Helping future proof the East of England’s cancer workforce

The collaboration between GE Healthcare and various elements of the National Health Service (NHS)[1] in England is aimed at optimising the cancer care workforce across the East of England. Through data analysis, over 210 interviews and four workshops, this collaboration delivered 3-, 5- and 10-year future need projections in support of their strategic planning. It underlines the importance of a person-centred approach and a collaborative mindset when solving complex healthcare issues.

Challenges to improving early diagnosis and screening

Improving early-stage diagnosis and screening services for cancer has become a major priority for both policymakers and healthcare providers, with cancer waiting time targets in England seeing a net decline in performance over the last 10 years.[2] Although cancer survival rates in England are improving, the NHS is still performing below other comparable European countries.[3] There are four converging factors which make addressing the issue particularly tough:

1. Most people with cancer have at least one other long-term condition. The way these patients are treated may impact negatively on survival rates.[4]
2. Advances in treatments also means that cancer is, increasingly, a long-term condition for many patients. This has led to the need of expanded cancer screening services and the rollout of Rapid Diagnostic Services[5] across England.
3. Increasing diagnostics backlogs,[6] including in cancer care, has led to longer waiting lists and later diagnoses. Before the COVID pandemic there was already a recognition of a need for “radical improvement in diagnostic services.”[7]
4. The NHS is facing a serious shortage of trained, qualified cancer and diagnostic staff.[8]

The challenge of staff shortages potentially has the most serious long-term implications for the NHS in England. As well as dealing with the gaps that exist in provision right now, there is a need for strategic planning to address the future shape of the workforce.

Strategic cancer workforce planning across systems

GE Healthcare began working with Health Education England (HEE)[9] and the East of England Cancer Alliances[10] to evaluate strategic cancer workforce planning across their systems. It was a complex picture, which boiled down to answering two fundamental questions: How is the current workforce optimised to deliver the best outcomes for cancer patients? How might various future scenarios impact the workforce and what should that mean for future planning and subsequent actions in the near-term?

Evaluation, planning, validation and buy-in

To address these challenges, the GE Healthcare team listened to the issues and worked together with their partners to agree a process which consisted of three phases:

1. Evaluation: this involved a mix of data collection and assessment, and over 210 interviews with those involved in cancer care provision at all levels as well as with patients in the East of England. This generated a huge volume of information which allowed some preliminary conclusions to be drawn around possible new models of care.
2. Scenario planning: the scenario planning considered potential developments for specific cancer pathways, known upcoming legislative changes, and how planned transformation initiatives might impact activity, and therefore staffing in the future.
3. Validation and buy-in: four workshops were held with clinicians, nurses, managers, and other stakeholders to validate the preliminary findings and discuss views of the future in a group setting. This was a key stage of the process because it supported clinical buy-in and ‘ownership’ for the proposed new models of care which were vital for implementation.

Detailed recommendations and reporting

GE delivered detailed reports on four Sustainability and Transformation Partnerships (STP)[11] and Integrated Care Systems (ICS),[12] and a general report on another. The cross-system findings from these reports were deemed to be relevant for all six of the STP/ICS in the East of England. The findings included over 40 detailed recommendations for immediate action to optimise the current cancer workforce, and detailed future need projections for 3-, 5- and 10-years based on the different scenarios that had been considered. A separate report also recommended regional-level actions which highlighted possible synergies across the six systems.

At the regional level, the work enabled, amongst other things: pooled efforts to share best practice and identification of common challenges across the region, thereby removing duplication of effort; and the national publication of outputs to increase regional engagement and consistency.

At a local level, one specific area of work was the role of the Clinical Nurse Specialist (CNS)[13] and cancer nursing in general. A suite of tools[14] was developed to enable a consistent approach to the cancer nursing workforce at regional level, to allow easier training and recruitment, and to facilitate cross-border collaboration.

Another area provided the evidence to support the recruitment of additional support workers and CNS, additional pharmacy and support worker training, an extension of the geriatric assessment at the front end of the pathway.

Maintaining momentum

Building on the findings of this work, ensuring sustained change, and maintaining momentum, GE Healthcare continued to collaborate within the East of England Region and deliver local projects relating to the initial cancer and diagnostic workforce reports.

In addition, GE Healthcare continues to work with one of the systems[15] to develop a wider diagnostic workforce model. This ongoing work has provided a forum for three[16] diagnostic services to think strategically as 'one service across two sites' and supports the development of innovative, forward-thinking workforce development plans that aim to achieve sustainable diagnostic service delivery. 

The vision is that the services should be able to use outputs from the diagnostic workforce model to evidence their transformation plans which, in each case, aim to deliver a more sustainable and cost-effective skills mix. This will also make the Trust a more attractive place to work, with clear career development pathways to help improve retention and reduce reliance on recruitment.

Conclusion

The success of this work is undoubtedly down to three key factors: the scale of the collaboration, the shared goal, and the patient centric approach. These factors led to an innovative approach, extensive engagement across the different roles and teams, which in turn revealed actionable insights and a shared narrative to evidence the need to work differently.

Quotes from customers

Tonia Dawson OBE, Macmillan Clinical Lead, East of England Cancer Alliance, said: “Working with the GE team has been both enjoyable and enlightening. Their insight, drive and expertise has allowed us to look critically at our workforce as well as at the activity and demand on our services. It will make a real difference to how we redesign, plan and think about the overall structure and grade of staff[17] moving forwards.” (December 2019)

Dr James Ramsay BLMK[18] ICS Cancer Clinical SRO; Medical Director Bedfordshire Hospitals NHS Trust, said “Partnerships like this one with GE, the ICS and the Trusts help us build resilience into our workforce, which has been stretched as never before by the Covid pandemic. It will be very important in ensuring that our outstanding staff can continue to provide the very highest standards of patient care to this community.” (August 2021)

Sam Brown BLMK ICS Diagnostics Programme Director, said ''We know that the cancer workforce is challenged not only within our ICS but across the country.  Working in partnership with GE and HEE is helping us to truly understand and unpick the complexity and challenges in diagnostics in our ICS and to support our thinking in optimising the staffing skill mix; enhancing multi-disciplinary working, co-ordinating workforce planning and training with new ways of working.'' (August 2021)

Karen Cheetham, Head of the EMEA Process and Pathway Optimisation Team at GE Healthcare, said: “GE has primarily built its reputation on technological innovation, but while good cancer care requires cutting edge equipment, its quality and sustainability ultimately relies on the people delivering it. Given the pressures on healthcare capacity everywhere, improving workforce optimisation is a priority for many health service providers.” (August 2021)