Cancer leaders sound alarm at worsening delays for patients
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 devastating impact on cancer patients
- 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.
- Our 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.
- 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%.
- A ticking timebomb is putting patients at risk – more doctors are retiring early, and the growing reliance on outsourcing/locums is unsustainable and expensive. We face a 29% shortfall in radiologists, which will rise to 40% by 2027 if action is not taken – at a time when demand for healthcare will be rising.
- Huge inequalities exist across the country. There are fewer doctors per patient in rural areas compared to urban areas, and more long-term unfilled vacancies, risking a postcode lottery in patient outcomes. London has 10.5 oncologists for every 100,000 older people (55+), compared to just 4.7 in the Midlands and 3.1 in North/West Wales.
NHS cancer leaders have growing concern that workforce shortages are leading to delays in cancer diagnosis and treatment and putting patients at risk, say the two new reports released today.
Almost 100% of cancer centres have delayed treatment
The RCR’s annual workforce censuses reveal that in almost all UK cancer centres (97%), patients’ treatment was delayed because of staff shortages. Shortages are causing monthly delays in starting chemotherapy or radiotherapy treatment in about half of cancer centres, and weekly delays in about a quarter of centres, compromising patient care.
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.
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. Delays are potentially harmful to patients: every month that cancer treatment is delayed can raise the risk of death by 10%[i]. These types of waits are now sadly routine.
Delays are the result of Government inaction to tackle workforce shortages
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 Government has failed to tackle this worsening workforce crisis, by not training enough doctors over recent years and failing to retain the doctors we have.
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.
“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
We face a ticking timebomb in the workforce, putting future patients at risk
The reports show the UK sitting on the ticking timebomb in cancer diagnosis and care, putting patients at risk. Doctors are leaving in their droves due to stress and burnout, and more than 75% of clinical oncologists and radiologists who left the NHS in 2022 were under 60.
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.
“We are dealing with the moral injury brought about having to face up to tough choices between looking after patients and the need to protect staff.” – consultant clinical oncologist
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.
This 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.
Regional disparities
Across the UK, the cancer workforce is under immense stress. However, there are blatant inequalities in the access to specialists people have depending on where they live.
London has 10.5 oncologists (medical and clinical) for every 100,000 older people. But in North and West Wales, there are just 2.1 oncologists per 100,000 older people, compared to 8.1 in South Wales. Similarly, there are just 0.8 clinical oncologists per 100,000 older people in the area – compared to the UK and Wales average of 3.8.
Wales’ clinical oncologist vacancy rate is significantly higher than the 9% average, at 11%. 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.
It’s a sobering picture in Scotland, where 100% of clinical directors surveyed are concerned or highly concerned that patient safety will suffer due to workforce shortages. Last year, the North of Scotland’s Clinical Radiologist workforce actually 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.
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.
‘Action from the Government is now critical. We must train more doctors, while doing more to retain the ones we have. There is no luxury of time: doctors are stretched, stressed, and scared for their patients. By publishing the long-awaited workforce plan, the Government can reset the system and ensure patients receive the care doctors so desperately want to provide.’
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.
‘Severe shortfalls of clinical breast oncologists – who play a pivotal role in delivering treatments – mean some breast cancer services are already struggling to ensure new treatments reach the people who desperately need them. We fear this could have a tragic impact on survival for breast cancer patients. With almost half of clinical breast oncologists set to retire within the next decade, the situation is set to get much worse.1
‘Publication of the government’s long overdue NHS workforce plan cannot come soon enough. Crucially, it must provide significant investment in growing, retaining and supporting the breast cancer workforce. Only then can we avoid seeing decades of progress unravelling and instead, guarantee people with breast cancer the best chances of survival, now and in future.
‘Anyone looking for support or information can call our free Helpline on 0808 800 6000 to speak to one of our expert nurses.”
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. It is yet another wake-up call that Governments across the UK must urgently commit to providing long-term fully-funded workforce plans, which clearly sets out the numbers of healthcare staff needed in the years to come to ensure everyone receives the timely and quality care they critically need.’
Notes to editors
Press contact: [email protected]
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Methodology
All stats, if not otherwise specified, have been taken from the two RCR reports: the 2022 Clinical Radiology Census Report and the RCR Clinical Oncology 2022 Census Report.
For over 11 years, the RCR has collected key Clinical Radiology and Oncology workforce data from Clinical Directors and Cancer Service Heads across the UK to identify trends, issues and make evidence-based recommendations. With a 100% response rate, this year’s data reflects the workforce as it stood on 1st October, 2022.
The link between Clinical Radiology and Cancer
Clinical Radiologists are an integral part of patient pathways and care. More than 80% of hospital pathways involve imaging and its interpretation, making clinical radiologists central to diagnostics for cancer, as well as heart disease, stroke and COVID-19 complications.
Anonymous quotes from cancer doctors
“[The] constant stumbling block is money. [It] hampers patient care…there have been very significant near misses, and I am surprised a patient has not died as a result of the lack of cover out of hours. I suspect it is only a matter of time”. –consultant radiologist
“Several consultants have stated in job plan reviews how close they are to needing time off due to stress and burnout – worryingly the only thing keeping them at work is their concern of how that will impact already over-stretched colleagues, so they limp on”. – consultant clinical oncologist
“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
“[We are] dealing with the moral injury brought about having to face up to tough choices between looking after patients and the need to protect staff.” - consultant clinical oncologist
“Outsourcing is costing us a small fortune. In addition to the usual negatives about using outsourcing, we are now finding that our outsourced service is itself maxed out in capacity” – consultant radiologist
“The reliance on a locum Consultant workforce makes the service vulnerable and creates resentment among the substantive workforce” – consultant clinical oncologist
“Workforce shortages result in unacceptable delays for patients. Some services simply cannot be provided”