NHSreality warned you it was going to get worse, and sure enough it is. It may be that the current crisis is forcing the oncologists to make decisions that they have ducked to now. Patients can often be led into making the right decision, and rarely is it to have toxic therapies that prolong their lives for only a few weeks. The letter from Dr Burt needs to be read and re-read. People are the most valuable resource in the UKs four health services, and we have just not trained enough.
The Times leader 10th Jan 2018: Care Critical – A dire shortage of specialist cancer nurses in Oxford reflects a staffing crisis across the NHS that can only be rectified with better long-term planning
If anywhere in Britain can offer first-rate cancer treatment, Oxford should be on the list. It has some of the world’s best teaching hospitals, a good record of health service management overall, and every inducement for doctors and nurses considering where to live and work. Yet these inducements seem to be failing. Largely for want of specialist nurses, cancer care in Oxford faces severe rationing that could shorten the life expectancy of terminally ill patients and hurt the chances of recovery for the newly diagnosed.
Emails seen by The Times, written by a senior Oxford oncologist, describe a 40 per cent nursing shortfall that he considers “unsustainable in the short, medium and long term”. They set out a plan to delay the start of chemotherapy for new patients and stretch out fewer cycles over longer periods for those already undergoing treatment.
It is not the drugs that are in short supply, but the staff to administer them. If this were an isolated case the blame could be laid squarely at the door of local NHS managers. In reality the problem is more complex and widespread. Because of falling morale, falling real wages, the scrapping of nurse training bursaries and the impact of Brexit, a general nursing shortage is threatening the quality of care across the NHS. Andrew Weaver, the Oxford oncologist, has issued an appeal for constructive suggestions to fix his staffing crisis. On the national level similar appeals have produced a ten-year NHS “workforce strategy” and an undertaking to train 10,000 more nurses a year, starting in September. This is the right approach, with one glaring shortcoming. It should have been adopted a decade ago.
It takes three years to train a nurse and at least two more for him or her to specialise in cancer care. The work involves delivering lifesaving but also potentially lethal drugs and cannot safely be delegated to non-specialists. Faced with staff shortages, NHS trusts have historically muddled through or sought emergency funding to hire from agencies, overseas or both.
Muddling through is not an option for patients in urgent need of chemotherapy. Emergency funding is in short supply, and hiring from agencies is rightly frowned upon as an inefficient use of public money. Hiring from overseas has been complicated by Brexit.
In the year after the EU referendum the number of nurses from the European Economic Area (EEA) registering to work in Britain fell by 32 per cent. Some of the decrease was accounted for by nurses failing new and necessary language tests, but the fall was still significant. It has been compounded by a sharp increase in the number of EEA nurses opting to leave in the same period.
In absolute terms an exodus of British nurses from the profession is even more troubling. In 2015, for the first time, more left the national register of the Nursing and Midwifery Council than joined it. Last year the net loss was nearly 5,000. The Royal College of Nursing has spoken of a “perfect storm” of factors leading to a record 40,000 nursing vacancies nationwide. Prominent among these is a vicious circle of increasing workloads deterring new recruits.
Macmillan Cancer Support recently listed the consequences of a “historic lack of long-term planning”. One is that a majority of doctors and nurses are no longer confident that the NHS gives cancer patients even adequate care. Where this care is prompt, personalised and comprehensive it can still be second to none. Where it is not, outcomes and survival rates lag behind those of other advanced countries. Having fought to stay on at the Department of Health, Jeremy Hunt will want to do better. A good first step would be a more ambitious expansion of nurse training and a reinstatement of bursaries for specialist training where it is most needed. Starting with cancer.
Top hospital cuts cancer care due to lack of staff Chris Smyth, Health Editor
A seminal letter on this subject 9th Jan 2018:
Sir, Oncologists need to take a long hard look at what they are trying to achieve. Response rates in second and third-line chemotherapy are very poor and inevitably interfere with quality of life. There is an obsession with including patients in clinical trials, which are costly and are often used for career progression rather than cancer progression. The hardest thing for an oncologist to learn is not how to treat patients but when to treat them. Many need to learn that no treatment is often the best treatment. It takes guts to tell a cancer patient that no further active anti-cancer treatment is now right for them. The best oncologists do that.
Oncology can surely not moan about staff shortages when literally dozens of consultants and senior nurses sit down for hours on end to discuss routine cancer cases, the management usually being obvious. Multidisciplinary team-working (or medicine by committee) is the biggest waste of NHS resources bar none.
Dr Paul Burt
Retired clinical oncologist, Stockport