Major challenges threaten future of cancer nursing, in-depth study reveals

Originally published: 30 April 2018

Macmillan Cancer Support today (Monday 30 April) reveals the findings of its census of specialist cancer nurses and support workersᶦ, the first in depth investigation into the cancer nursing and support workforce in England since 2014.

Macmillan Cancer Support’s census shows:

  • The number of new cases per specialist cancer nurse is dramatically different across the countryᶦᶦ
  • A greater proportion of specialist cancer nurses being paid in lower pay bands than in 2014ᶦᶦᶦ
  • Higher vacancy rates in specialist cancer nurse and cancer support worker roles than the UK average for health and social work
  • The proportion of specialist cancer nurses aged over 50 has increased.

The Census reveals a startlingly broad variation in the number of new patients diagnosed each year per specialist cancer nurse, in some areasᶦᵛ and some specialisms as many as three times others.

Examples of this variation by specialism include:

  • The number of new cancer diagnosesᵛ each year per urology nurse varies from 87 to 251 by area
  • The ratio of new cancer diagnosesᵛᶦ per breast cancer nurse each year varies by area from 56 to 145
  • Numbers of new lung cancer casesᵛᶦᶦ each year per specialist nurse vary from 62 to 203 by area.

Macmillan warns that such wide variation may mean that patients may not be getting access to badly-needed specialist care.

The in-depth study, which gives the most accurate picture of the cancer nursing workforce in England to date, suggests further worrying trends. While the workforce as a whole has grown, a greater proportion of specialist nurses are now employed in lower pay bands than in 2014, when Macmillan last conducted a census of the workforce.ᵛᶦᶦᶦ

Macmillan warns that a trend of highly trained specialists taking on increasingly complex caseloads for lower pay may be exacerbating recruitment and retention problems in the cancer nursing workforce.

The census looked at four roles: specialist cancer nurses, chemotherapy specialist nurses, specialist palliative care nurses who focus on cancer and cancer support workersᶦˣ. It found vacancy rates higher than the UK rate for health and social workˣ across all four roles, with as many as one in seven chemotherapy nurse positions being unfilled in some parts of England.

The study also found that the proportion of specialist cancer nurses aged 50 or over has increased since the last census in 2014ˣᶦ, which Macmillan says highlights the importance of making sure plans are in place to make the workforce sustainable in the long term.

Dr Karen Roberts, chief nursing officer at Macmillan Cancer Support, said:
“Having the expertise and support of a specialist nurse from the point of diagnosis has a huge bearing on whether or not a cancer patient has a positive experience of the care they receive. We are concerned that cancer nurses are being run ragged, and that some patients may not be receiving the level of specialist care they need.

“Nurses working in cancer care tell us that their increasingly complex and pressured workload is beginning to affect the quality of care patients receive. It is no surprise that hospitals are struggling to recruit to these roles, given this unprecedented pressure.”

Dr Fran Woodard, executive director of policy at Macmillan Cancer Support said:

“While the cancer workforce has grown, it has done so over a number of years without adequate long-term planning or direction. Macmillan has undertaken this work to highlight the strain this puts on those working in cancer care and to ensure that action is taken. This situation will become more acute as the number of people being diagnosed with cancer continues to grow.

“We welcome the progress Health Education England is making on the cancer workforce strategy. However, this census highlights the urgent need for this essential part of the NHS workforce to be properly equipped to cope with the increasingly complex challenge that cancer poses in the years to come, and it is therefore vital that the Department of Health and Social Care ensures that the cancer workforce strategy is appropriately funded”.

To read the full report click here.


Notes to editors

For further information, please contact:

Patrick Pringle, Senior Media & PR Officer, Macmillan Cancer Support.

Tel: 0207 840 4891 (out of hours 07801 307068).

About Macmillan Cancer Support

There are 2.5 million people living with cancer in the UK. One in two people are likely to get cancer in their lifetimes. Cancer can affect everything, including a person’s body, relationships and finances.

Macmillan Cancer Support provides practical, emotional and personal support to people affected by cancer every year. The charity is there to support people during treatment, help with work and money worries, and listen when people need to talk about their feelings.

Macmillan receives no government funding and relies on generous donations from the public. People up and down the country show their support for Macmillan — from hosting or attending a World’s Biggest Coffee Morning to running a marathon or giving up alcohol — so the charity can help more and more people affected by cancer every year.

Life with cancer is still your life and Macmillan is there to help you live it.


ᶦ Macmillan Cancer Support, Cancer Workforce in England: A census of cancer, palliative and chemotherapy speciality nurses and support workers in England in 2017.

ᶦᶦ Based on cancer incidence in 2015 (National Cancer Registration and Analysis Service and Macmillan. 2018. Cancer Incidence and 2-year prevalence by Cancer Alliance and WTE of specialist cancer nurses. The analysis was conducted for each cancer type individually.

ᶦᶦᶦ In 2014, 23% of specialist cancer nurse WTE were at Agenda for Change banding 5 or 6. In 2017 28% of specialist cancer nurse WTE were at Agenda for Change banding 5 or 6. Note there were some changes in the inclusion criteria between the 2014 and 2017.

ᶦᵛ Based on patients diagnosed within the area of cancer alliances or the national cancer vanguards and specialist cancer nurse based in hospitals with their main address within each cancer alliances or national cancer vanguards.

ᵛ Cases of urology cancer including prostate and testicular (C60-C68) and in situ of other and unspecified sites (D09).

ᵛᶦ Cases of breast cancer including in-situ cases (C50,D05).

ᵛᶦᶦ Based on all respiratory cancers (C33-C34, C37-C39, C45).

ᵛᶦᶦᶦ In 2013 67% of specialist cancer nurses were employed in the higher paid Band 7, in 2017 61% were employed in the same band. Meanwhile in 2014 23% were employed in lower paid Band 5 and 6 roles, which increased to 28% in 2017.

ᶦˣ These roles were defined as part of the research see Appendix A iii. inclusion and exclusion criteria, Macmillan Cancer Support, Cancer Workforce in England: A census of cancer, palliative and chemotherapy speciality nurses and support workers in England in 2017.

ˣ There were 3.2 vacancies per 100 employee jobs in human health & social work activities in September to November 2017 (Office for National Statistics, March 2018. Vacancy Survey, VASC02: Vacancies by Industry, 21 February 2018). In the Macmillan study it identified a rate of 4.3 vacancies per 100 filled roles (based on WTE) for specialist cancer nurses, 6.3 for chemotherapy nurses, 4.8 for specialist palliative care nurses working in cancer and 10.6 for cancer support workers.

ˣᶦ 2014 33% of filled specialist cancer nurse posts (headcount) were aged 50 or over. In 2017 37% of filled specialist cancer nurse posts (headcount) were aged 50 or over. This is based on filled posts where the age band was specified.

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