This week the Nuffield Trust published a new research report, Reshaping the workforce to deliver the care patients need. To coincide with the research, we will be unpicking the major themes from the report in a series of comment pieces from our researchers and expert guest contributors. In this blog, Moira Fraser, Director of Policy, Public Affairs and Campaigns at Macmillan Cancer Support, outlines some of the work Macmillan are doing to experiment with new cancer support roles.
The story of cancer is changing. There are currently 2.5 million people living with cancer in the UK – this has grown by 400,000 in the last five years and we expect to see this figure reach four million by 2030. With these growing numbers, it is vital that we get the right workforce in place to ensure that everyone with cancer has the best possible care and treatment.
While having access to a clinical nurse specialist (CNS) is strongly associated with people with cancer receiving a good experience of care, we know that one in 10 people with cancer do not have access to this expertise.
Addressing this increasing need will be important, but responsibility for supporting people affected by cancer does not fall on the specialist cancer workforce alone. People with cancer have increasingly complex needs and multi-morbidities. At Macmillan Cancer Support we have been thinking about new ways to meet these needs beyond increasing and developing the current workforce and the kind of skills and roles the whole system will need for the future.
Teams in different sectors and professional groups must work together to provide seamless care. People with cancer say they want to feel in control of their own care, working with and supported by people who understand that they are more than their illness. They also want to access specialists when they need them who really understand their disease and can best help to coordinate their care.
Creating the cancer workforce of the future
From our own experience, there are many opportunities to start exploring new roles and changes to the mix of skills needed in the workforce. The Nuffield Trust argues that these kinds of roles will be vital to sustain new models for our changing population. We want to ensure we have the right workforce with the right skills to meet the changing needs of people affected by cancer.
At Macmillan, we have already started testing out new roles – for example, we have recently piloted a support worker role. This is a non-nursing role that provides coordination of care to people identified as having non-complex needs. These people can be supported to self-manage their own care with support, while still having access to their care team.
Support workers help individuals to take control of their own care – to be the manager of their own cancer care team – by providing emotional and practical support; signposting to services, including those in the community; building relationships across organisations; and, crucially, releasing specialist CNS/allied health professional (AHP) capacity that can be utilised for service redesign, education and more complex clinical care.
It is also important that we increase the capacity of the non-cancer workforce and their awareness of the needs of people living with cancer. For example, we are running role development programmes for nurses and AHPs with an interest in specialist practice, as well as a cancer course for primary care practice nurses to support them to help people with cancer as a long-term condition.
Meanwhile, we are creating opportunities for different health professionals – such as GPs and oncologists – to share perspectives and explore opportunities to improve cross-boundary team working.
What about carers and volunteers? How can we best support carers to be equal partners in care where this is their wish? How can we support and equip them with the skills to provide the care that they want to provide? Also, if we are thinking differently about the cancer workforce, acknowledging and enhancing the role of volunteers, including retired professionals, will be vital.
Fit for the future
The next few years will be crucial in shaping the future of the NHS. The Five Year Forward View and the England Cancer Strategy have set a huge level of ambition for what we can achieve, and it is important that we use this momentum to transform the way care is delivered for people affected by cancer.
The strategic review of the cancer workforce recommended in the England Cancer Strategy is a huge opportunity to make this vision a reality, so we must ensure its scope is ambitious, it must take a long-term look ahead and drive real change right across the cancer pathway and beyond.
Fraser M (2016) ‘Thinking differently about the cancer workforce’. Nuffield Trust comment, 18 May 2016. https://www.nuffieldtrust.org.uk/news-item/thinking-differently-about-the-cancer-workforce