and quality care they critically need.”
Dr Katharine Halliday, President of the Royal College of Radiologists, said:
“Today's reports reveal a stark reality: the crisis in the radiology and oncology workforce is jeopardising patients' health. Despite our dedication to providing the best possible care, severe workforce shortages are significantly hindering our efforts. We simply do not have enough doctors to manage the increasing number of patients safely, and this problem will only worsen as demand continues to rise and more doctors leave the NHS. The immense strain on an overburdened system, coupled with exhausted staff and increasing demand, creates a toxic cocktail for our NHS.
“Action from the new Government is essential. Time is critical. Doctors are working under extreme stress and are deeply concerned for their patients. We urge the new Government to heed the advice of doctors and implement a forward-thinking strategy to recruit, train, and retain staff. Only this approach can help reset the system, safeguard the NHS, and guarantee patients receive the quality care they deserve.”
Cancer Research UK's chief executive, Michelle Mitchell, said:
"These reports demonstrate that worsening shortages of radiologists and oncologists are directly impacting cancer patients, with some facing worrying delays in receiving vital treatment. Cancer services are struggling to see people as quickly as they should, and the last time all cancer wait time targets were met in England was as far back as 2015. Demand will increase too. By 2040, there are projected to be around half a million cancer cases a year across the UK.
"To address these issues it is imperative that all political parties commit to making this general election a turning point for cancer. Post-election, any UK government must invest in the staff and equipment that are desperately needed to ensure patients have access to the best cancer care. Cancer patients expect nothing less.”
Mairaid McMahon, Policy Manager at Macmillan Cancer Support said:
“The latest census from the Royal College of Radiologists once again highlights the significant shortages that remain within the cancer workforce. These shortages impact negatively on patient care, cause delays to diagnosis and treatment, and could potentially to lead to worsening outcomes for people with cancer.
“The incoming government needs to do more to address recruitment and retention, not just in generalist roles, but also specialist roles that are key to cancer treatment. We need to see targeted funding to increase the size of the cancer workforce, ensuring that everyone receives the timely and quality care they critically need.”