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Escalating workforce crisis jeopardising cancer care and patient health, warns RCR

Escalating workforce shortages are causing ‘growing delays’ in cancer diagnosis and treatment in the UK that are ‘putting patients’ lives at risk’, according to two new reports published by the Royal College of Radiologists (RCR).

Based on 100% response-rate surveys of cancer centre heads and clinical directors of radiology departments, the RCR 2023 clinical radiology and clinical oncology workforce census reports reveal dangerous shortages of doctors essential in the diagnosis and treatment of cancer, and other conditions including stroke.

The data showed patients in half (47%) of cancer centres faced weekly delays to start systemic anti-cancer therapy (SACT), an increase from 28% the previous year. The RCR said the situation is ‘similarly dire’ for radiotherapy, with weekly treatment delays nearly doubling from 22% in 2022 to 43% in 2023. 

More than eight in 10 cancer leaders (85%) expressed concern that workforce shortages that contributed to the treatment delays were impacting patient safety.

Released at the same time, a report from Cancer Research UK found that 382,000 cancer patients in England were not treated on time since 2015. The charity warned that only 66.6% of people in England received their diagnosis and started their first treatment within two months of an urgent referral in April 2024, with the 85% target having not been met since December 2015.

Workforce, delays and backlogs

The RCR said the results of it 2023 clinical radiology workforce census report reveal a 30% shortfall of clinical radiology consultants (1,962 doctors) and stressed that ‘without further action this shortfall is forecasted to increase to 40% (3,670 doctors) by 2028’. 

The RCR report also showed almost all (97%) of the radiology leaders it surveyed saying that workforce shortages caused delays and backlogs.

Noting that the demand for SACT, including chemotherapy, surged by 6-8% in 2023, while the consultant workforce expanded by only 3.5%, the RCR said this ‘glaring imbalance has created a crisis where demand vastly outstrips the capacity of the cancer workforce’.

Similarly, while the clinical radiology workforce grew by 6% in 2023, demand for CT and MRI reporting surged by 11%. As a result, the data showed nearly three quarters of a million patients (745,290) in England waited over four weeks to receive the result of their imaging test following the scan.

Dr Katharine Halliday, president of the RCR, said: ‘[These] 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.’

Impacts on workforce and patients

Indeed, according to the RCR, every service leader reported concerns that workforce shortages were impacting staff morale and burnout, which is having ‘a clear impact with earlier retirement’ – the average age that clinical oncologists left the workforce in 2023 was just 54, compared to 57 in 2022.

The survey also showed inequities in access to cancer specialists persists across the country, with rural areas disproportionately affected, and the RCR warned that ‘disparities in workforce distribution exacerbate these inequalities, leaving some regions with significantly fewer doctors per patient’.

For example, according to the data, the West Midlands has only 4.9 clinical oncologists per 100,000 population aged 50 plus, while London has almost three times that number in its workforce at 11. The RCR said 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’. 

The RCR warned that despite advancements in cancer treatments, workforce shortages are impeding delivery, depriving patients of potentially life-saving therapies’, adding that ‘any delay is critical for cancer patients, as every month delay in cancer treatment raises the risk of death by around 10%.’

Government call to action

The survey results have led the RCR to issue an urgent call to action to the next Government to address what it calls ‘the dire state of cancer care in the UK due to escalating workforce shortages’.

In a statement, the RCR said: ‘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.’

The RCR said it has written to major political party leaders warning that, without immediate intervention, the UK risks undoing decades of progress in cancer care.

The Royal College is 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’, and said it is calling on 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’.

Commenting on these demands, Dr Halliday said: ‘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.’

Widespread support to improve cancer care

Cancer charities have also added their voice to the call to action for the next Government to improve workforce issues and safeguard patient care.

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.’

She added: ‘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 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.’

In January 2024, a census report from the Royal College of Surgeons of England also highlighted workforce challenges, treatment delays and staff burnout.

This was followed by the latest NHS Staff Survey results in March, which shows that while the NHS workforce appears to be recovering from the impact of the Covid-19 pandemic, there are still issues around workforce shortages, mounting pressures and widespread dissatisfaction with pay.