Time for action on the shortfalls in the cancer nursing workforce
Health Education England chief says problems are ever-increasing and a plan of action needs to be implemented urgently
Health Education England chief says problems are ever-increasing and a plan of action needs to be implemented now
Leaders at Health Education England (HEE) are promising to act on the findings of the long-awaited audit of the cancer nursing workforce in England.
HEE says phase two of the Cancer Workforce Plan is expected to be published later this year, and will build on the original proposals set out in December 2017.
Plans for nursing were largely absent from that document as the Macmillan Cancer Support audit was under way.
specialist cancer nurse roles
But HEE chief nurse Lisa Bayliss-Pratt says now is the time to act.
Once the phase two report is published, Professor Bayliss-Pratt says there will be detailed conversations with the cancer alliances to develop local plans that plug the gaps.
She acknowledges while there has been growth in nurse numbers there are ‘clear variations in both numbers and access to training’.
Professor Bayliss-Pratt says the ambition is to ‘increase the overall net supply of nurses working in cancer’ and ‘better support’ them when they are working in the field.
A big focus is expected to be on how specialist nurses are banded and the training they are offered.
The Macmillan audit – the first since 2014 – showed a huge variation in approaches being taken across England. Overall, the number of specialist nurses had risen by almost one third to 4,020 full-time equivalents, although changes in methodology meant it was unclear exactly how much of this rise was down to a true increase in numbers.
But beyond this good news there were also a number of ‘worrying’ trends, Macmillan said.
There has been a shift towards lower banded roles for specialist nurses. The proportion of nurses in band 5 and 6 roles rose from 23% to 28%, while band 7 roles fell from 67% to 61%.
adult chemotherapy nurse posts
The workforce also appears to be ageing. The proportion of specialist nurses over 50 increased from 33% in 2014 to 37% in 2017.
Regional variations were also a cause for concern, Macmillan said. Workloads in terms of newly diagnosed patients per specialist nurse ranged between 62 and 203 for lung cancer and 87 to 251 for urological cancers.
Breast cancer posts were the most common – 16% worked in this field. Their workloads varied between 56 and 145. Some 14% did not work in specific fields of cancer.
Nurses are being 'run ragged'
Overall vacancy rates varied between 11 per 100 filled posts to one regionally.
Macmillan chief of nursing and allied health professionals Karen Roberts says the findings should act as a wake-up call.
‘We’re concerned cancer nurses are being run ragged. Nurses tell us that their increasingly complex and pressured workload is beginning to effect the quality of care patients receive.’
‘It’s no surprise hospitals are struggling to recruit given this unprecedented pressure.’
But it was not just specialist nurses the audit looked at. There were four staff groups in total – with adult chemotherapy, palliative care and cancer support workers completing the set.
The audit found there were just more than 3,000 individual chemotherapy nurse posts – the equivalent of 2,686 fulltime equivalents. Half were at band 5 and in some places there were vacancy rates of 15 per 100 filled posts. Some 17% were over the age of 50.
palliative care nurses
On top of that there were 1,124 individuals – 978 full-time equivalents – working in cancer palliative care. Those posts were defined as spending at least half of their time with adult cancer patients. Some 40% were over the age of 50.
Meanwhile, the cancer support workforce totalled 702 individuals – 635 full-time equivalents – working at band 3 and 4. One third were over age 50.
Additional specialist training was reported as required for most. But Royal College of Nursing cancer and breast care forum chair Sue Cruickshank says she was still ‘really surprised’ by the findings, particularly in terms of advanced communication and psychological support training.
One in six specialist cancer nurses were not trained in advanced communication, while one in three had not achieved level two in psychological support.
‘These are critical skills,’ Ms Cruickshank says.
‘The terminology and titles also continues to be a source of concern and may lead to confusion among people affected by cancer as well as other nurses, resulting in wide differences in knowledge, expertise and skills.’
Ms Cruickshank says the cancer nursing education and career framework produced by the RCN should be a ‘starting point’ for ensuring consistency.
cancer support workers (all whole-time equivalents)
She also says the drift towards lower banding needs looking at, pointing out there were ‘very few’ nurses working with patients beyond band 8a.
‘If we want to recruit and retain a good quality cancer workforce we need all these issues addressing.’
Alison Keen, head of cancer nursing at the University Hospital Southampton NHS Foundation Trust and chair of the UK Lead Cancer Nurse Forum, agrees.
In particular, she believes there needs to be a greater emphasis on succession planning. ‘In medicine, doctors have a clear career structure and follow a specialist pathway early on in their career.
‘There are frameworks in place for advanced nursing practice now which we need to embed in cancer nursing to provide a clear career path for nurses.’
A view from...
The palliative care nurse
Kelly Critcher, a specialist palliative care cancer nurse at the London North West Healthcare NHS Trust, says:
‘Services are very stretched. We are seeing an increasing number of referrals every year.
‘It means some patients end up on a general medical or surgical ward and because symptoms are becoming ever more complex there is a limit to what staff can do. It is not just physical symptoms, it is the psychological side of it too. But on these wards, they don’t even have time to take a coffee break.
‘And even with the patients we do get to see, you find yourself having to make compromises. You may not be able to spend the time you want with them or give them as much help with symptom management as you would like.’
The cancer nurse specialist
Maria Noblet, consultant nurse in breast cancer at Portsmouth Hospitals NHS Trust, says:
‘Now I’m getting towards the end of my career, I’m becoming impatient. We‘ve known about the problems for years. We need action not words.
‘It’s patients who lose out – and that’s distressing for cancer specialists. I have a very good team at Portsmouth and we provide good care, but I do hear of problems elsewhere.
‘Because cancer services are overwhelmed you find continuity of care being compromised which is so important. Our ability to develop individual plans for each patient also suffers. We don’t have the time to get to know them and recovery planning becomes a tick-box exercise then.’
The chemotherapy nurse
Wendy Anderson, Macmillan chemotherapy nurse at South Tees NHS Trust, says:
‘When you go out to recruit you are very lucky if you get a trained chemotherapy nurse. We tend to train our own. It is the only way we can fill the gaps.
‘There are however still concerns that vacancies and the increasing number of patients and ever-increasing complex regimens will have a detrimental effect on standards of care and patient experience.
‘And the increasing age profile of the workforce means that succession planning is very important. We’re trying to find ways of making the roles more attractive and retaining trained staff with ideas such as flexible working and partial retirement.’
The cancer support worker
Miranda Jose, from Worthing Hospital, part of the Western Sussex Hospitals NHS Trust, says:
‘The supporter worker role is different wherever you go. It’s relatively new here. I cover five different tumour sites – in other places there’s a support worker for each.
‘I spend my time supporting the patients and cancer nurse specialists, helping to obtain results from scans, blood tests, triaging phone calls and organising holistic needs assessments which informs our health and well-being events.’
‘I love my job as every day is different, but this comes with pressure. The workload is demanding and the number of patients is ever-increasing. Meeting the needs of every patient can be challenging.
‘But feedback has been consistent in that our role has made a real difference to them. With more resources we could impact on a greater number.’