Beating cancer: ambition and action

7. Workforce

Our Ambitions

To have a diverse, sustainable, workforce caring for people with cancer.

To support equity of access to specialist care regardless of geography.

To see all people with cancer, who need it, have access to a specialist nurse during and after their treatment.

People with cancer require sustainable care across a spectrum comprising primary and community care, diagnostic services, treatment and care after their treatment, palliative and end-of-life care.

That means a wide range of skilled staff provide advice, support and targeted care to individuals with cancer. Many of these staff may not specialise in cancer but nevertheless have a broad range of knowledge and skills equally as relevant for each person. Workforce planning is therefore key to ensuring we have in place all of the relevant skills and expertise required in general practice, in the community and in secondary and tertiary care provided in hospitals across the country.

Acknowledging the complexities of a challenging clinical area, we know that for some healthcare professions and specialities it can be difficult to recruit staff. For all services, we work closely with NHS Boards to support their efforts to recruit and retain highly skilled staff.

But, as noted throughout this plan, we know demand for services is rising, fuelled by our ageing population with the consequential increase in the number of cancer diagnoses per year, and the broader spectrum of services required by people living with cancer. While we know that through their unstinting efforts our existing workforce has so far coped with these pressures, we need to find more sustainable approaches to delivering person centred services across the spectrum from primary/community care to highly specialised care over the longer term.

Evidence shows that we are moving in the right direction.

The total NHS workforce in Scotland has grown to an all-time high of 161,000 (138,000 WTE). Looking at just one of the specialties closely associated with cancer care, we have seen numbers of consultant clinical radiologists increase by 97.3 WTE, or 43.5% under this Government and by 12.3% in the last 2 years. In terms of future medical and nursing supply, the £27 million announced in February 2016^[73] to train additional nurses and doctors is a contribution towards ensuring Scotland's NHS has a more sustainable workforce, some of whom will be involved in providing the cancer services of the future.

NHS Education for Scotland (NES) has already taken steps to increase the number of Radiology training posts by 16 places over the past 3 years and will keep this trainee establishment under review. Clinical oncology training posts have also been increased by six over the past 2 years in recognition of the need for further growth in the consultant establishment. For therapy radiographers (who support planning an delivery of radiotherapy) 32 additional training places were put in place. The second tranche of training for the previous intake of radiographers has now started and this 3-year programme will be completed by end 2016-17.

Planning for Demand

Rising demand for cancer services is not unique to Scotland, and several European countries are experiencing similar issues. In October 2015 the Royal College of Radiologists reported that Scotland has around seven radiologists (consultant and trainees) per 100,000 population. This is comparable to the rest of the UK but is lower than other European countries including Germany (11 per 100,000), Finland (13 per 100,000) and Norway (12 per 100,000).

Many NHS professions provide cancer services, and having sufficient staff is vital to providing any high quality service. But numbers alone will not meet the constantly shifting challenges. That means we must maximise the contribution from the whole healthcare workforce, and deliver high quality services as flexibly as we can to those who need them. It means considering the wider characteristics of the workforce required to provide high quality services - drawing on the full range of professional skills offered, for example, by Specialist Nurses, Advanced Nurse Practitioners, by allied health professionals such as Radiographers, Speech and Language Therapists and/or by those who work within the Healthcare Sciences.

Some individuals will continue to require the support of specialised staff who can provide the highest quality high technology care available. Others may need more generalist care. The complexity of this clinical environment means there is often no single solution about how to provide the best balance of treatment and care. Skilled planning involving professional judgement is required in finding the right workforce to provide the best possible outcomes, involving:

• Combining generalist as well as specialist skills.
• Working effectively in teams.
• Valuing the contribution of all disciplines to addressing individual needs.
• Excellent generic skills, such as listening, communication, leadership and improvement skills.
• Engaging in life-long learning, recognising the pace of change in health and social care.
• Remaining flexible, able to adapt to changing technology and individual need.

Risk can arise in over-emphasising workforce issues at the expense of service planning and delivery, and solutions which may have worked previously may no longer apply. It is therefore worth restating that planning for the right workforce cannot and must not be carried out in isolation. Many factors combine to influence this, including demand for services, new technology, new developments in diagnosis and treatment or location. This has particular relevance for cancer services planning and delivery across the country.

Providing Scotland's people with high quality services requires sufficient numbers of the right staff in the right location with appropriate skills. That applies universally to the services NHSScotland delivers. But harnessing the knowledge, skills and attributes of the workforce, and deploying them in the right way, are particularly important for cancer services which involve so many different aspects of diagnosis, treatment and care, and such a diversity of professional challenges.

Just as our National Clinical Strategy sets the direction for NHS services, including cancer services, our framework for Everyone Matters: 2020 Workforce Vision,^[74] provides a clear workforce vision and plan, thought through and co-produced with our staff. We continue to support our workforce alongside staff side partners through the priority areas identified in that plan:

• Healthy organisational culture
• Sustainable workforce
• Capable workforce
• Workforce to deliver integrated service
• Effective leadership management.

Actions - Workforce

• Workforce planning for cancer, including for training and education, will move to be undertaken on a national basis over time. This will be taken forward in our well-established partnership approach to create the sustainable workforce we need for the future. This will ensure that workforce planning for cancer spans the entire cancer care pathway and will complement the workforce vision and plan in Everyone Matters.
• We will put the necessary levels of training in place to ensure that by 2021 people with cancer who need it have access to a specialist nurse during and after their treatment and care.
• We must ensure that our investment in radiotherapy equipment is being fully utilised and delivering to its full potential, so we are making at least £11 million available over the next 5 years to support additional radiotherapy training and staff for these specialist services. A sub-group (of NCCSG) are developing a plan, including appropriate training and support, to ensure that advanced radiotherapy techniques become the norm.