An in-depth study of the cancer nursing workforce has revealed major challenges, including startling variations in caseloads and higher than average vacancy rates.
The census commissioned by Macmillan Cancer Support also reveals that a greater proportion of specialist cancer nurses are in lower pay bands despite the complex work they do, which may be contributing to recruitment problems, the charity warned.
“It is no surprise that hospitals are struggling to recruit to these roles, given this unprecedented pressure”
It said the census painted a picture of services under strain, with fears nurses were being “run ragged” and cancer patients were not getting the specialist care they needed.
The research, which provides a snapshot of the adult cancer nursing workforce in England on a single day in October last year, looked at four roles – specialist cancer nurses, chemotherapy specialist nurses, specialist palliative care nurses focusing on cancer and cancer support workers.
It indicates that the specialist cancer nurse workforce has grown since the exercise was last carried out, with 4,020 whole-time equivalent nurses working in the field in 2017 compared with 3,088 in 2014.
However, the census – titled the Cancer Workforce in England – also reveals some worrying trends, including a “startlingly broad variation” in the number of new cancer cases per specialist nurse across the country.
For example, the number of new cancer diagnoses each year per urology nurses varied from 87 to more than 250 between different areas.
“This situation will become more acute as the number of people being diagnosed with cancer continues to grow”
The ratio of new patients per breast cancer nurse varied from 56 to 145 and numbers of new lung cancer cases per specialist nurse varied from 62 to more than 200.
Macmillan warned these wide differences may mean many cancer patients were not getting access to vital specialist care.
In all, 144 out of 149 NHS trusts in England that provide cancer submitted data to the census, which shows it is common for posts across all four types of roles to be filled on a part-time basis.
It identified a total of 4,589 individual specialist cancer nurse roles in 2017 – 4,020 whole-time equivalent (WTE) roles.
There were 3,071 individual chemotherapy posts – 2,686 WTE posts – and 1,124 individual specialist palliative care nurses working in cancer – 978 WTEs. The data shows 702 individual cancer support worker posts – 635 WTE
While the workforce has grown, the study shows a greater proportion of specialist nurses are now employed in lower pay bands than in 2014, with an increase in the proportion of band 5 and 6 roles and drop in the proportion of band 7s.
“Ministers must look again at the recruitment, training and retention of specialist nursing staff”
Census data from 2014 shows 23% of specialist cancer nurses were at band 5 or 6, but that went up to 28% in 2017. Meanwhile, the proportion of band 7 specialist cancer nurses fell from 67% in 2014 to 61% in 2017.
“We are concerned that this could mean that highly trained specialists are taking on more complex caseloads, and that this is not being recognised in terms of the pay they receive,” said Fran Woodward, executive director of policy at Macmillan.
“If this is the case, it could risk exacerbating well established problems with recruitment and retention in the nursing workforce,” she said in an introduction to the report.
Across all four types of cancer nursing role, the study found vacancy rates were higher than the UK average vacancy rate for health and social work.
As many as one in seven chemotherapy nurse positions in some parts of England were unfilled, with wide variation in vacancy rates across the country.
Vacancy rates for specialist cancer nurses varied from just one vacancy per 100 filled roles to 11 vacancies per 100 filled roles.
Meanwhile, the proportion of specialist cancer nurses aged over 50 and getting closer to retirement increased from 33% to 37% with variations by area of practice.
For example, 45% of all breast cancer nurses were aged 50 and above, as were 43% of gynaecological cancer nurses and 40% of specialist palliative care nurses working in cancer.
Variation in the age profile across the country meant “succession planning will be increasingly important”, highlighted the report.
Karen Roberts, chief nursing officer at Macmillan Cancer Support, said the support provided by specialist nursing staff made all the difference to cancer patients.
“Having the expertise and support of a specialist nurse from the point of diagnosis has a huge bearing on whether or not a cancer patient has a positive experience of the care they receive,” she said.
“We are concerned that cancer nurses are being run ragged, and that some patients may not be receiving the level of specialist care they need,” said Ms Roberts.
“Nurses working in cancer care tell us that their increasingly complex and pressured workload is beginning to affect the quality of care patients receive,” she said. “It is no surprise that hospitals are struggling to recruit to these roles, given this unprecedented pressure.”
Ms Woodard said that, while the cancer workforce had grown in recent years, this had happened “without adequate long-term planning or direction”.
“Macmillan has undertaken this work to highlight the strain this puts on those working in cancer care and to ensure that action is taken,” she said.
“This situation will become more acute as the number of people being diagnosed with cancer continues to grow,” she added.
While the charity welcomed progress made so far by Health Education England on the cancer workforce, she said the government must ensure this was properly funded.
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Ann McMahon, research and innovation manager at the Royal College of Nursing, called on government to look at the training, recruitment and retention of specialist nursing staff, because shortages were “putting patients’ lives at risk”.
“Not having enough specialist staff available can delay, or reduce access to treatment including life-saving chemotherapy,” she said, commenting on the report.
“For patients diagnosed with cancer, any delay can lead to worse outcomes, and it is difficult to overstate the distress felt by patients and their families as they wait to begin the treatments lives can depend on,” she said.
Ms McMahon warned that poor workforce planning and cuts to training budgets had left specialist service struggling to recruit the skilled nurses they needed.
“Patients deserve better than this, and ministers must look again at the recruitment, training and retention of specialist nursing staff,” she added.