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The NHS workforce crisis is holding back cancer diagnosis

As technology to detect cancer advances, staff shortages are curbing its potential.

By Sarah Dawood

In treating cancer, prevention and early detection are key to saving lives, and technology in this area is advancing at pace. Last week, the Health Secretary Steve Barclay committed to delivering personalised cancer vaccines by 2030 in partnership with the biotechnology company BioNTech. While last month, a new blood test that can detect 50 types of cancer at a very early stage showed promising results in an NHS trial.

The Galleri blood test picks up on fragments of tumour DNA in the bloodstream. In a trial of 5,461 people who had visited their GP with suspected cancer symptoms, it correctly detected two out of every three cancers; and in 85 per cent of positive cases, it pinpointed the original site of cancer. The test is currently undergoing another major trial of 142,000 people with no symptoms, and if successful, could be offered to a million people from 2024.

But amid these exciting inventions, NHS patients are facing life-threatening delays to treatment. Severe staff shortages have led to longer waiting times at nearly all the UK’s cancer centres, a recent poll from the Royal College of Radiologists has found. As the college’s president Dr Katharine Halliday noted for New Statesman Spotlight last week, doctors face the “moral injury” of knowing that they could do so much more to improve patient’s chances of survival, if only they had the resources and time.

Earlier this month, the government and the NHS jointly published their long-awaited long-term workforce plan, which recognised the cancer treatment workforce as a priority. It committed to 1,000 more specialty training places in areas with the greatest shortages, which includes cancer and diagnostics, alongside 150 more radiographers every year, and ensuring all cancer patients have access to a clinical nurse specialist. These nurses act as the main point of contact and expertise.

Mark Middleton, professor of experimental cancer medicine at the University of Oxford and the lead researcher on the Galleri trial, told Spotlight that the blood test’s “exciting technology” could be applied at scale across the NHS, and while it is not strictly a diagnostic tool, it could help doctors decide who should have further investigations like scans and biopsies for specific cancers.

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It could also be used to rule out people from having unnecessary invasive investigations. “This would be really helpful as it will spare people worry, free up capacity and speed up cancer diagnosis,” he said. However, more testing could also lead to “false positives”, so NHS trusts would need a good system in place to warn people of this, pick up on it and clear them from further investigations.

Another challenge is the prospect that many more people may need follow-up scans, putting even more pressure on cancer services. “The system is already running hot,” said Middleton. “That’s why we’re excited by the ‘rule out’ potential of a tweaked test, as this would allow us not to do tests we currently do.”

Steve Brine, Conservative MP for Winchester and chair of the cross-party Health and Social Care Committee, told Spotlight that the Galleri test and similar technology will also help to spot cancers that don’t currently have regular screening programmes, such as ovarian and pancreatic, and cancers that are often detected at a later stage.

[See also: Too many of us know the anxiety of waiting for cancer treatment]

Charity leaders have backed calls for greater investment in the workforce to enable the NHS to roll out such technologies. Speaking to the Health and Social Care Committee in parliament in late June, Gemma Peters, chief executive at Macmillan Cancer Support, said there was “no shortage of innovation” but that adoption was being haltered by a lack of “skills, capabilities and capacity of people to be able to implement change”.

Peters also stressed the importance of clinical nurse specialists in giving patients personalised care, and said that access to these experts “is the single biggest indicator of what your cancer experience will be like”. Alongside the need to train more nurses, it was also discussed that training should cover rare and less common cancers.

Giving patients access to detection tools before there is capacity to treat them could create worry among the population, Peters added, so this requires forward-thinking around support services. “If we are able to identify many more cancers much earlier and do not yet have treatments… [we are] turning large sections of the population into patients before we have anything to do with [them],” she said. For example, some slow-growing blood cancers are currently not treated for several years because the treatment can be more harmful to the patient than the cancer.

A postcode lottery exists in terms of access to new treatments and tests. Michelle Mitchell, chief executive at Cancer Research UK, noted in the same committee session that there is a lack of investment in new technology across the NHS. The King’s Fund recently identified that less than 0.1 per cent of funding is available for the adoption and spread of innovation across the service, resulting in regional inequalities and long waits for new therapies to become available.

Saving lives and improving people’s outcomes also does not solely rely on innovation – legislation around public health is a simple mechanism that could make a big impact. “We want to see this government, or any future government, be incredibly bold about making it much harder to start smoking and much easier to stop smoking,” said Mitchell. “It may not be as shiny and exciting as precision medicine and AI, but it is one intervention that could make a huge difference.”

The NHS long-term workforce plan has made bold commitments regarding staffing, but cancer charities are calling for a funding pot specifically to enable the cancer workforce to adopt new technology. Cancer Research UK estimates a need for £35m-£40m of investment to ensure staff have the training, skills and capacity to implement innovative treatments and tests. Ringfenced funding would “send an immediate signal” that the government was serious about improving cancer survival and tackling the cancer crisis, said Mitchell.

[See also: Can apprenticeships solve the NHS workforce crisis?]

This article was originally published on 10 July.

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