Cancer and Diagnostics Careers
– a helpful Resource Guide
– to assist employers, managers, cancer alliances, workforce leads, commissioners and staff with practical workforce solutions
Apprenticeships to support Cancer and Diagnostic roles and services
Imaging Workforce-apprenticeships and other workforce resources
Pathology Workforce-apprenticeships and other workforce resources
Endoscopy Workforce-apprenticeships and other workforce resources
Cancer Nursing and the Cancer Nurse Specialist Pathway
New Roles in Cancer and Diagnostics Careers
New ways of working-Case Studies from the South East
Kent and Medway Healthcare Science (KMHCS) Network
Health Education England (HEE) information and resources on Cancer and Diagnostic Careers
Funding and Support-Health Education England
Other support-Macmillan Cancer Support
Introduction
Health Education England South East (HEE SE) has been working with Skills for Health to explore with trusts and cancer alliances in the South East how to help deliver on the priorities of their Cancer and Diagnostics strategy and the focus on new routes into cancer and diagnostic careers. The aim is to ensure a flexible and sustainable, supported cancer and diagnostic workforce, sharing good practice, and capturing innovation. The work included scoping work, focus groups and an on-line consultation to identify the spectrum of cancer and diagnostics training, and roles, as well as potential opportunities for new skills and competencies. The work aimed to identify areas of existing good practice within the South East and/or elsewhere which the South East may wish to implement.
The Cancer and Diagnostics Careers programme linked to the five enablers of workforce transformation in the STAR approach i.e. Supply, Upskilling, New roles, New Ways of Working and Leadership.
Outputs were to identify and develop case studies and produce this Cancer and Diagnostic Career Resource Guide to support HEE South East, employers, cancer alliances, education and training providers, workforce leads, Integrated Care Systems (ICSs),commissioners as well as managers who all have a role to play in the recruitment, retention and education and training of the Cancer and Diagnostics workforce:
Figure1. Scope of the Health Education England Cancer and Diagnostics Programme
This on-line interactive Cancer and Diagnostic Career Resource Guide aims to demonstrate the wide range of workforce solutions which have been developed both nationally and by Health Education England, trusts, organisations and cancer alliances in the South East to help recruit, retain and develop current and existing staff to ensure they have the workforce to meet current and growing patient needs across the cancer and diagnostic pathway.
From developing new roles, new ways of working, differing methodologies to training such as utilising the new apprenticeship standards, and strategic approaches to workforce planning, there is a plethora of good and best practice across the South East.
Many thanks to the numerous operational and educational managers, clinicians and role holders who willingly gave their time to provide the information to inform the case studies and this Cancer and Diagnostic Career and Resource Guide to, in turn, assist other colleagues across trusts and cancer alliances in the South East.
There are many sources of information about cancer and diagnostic careers and roles available and this Cancer and Diagnostic Career and Resource Guide aims to centralise these to assist employers, cancer alliances, managers and commissioners.
Apprenticeships to support Cancer and Diagnostic roles and services
As NHS trusts now have to pay an Apprenticeship Levy it makes economic and workforce sense to utilise these routes to fund training and education and engage with local colleges and universities to help invest in and develop new and existing staff to assist recruitment and retention. Apprenticeship Standards are available from levels 1,2 and 3 support roles, level 4 assistant associate and practitioner roles, through to degree and masters level for registered professional and clinical roles.
Apprenticeship Standards offer an alternative model of education and training, supporting the expansion and growth of the workforce. Apprenticeships provide an excellent opportunity for organisations to ‘grow their own’.
Cancer and Diagnostic Apprenticeships are an employment-based route into related professions. To undertake an apprenticeship, learners must be employed within a department that allows them to practice and use their skills, this could be a radiography department or an oncology service for example. Typically, apprenticeships combine extensive workplace learning and practice within a specific department, supported by academic learning at university and distance learning.
