The Long-Term NHS Workforce Plan – what does it really mean for lung cancer care?

The UKLCC welcomes the publication of the long-awaited Long-Term NHS Workforce Plan today (30th June 2023).1 The Government is pledging £2.4 billion of investment over five years to expand the NHS workforce and stop people leaving amidst a massive staffing crisis.   

Much of the new Workforce Plan focuses on boosting early-stage training in England, such as new and shorter medicine degrees and more apprenticeships.  While this is important, it takes many years to produce highly qualified staff and many clinicians and specialist nurses are currently facing burnout and leaving the profession in droves. 

The Plan does speak to the importance of retention among the workforce, for example, ensuring staff can work flexibly; have access to health and wellbeing support; delivering on the changes to pension tax arrangements, and retired consultants given the option to return to work. However, perhaps not surprisingly, there is no mention of pay or conditions.

While we appreciate that the Plan covers the whole NHS workforce, (a dedicated Cancer Workforce Plan was last published in 2017),2 the Workforce Plan only mentions the radiology workforce once, and specifically regarding the introduction of new AI technology to help facilitate their role and reduce waiting times.  Currently the NHS has a shortfall of nearly 2,000 FTE radiologists.3 To deliver the recently announced national targeted lung cancer screening programme and meet the demand of performing and reporting extra CT scans, we need to focus on training and retention of radiologists urgently.4

Another obvious omission from the UKLCC’s perspective, is the investment and recruitment of support staff, for example in the form of pathway navigators. Pathway navigators perform a vital administrative role. By booking CT scans, and coordinating and tracking tests and appointments, they can prevent delays and free up nurse specialists and doctors to concentrate on their clinical work – thus optimising the pathway.

Cancer nurse specialists are also under threat and the Plan does not appear to address the fact these posts are being downgraded or that the CNS role is not being replaced when individuals leave the profession, either due to retirement or overwork.  This is reducing the overall number of experienced lung CNSs in the NHS workforce.

The Lung Cancer Service Specification sets out how much specialist clinical capacity a trust should have to look after their lung cancer patients. This specifies both the amount of time and the level of expertise / specialism a lung cancer clinician should have based on what proportion of their role is focused on lung cancer. Compliance with this standard was measured in the latest National Lung Cancer Audit’s Organisational Report which showed how many trusts are achieving the standards. Unsurprisingly, the results demonstrate that more work needs to be done to ensure that we have an optimal workforce across the country.5

Pathology is a vital element of lung cancer care and there is a major shortfall in pathology staff at all levels, which seriously threatens the roll out of the genomic medicine programme, so vital to rapid and accurate treatment in lung cancer patients.  The Royal College of Pathology conducted a workforce census in 2018 which found that only 3% of histopathology departments have enough staff to meet clinical demand.

While the NHS Chief Executive, Amanda Pritchard, says that this first Long-Term NHS Workforce Plan is ‘the first step in a new iterative approach to NHS workforce planning’ and will allow NHSE to’ take the actions locally, regionally, and nationally to address the gaps we have in the current workforce’ – there is an absence of fully costed plans. The devil will be in the detail.

Workforce shortages are a major limiting factor in achieving universal access to optimal lung cancer services. There are a range of different issues at play and the UKLCC will continue to address the specific workforce challenges in lung cancer.

 

  1. NHS Long Term Workforce Plan 2023: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan.pdf
  2. NHS Cancer Workforce Plan 2017: https://www.hee.nhs.uk/our-work/cancer-workforce-plan
  3. Royal College of Radiologists Census 2021: https://www.rcr.ac.uk/posts/new-rcr-census-shows-nhs-needs-nearly-2000-more-radiologists
  4. Press release - New lung cancer screening roll out to detect cancer sooner: https://www.gov.uk/government/news/new-lung-cancer-screening-roll-out-to-detect-cancer-sooner
  5. NLCA Organisation Audit January 2020: https://nlca.rcp.ac.uk/Content/misc/NLCA_organisational_audit_2019.pdf
  6. Royal College of Pathologists, Meeting Pathology Demand – Histopathology Workforce Census, September 2018: https://www.rcpath.org/static/952a934d-2ec3-48c9-a8e6e00fcdca700f/Meeting-Pathology-Demand-Histopathology-Workforce-Census-2018.pdf