FULL TEAM AHEAD: UNDERSTANDING THE UK NON-SURGICAL CANCER TREATMENTS WORKFORCE DECEMBER 2017

Full team ahead: understanding the UK non-surgical cancer treatments workforce

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CONTENTS

LIST OF FIGURES AND TABLES .............................................................................. 4

EXECUTIVE SUMMARY ......................................................................................... 5

1 INTRODUCTION ............................................................................................... 11

2 MODEL FOR TREATMENT WORKFORCE PLANNING ......................................... 15

3 THE CURRENT WORKFORCE ............................................................................ 17

4 HORIZON SCANNING ....................................................................................... 28

5 TEAMWORK AND SKILL MIX ............................................................................ 33

IMPLICATIONS FOR WORKFORCE GROUPS

6 CLINICAL SCIENTISTS ....................................................................................... 45

7 CLINICAL TECHNOLOGISTS .............................................................................. 47

8 NURSES ........................................................................................................... 53

9 ONCOLOGISTS ................................................................................................. 58

10 PHARMACISTS ............................................................................................... 66

11 THERAPEUTIC RADIOGRAPHERS .................................................................... 68

12 CONCLUSIONS ............................................................................................... 73

APPENDICES ....................................................................................................... 74

1. AREAS OUT OF SCOPE ............................................................................... 74

2. DATA COLLECTION ISSUES ........................................................................ 74

3. AVAILABLE DATA FROM PROFESSIONAL BODIES AND CHARITIES ............. 75

4. SITE VISITS ................................................................................................ 78

5. FULL SURVEY ............................................................................................. 78

6. BEST PRACTICE MODELLING METHODOLOGY ........................................... 83

7. SKILLS MIX CASE STUDIES ......................................................................... 92

REFERENCES…………………………………………………………………………………………………102

Full team ahead: understanding the UK non-surgical cancer treatments workforce

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REFERENCE This report should be referenced: ‘Cancer Research UK (2017) Full team ahead: understanding the UK

non-surgical cancer treatments workforce’.

AUTHORS Katie Burns

2020 Delivery

Mike Meredith

2020 Delivery

Matthew Williams

Institute of Employment Studies

Clare Huxley

Institute of Employment Studies

Camilla Pallesen

Cancer Research UK

ACKNOWLEDGEMENTS Cancer Research UK commissioned 2020 Delivery and Institute of Employment Studies to carry out this research study. We are grateful for the valuable input of our advisory group. This group was comprised of Diane Gagnon, Liz McSheehy, Jane Barrett, Harriet Adams, Fiona Ingleby, Karen Darley, Fiona Dennehy, Maggie Kemmner, Helen Beck and Camilla Pallesen. It is particularly worth highlighting the contributions of Diane Gagnon and Liz McSheehy, who ensured that the views of people affected by cancer were represented throughout this research. We are also very grateful for the contributions of our clinical panel: Andy Beavis, Andrew Goddard, Charlotte Beardmore, David Bloomfield, David Cunningham, Jeanette Dickson, Helena Earl, Jemimah Eve, Harriet Gordon, Spencer Goodman, Simon Grumett, Johnathan Joffe, Alison Norton and Peter Selby. We are grateful to all health professionals who participated in our survey and interviews.

ABOUT CANCER RESEARCH UK Cancer Research UK is the world’s largest independent cancer charity dedicated to saving lives through research. It supports research into all aspects of cancer and this is achieved through the work of over 4,000 scientists, doctors and nurses. In 2016/17, we spent £432 million on research institutes, hospitals and universities across the UK. We receive no funding from the Government for our research and are dependent on fundraising with the public. Cancer Research UK wants to accelerate progress so that three in four people survive their cancer for 10 years or more by 2034. Cancer Research UK is a registered charity in England and Wales (1089464), Scotland (SC041666) and the Isle of Man (1103)

Full team ahead: understanding the UK non-surgical cancer treatments workforce

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LIST OF FIGURES AND TABLES Figure 1 Site visit locations

Figure 2 Representation of modelling methodology

Figure 3 Best practice model for breast cancer

Figure 4 Proportion of staff in UK nations

Figure 5 Number of staff per million people

Figure 6 Annual UK change in numbers

Figure 7 Clinical technologists compared to best practice model

Figure 8 Time spent by clinical technologists

Figure 9 Future workforce projections for clinical technologists

Figure 10 Skill mix impact for demand of clinical technologists

Figure 11 Time spent by surveyed chemotherapy nurses

Figure 12 Time spent by surveyed clinical nurse specialists

Figure 13 Oncologists compared to best practice model

Figure 14 Oncology workforce projections

Figure 15 Potential of skill mix for oncologists in 2022

Figure 16 Therapeutic radiographers compared to best practice

Figure 17 Time spent by surveyed therapeutic radiographers

Figure 18 Therapeutic radiography workforce projections

Figure 19 Skill mix impact for therapeutic radiographers

Figure 20 High-level breast pathway representation

Figure 21 Radiotherapy delivery pathway

Figure 22 Chemotherapy delivery pathway

Figure 23 High-level breast cancer treatment pathway

Figure 24 High-level lung cancer treatment pathway

Figure 25 High-level prostate cancer treatment pathway

Figure 26 High-level bowel cancer treatment pathway

Figure 27 Head and neck cancer treatment pathway – local

Figure 28 Head and neck cancer treatment pathway – local/regional

Figure 29 Head and neck cancer treatment pathway – metastatic

Figure 30 Non-Hodgkin lymphoma treatment pathway

Table 1 Survey responses – compared to total workforce

Table 2 Size of UK workforce, 2015

Table 3 Trends in headcount numbers by nation

Table 4 Additional hours spent by staff

Table 5 Non-UK nationals in workforce, England

Table 6 Skill mix opportunities in Systemic Anti-Cancer Therapy

Table 7 Skill mix opportunities in radiotherapy

Table 8 Workforce projections for clinical oncologists

Table 9 Workforce projections for medical oncologists

Table 10 Aggregation of cancer sites

Full team ahead: understanding the UK non-surgical cancer treatments workforce

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EXECUTIVE SUMMARY More than 360,000 people in the UK are diagnosed with cancer each year1. By 2022 it is projected that this figure will reach 422,000 people2,3. Yet while more people will develop cancer, survival is improving. Currently half of all cancer patients survive their disease for 10 years or more. Cancer Research UK wants to accelerate progress so that 3 in 4 people survive by 2034. Early diagnosis followed by access to the best, evidence-based treatment is critical to achieve this. As we strive towards earlier diagnosis of cancer, treatments will change. Increasingly, treatments are tailored to an individual’s cancer; combinations of treatment types are being used to target cancers differently and there are more treatment options than ever before. Additionally, an ageing population, often with comorbodities, means the treatment of cancer has become more complex. As such, ensuring better access to treatments is rightly a priority in the cancer strategies for England4, Scotland5, and Wales6. Northern Ireland does not have an up-to-date cancer strategy at the point of publishing this report. Having the optimal workforce is fundamental to ensuring treatment can be provided to meet the needs of patients.

OUR APPROACH Cancer Research UK commissioned this research study to investigate the current and future needs, capacity, and skills of the non-surgical oncology workforce to provide optimal treatment to the UK population. The research combined data analysis of

current workforce data; a survey of the workforce across the UK (> 2500 responses); in-depth interviews with workforce staff; and expert advice from health professionals. We knew at the start of the research that data on staffing levels is limited across the UK. This makes it difficult for health bodies to make well-informed decisions about workforce planning7,8. For example, in England healthcare providers report staffing