Analysis

Funding and staffing main problems in delivering English cancer strategy

Two reports by charity Macmillan Cancer Support have highlighted the difficulties the NHS is facing to transform services and deliver a sustainable cancer strategy for England.

Two reports by charity Macmillan Cancer Support have highlighted the difficulties the NHS is facing to transform services and deliver a sustainable cancer strategy for England.

The strategy, which is a response to recommendations from the 2015 Independent Cancer Taskforce, must be delivered by 2020.

Delivery scepticism

The first report, Warning Signs (2017a), highlights that while there is agreement the strategy is the correct approach, there is scepticism among NHS leaders and health professionals about how easy it will be to deliver.

The report states that mixed messages from national bodies such as NHS England and the Department of Health mean it is often unclear who is responsible for redesigning cancer services at regional and local levels.

Sustainability and transformation plans (STPs), which could

...

Two reports by charity Macmillan Cancer Support have highlighted the difficulties the NHS is facing to transform services and deliver a sustainable cancer strategy for England.


Clinical nurse specialists' skills should be used to best effect in supporting patients
Picture: Tim George

The strategy, which is a response to recommendations from the 2015 Independent Cancer Taskforce, must be delivered by 2020.

Delivery scepticism

The first report, Warning Signs (2017a), highlights that while there is agreement the strategy is the correct approach, there is scepticism among NHS leaders and health professionals about how easy it will be to deliver.

The report states that mixed messages from national bodies such as NHS England and the Department of Health mean it is often unclear who is responsible for redesigning cancer services at regional and local levels.

Sustainability and transformation plans (STPs), which could represent a shift in the way the NHS plans services, are adding to the complexity of responsibility, according to the charity.

7,000

The estimated deficit of clinical nurse specialists by 2030

(Macmillan Cancer Support)

STPs feature in the NHS shared-planning guidance to implement the Five Year Forward View and represent an attempt to bring together NHS providers, clinical commissioning groups, local authorities and other health and care services.

They cover 44 areas across England and are aimed at improving health and care outcomes between 2016 and 2021.

A transformation fund created by NHS England is supposed to help local regions deliver targets for services in areas such as cancer. From April, STPs will become the single application and approval point for local organisations to access NHS transformation funding.

Forming alliances

Cancer alliances, established in late 2016, are another recommendation from the cancer taskforce, designed to bring together local senior clinical and managerial leaders.

But Macmillan warns that the alliances need to be given adequate resources and guidance to improve services locally.

The report also states that stronger national leadership is needed to address workforce challenges and enable the NHS to support the future cancer population.

One in ten

Patients in England who do not have access to a clinical nurse specialist

(Macmillan Cancer Support)

Stretching time

Pressures on the cancer workforce are central to the charity’s second report, Thinking Differently (2017b), which warns that there could be a deficit of 7,000 clinical nurse specialist (CNS) posts by 2030.

One in ten patients in England still do not have access to a CNS and Macmillan nurses have revealed to the charity that their time is increasingly stretched and taken up with non-specialist tasks such as administration.

Macmillan head of policy, Duleep Allirajah explains: ‘What we are hearing from our CNSs is that colleagues are leaving their roles and these positions are not always being replaced on a permanent basis.

‘This is concerning when we know that nearly a third of nurses are due to retire in the next ten years.

‘We need to develop a greater skill mix in teams so we can make sure specialist skills are used to best effect. Securing the future of nursing is critical – particularly at a time when the health service is under immense pressure.’

64%

Of people diagnosed with cancer have reported experiencing depression, anxiety or fear while waiting for treatment to start

(Macmillan Cancer Support)

Workforce stress

London South Bank University professor of healthcare and workforce modelling, Alison Leary says that the pressures on the entire system mean cancer services are under incredible stress – including the workforce.

‘Perhaps the most pressing of these is the financial pressure. Cancer nurse specialists are still seen by some organisations as a nice extra, which means that to save money they are not being replaced.’

However, Professor Leary, a lung cancer nurse specialist, explains that the situation is complex: ‘Even organisations that do see the value of CNS posts cannot recruit. These are experienced front-line professionals and the market means there are other opportunities, so retention is also a major issue. Added to cuts in continuing professional development creates the perfect storm.

‘The dissolution of organisations, such as the National Cancer Action Team in England and the regional infrastructure support given by cancer networks from 2013 onward, is now being felt.’

Five ways to address workforce challenges
  • Improving career pathways to and through specialist cancer roles.
  • Improving skill mix and introducing new types of cost-efficient roles.
  • Enhancing the skills and confidence of existing staff, and communication between them.
  • Improving ways of working.
  • Exploring how new ways of understanding the cancer population can be used to support workforce planning based on need rather than tumour type.

(Macmillan Cancer Support 2017b)

 

James Buchan, workforce expert and professor in the school of health sciences at Queen Margaret University, Edinburgh says: ‘Macmillan have identified funding and staffing as the two key problems in delivering effective and comprehensive cancer services in England.

‘They are clearly concerned that the deadline for the promised national strategic vision for the cancer workforce has been pushed back. They name names, pointing to the need for Health Education England (HEE) to deliver this work.’

Publishing upset

In October 2016 HEE caused upset in the sector after it confirmed it would not be publishing baseline figures for the current cancer workforce.

The All-Party Parliamentary Group on Cancer highlighted concerns last year about the ‘lack of visible progress’ on implementation of the cancer strategy and that some of the timescales set out in the plan had slipped.

Wait continues

HEE director of strategy and planning Rob Smith said the organisation is developing a workforce strategy which responds to the recommendations of the cancer taskforce and which also reflects the challenges being identified by the cancer alliances who are delivering the cancer transformation programme.

‘This approach is essential so that any solutions to workforce challenges are sustainable and patients get the right care at the right time in the right place,’ he says.

‘HEE is also working in partnership with Macmillan on aspects of the strategy, initially to provide access to education opportunities for nurses and others to develop their skills and knowledge in supporting patients with cancer and their families.’

But the wait continues as, despite all the plans from HEE, a spokesperson could still not confirm to Cancer Nursing Practice a publication date for the workforce strategy.

Thinking Differently: recommendations

⁍ Health Education England (HEE) must play a critical role in leading the development of a strategic vision for the cancer workforce and it is crucial that they work closely with partners across the health sector, including NHS England, to do this.

⁍ The Department of Health needs to hold HEE to account and ensure there is a strong, strategic focus on workforce across the NHS and that the vision for the cancer workforce aligns with this wider work.

⁍ To ensure people living with cancer experience coordinated continuity of care, local workforce action boards, sustainability and transformation plan leads and cancer alliances need to:

  • work closely with providers to help translate the national vision in a way which works for local health economies.
  • adopt an approach to service redesign that begins with a clear understanding of the workforce gaps based on patient need and considers the five ways of addressing workforce challenges.

(Macmillan Cancer Support 2017b)

 

Reports

 

 

 

 

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