Estimating the gap in the provision of specialist cancer nurses in England


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Rachel White1,Jacqueline Goodchild1
1Macmillan Cancer Support

Abstract

Background

Specialist cancer nurses play an essential role in supporting people living with cancer.  The Macmillan Cancer Workforce in England census identified 4,000 whole time equivalent posts in October 2017.  However, the system is showing signs of strain and nurses report this number is insufficient to give people living with cancer the care they need.  To guide national planning for the future workforce, we have estimated the number of additional specialist cancer nurses needed in England.

Method

Published data were used to predict the number of people living with cancer in 2017 and 2030.  This was partitioned into ten cancer type groupings, by Cancer Alliance and by stage in the cancer pathway – suspected cancer, the year of diagnosis, follow-up (stratified into complex patients, patients who can receive supported self-management and long-term follow-up), advanced cancer and the last year of life.

Over 50 nurses provided insight into the scope of their roles, and informed assumptions about the time that should be spent on each nursing activity to provide high quality patient care throughout the cancer pathway. We use these assumptions to produce an estimate of the ideal ratio of nurses to people with cancer. These ratios were applied to the modelled cancer population to estimate the number of nurses needed in 2017 and 2030. 

Finally, the required number of nurses was compared to data from the Macmillan census, after excluding posts in Acute Oncology Services and vacant posts.

Results

In 2017, specialist cancer nurses needed to support 350,000 newly diagnosed cancers (in the ten cancer groups, including key carcinomas in situ), one million people in follow up and 130,000 people who died from cancer.  The numbers of extra nurses we believe are needed to deliver high quality patient care to this number of patients will be presented.

Conclusion

Specialist cancer nurses are critical in providing holistic care to people living with cancer, but this can only be delivered if, amongst other factors, the workforce is large enough to deliver a high-quality service.  These estimates offer a national benchmark both now and for the future, though workforce planning should be tailored to the local context.