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Lack of ‘serious effort’ on cancer workforce shortages risks reversal of survival rates

5 April 2022

The absence of a serious effort by Government to tackle gaps in the cancer workforce is jeopardising earlier diagnosis, the key to improving overall survival rates and catching up with comparable countries.

In a highly critical report on cancer services in England, MPs raise the alarm on the damaging and continuing impact of the pandemic and warn of a real risk that gains in cancer survival will reverse.

Evidence provided to the Committee by the Government and the NHS demonstrates that the NHS was not on track to meet its target on early cancer diagnosis. Without progress, that would mean more than 340,000 people between 2019 and 2028 missing out on an early cancer diagnosis.

Overall progress made by the Government against targets on cancer services in England was rated as ‘inadequate’ last week by the Committee’s Expert Panel. Its evaluation also rated progress to diagnose 75% of cancers at stage 1 or 2 by 2028 as inadequate.

MPs say there appeared to be ‘no detailed plan’ to address shortages of clinical oncologists, consultant pathologists, radiologists and specialist cancer nurses with gaps threatening diagnosis, treatment and research equally.

Despite some progress in one-year cancer survival rates since the 1970s, outcomes in England lag behind other countries such as Canada or Australia. By comparison fewer people in England will live for five years or more diagnosed with colon cancer or stomach cancer.

Chair's comment

Health and Social Care Committee Chair Rt Hon Jeremy Hunt MP said:

“Earlier cancer diagnosis is the key to improving overall survival rates however progress is being jeopardised by staff shortages which threaten both diagnosis and treatment.

“We do not believe that the NHS is on track to meet the Government’s target on early cancer diagnosis by 2028, reinforced by our Expert Panel’s rating that progress against this target is inadequate.

“We are further concerned at the damaging and prolonged impact of the pandemic on cancer services with a real risk that gains made in cancer survival will go into reverse.

“A mother told us of her 27-year-old daughter’s five-month struggle to get a diagnosis of cancer - tragically she died three weeks after it came. Unfortunately, many more lives will almost certainly end prematurely without earlier diagnosis and prompt treatment. That is why we are calling on the Government and the NHS to act now to address gaps in the cancer workforce upon which success depends. To date we have found little evidence of a serious effort to do so.”

Key recommendations

Department of Health and Social Care and NHS England should:

  • Develop specific plan to address gaps in diagnostic workforce, short-term and long-term shortages in key professions and level of investment required to deliver sustainable long-term increases.
  • Publish a detailed analysis of the extent of the cancer backlog to support the delivery of the elective care recovery plan.
  • Set out an estimate of what level of additional capacity in NHS cancer services will be needed to address the backlog in cancer services and treatment by March 2023.
  • Set out an action plan to ensure that NHS cancer services are able to provide this additional capacity above normal levels.
  • The new Office for Health Improvement and Disparities should conduct a rapid review of existing evidence of the impact of demographic factors on cancer outcomes and commits to developing a joint strategy with NHS England to address disparities in outcomes.

A full list of recommendations is provided in the attached Report

Earlier cancer diagnosis target not on track

Earlier diagnosis is identified as the most effective way of improving overall survival rates. For example, diagnosing bowel cancer at stage 1 means that 90% of people will live for five years compared to just 10% of people diagnosed at stage 4.

The NHS Long Term Plan set a target to diagnose 75% of cancers at stage 1 or 2 by 2028. On the basis of evidence supplied to the Committee by the Government and the NHS, MPs do not believe the NHS is on track to meet the 75% early diagnosis ambition set by the Government. The Committee’s independent Expert Panel also rated the Government's progress against this target as 'inadequate'.

Modelling submitted by Cancer Research UK predicts that a static early diagnosis rate until 2028 would mean 343,000 more people receiving a late diagnosis between 2019 and 2028 than if the target was met. In 2028 alone, 65,700 people would miss out on an early diagnosis.

MPs found areas of social deprivation experienced lower rates of early diagnosis and recommend measures to assess and address disparities. For cancers where average survival is worse, such as oesophageal, liver, brain, pancreatic, stomach and lung cancers, the UK performs particularly badly against comparable countries around the world.

Powerful testimony on late diagnosis

Andrea Brady gave testimony to MPs about her 27-year-old daughter’s struggle ‘to be taken seriously’ by her GP practice against the backdrop of the pandemic – eventually getting a diagnosis of stage 4 adenocarcinoma in her lungs, bones, spine and liver three weeks before her death. She raised particular concerns about the absence of face-to-face GP appointments, the lack of diagnostic tests and the ‘fragmented care’ her daughter received.

Cancer workforce gaps

The Report welcomes a £2.3 billion investment in Community Diagnostic Centres however notes that despite a commitment to invest in equipment, there was no detailed plan to address gaps in the diagnostic workforce.

The NHS is estimated on a full-time equivalent basis, to be short of 189 clinical oncologists, 390 consultant pathologists and 1,939 radiologists, and by 2030 will be short of 3,371 specialist cancer nurses. The Report finds that shortages across cancer services threaten diagnosis, treatment and research equally.

Drop in urgent referrals and diagnostic tests

MPs raise concern at the damaging impact the pandemic has had and is continuing to have on cancer services. Three million fewer people in the UK were invited for cancer screening between

March and September 2020; between March 2020 and March 2021 326,000 fewer people in England received an urgent referral for suspected cancer; 4.6 million fewer key diagnostic tests were carried out.

While NHS England has continued to prioritise cancer services, MPs are yet to be convinced that there is sufficient recognition of the scale of the issue and are deeply concerned that a target for clearing the backlog for cancer diagnosis and treatment has been moved back by an entire year.

Further information

Image credit: PA