NHS England’s workforce plan is finally here – but does it go far enough?

On Friday 30 June 2023, NHS England published its long-term workforce plan , something we have been calling on the Government to commit to and support for many years. NHS Consultant Oncologist and our Chief Medical Officer, Professor Richard Simcock reflects on what the plan tells us, what it means for cancer care, and what needs to happen next.

Why is the workforce plan important for cancer care?

Working as an NHS cancer care professional today can often feel like running up a downwards escalator. As hard as you try, it’s impossible to reach the top, with a never-ending flow of patients coming in the opposite direction, all with a range of unique and complex needs, and nowhere near enough healthcare professionals available to meet the demand. We enter our profession wanting to do the best for every single person we see and treat, but the sad reality is that chronic underfunding and understaffing has severely hampered our ability to give patients the timely and quality care they need. It’s an appalling situation for both patients and professionals.

This is why Macmillan Cancer Support has been calling for a long-term plan for the NHS cancer workforce for years. The recent publication of the 15-year Plan by NHS England is a shift in the right direction for cancer care, but this is not yet enough to sufficiently tackle the severe range of challenges facing cancer services.

What does the plan tell us?

The positive news is, there is some cause for cautious optimism. The plan commits to independent analysis every two years to ensure the assessment of demand remains up to date; it acknowledges there are shortfalls and gaps in the NHS workforce; it recognises a need to better understand different roles and skill sets to develop more accurate workforce plans; and it mentions personalised care, recognises its importance, and commits to the potential expansion of personalised care professions. We were pleased to see all these things included.

What does the plan miss out?

However, as we all sadly know too well, the plan is long overdue, and it lacks the crucial detail we need to ensure there will be enough staff and resources in place to account for the projected increases in cancer cases and treatment advancements over the next decade, as well as the complexity which living longer with cancer can bring. Without information on the staffing numbers and skills mix needed in key specialisms to tackle waiting times, meet growing demand and effectively deliver rapid advancements in new treatments, there’s no way we can be confident that this strategy will translate into any sort of meaningful change for people with cancer.

Future planning also needs to consider how medical roles and responsibilities are expected to evolve over time to support advanced practice. In cancer care, we have rapid developments in diagnostic technology, therapeutics, radiotherapy and surgery; in my own specialty of breast cancer, we have seen four new and beneficial drug indications introduced in the last 12 months. These are ‘good problems’ which signify positive progress but pile additional pressure onto a system that is already struggling to cope. In the future, healthcare professionals will have new tasks and roles, and there will need to be more flexibility to support people’s professional growth and improve healthcare systems. Future career paths should therefore be adaptable and offer modular educational support to develop the necessary skills in each area. This will require funding as well as collaborative working with education providers and accrediting bodies and is an important part of retention that should not be overlooked.

We had long called for the plan to be fully funded, but the ￡2.4 billion attached to it is ringfenced solely for education and training. Other measures, such as those around retention, haven’t been assigned any funding, meaning NHS Trusts are expected to deliver this out of their own budgets. Given how stretched NHS Trust budgets already are, combined with the ongoing impact of inflation, it’s hard to see at this stage how everything included in the plan will be funded and delivered.

Future forecasts in the plan have been made using high productivity assumptions. However, productivity among NHS professionals has been falling and it is unclear how the NHS will reverse this trend and increase productivity to the extent projected within the strategy. Due to the current strain on our workforce, there is a significant risk that these ambitions will not be met, particularly given how burnt out we know many cancer professionals already are.

The plan needs to go much further...

The plan also doesn’t explain how it will benefit people who are waiting too long for a cancer diagnosis and for their potentially life-saving treatment to start right now. A long-term plan for the workforce is crucial, but we also need to know what immediate measures will be put in place to help those people who are stuck waiting too long in the system today.

As is often the case with Government plans, the devil is in the detail. To be sure this strategy will bring about long-lasting change, it needs to go much further than it currently does, and we need to see NHS England and the UK Government working with organisations like Macmillan to develop the deeper thinking required for specific areas like cancer care, to ensure the millions of people with cancer across the country receive the timely and quality care they need both now, and in the years to come.