Health Apprenticeship Standards Online (HASO)
The Healthcare Apprenticeship Standards On-lIne (HASO) web site is the best place to navigate apprenticeships and technical education in the health sector. The site is aimed at employers and front-line managers and lists all the apprenticeships available to the health sector with other valuable information:
Other helpful information about apprenticeships:
Apprenticeship Implementation Toolkit
This toolkit is designed to support employers through the process, end to end, from setting out an organisational strategy through to when apprentices start within the workplace.
In addition, Health Education England Talent for Care (TFC) provides useful information about Apprenticeships, Widening Access and Participation and Volunteering to support the entry of new staff and staff development. Talent for Care aims to help people Get Ready, Get In, Get On and Go Further in their careers in the NHS which can include cancer and diagnostics careers. TFC supports employers to diversify their workforce supply through programmes that reach local communities of all ages, from raising awareness of careers in health for young people and those wishing to join the NHS including support for individuals to develop their long-term career including with relevant qualifications. This provides an inclusive approach and framework for staff at all levels while retaining a particular emphasis on improving opportunities for the support workforce.
Imaging workforce-apprenticeships and other workforce resources
There are workforce issues recruiting and retaining imaging staff in the South East, particularly for Diagnostic Radiography, Therapeutic Radiography, Sonography and Mammography.
There are several regional and local solutions to assist employers:
- Produced by Health Education England (HEE), the Society of Radiographers and profession-led expert group, this guidance will support services in reviewing the roles and responsibilities of their support workers and consider how their contribution might be enhanced.
- This infographic gives an example of the different options available for career progression within radiography, some of which relate to cancer and diagnostics careers.
Radiography Apprenticeships Infographic
- This guidance will provide employers with an overview of the apprenticeships they can use in Diagnostic Radiography, Therapeutic Radiography, Sonography and Mammography; the guide also highlights how assistant practitioner apprenticeships can be contextualised to a radiography setting.
Cancer and Diagnostic Apprenticeships – Employers Guide
Workforce Planning for Imaging (CT)
Surrey and Sussex Cancer Alliance recognised that there was a recruitment and retention issue in some staff groups in cancer and diagnostics services and that workforce supply and demand is challenging across their footprint. One particular area of challenge was diagnostic imaging with an aging workforce, location/lack of appeal of sites, and a disproportionate allocation of recruits with some trusts being more successful than others. The Alliance adopted a strategic competence-based workforce approach to the imaging (CT) workforce detailed in the following Case Study:
The Case Study HEE SE-A Strategic approach to workforce planning-Surrey and Sussex Cancer Alliance
Diagnostic Radiographer
The Diagnostic Radiographer Level 6 degree apprenticeship is available for this vital role in the patient‘s cancer pathway in undertaking the essential high-quality images and range of scans. Increasingly NHS trusts in the SE are adopting this route, initially in small numbers with some support from HEE.
Therapeutic Radiographer
The Therapeutic Radiographer Level 6 degree apprenticeship is available for this essential role in the treatment of cancer.
Sonography
There is a workforce shortage of sonographers, and a specific Sonographer Integrated Degree Apprenticeship Standard has been developed:
In addition, Health Education England (HEE) have been working with partners to develop solutions to improve education and training routes into sonography to develop a rewarding and attractive career path.
Radiographer to Sonographer and university lecturer case study
This case study plots the career pathway of a Diagnostic Radiographer who has progressed to being a Sonographer in Salisbury District Hospital [Salisbury NHS Foundation Trust] and combines this with a lecturing role in ultrasound.
Mammography Associate
Mammography Associates work within the breast imaging workforce undertaking routine two-view mammography (x-ray images of breasts) and this Mammography Associate Apprenticeship Standard is now available.
Cancer and Diagnostics Careers-Pathology Apprenticeships and Workforce resources
University Hospital Southampton NHS Foundation Trust employs 180 Healthcare Science staff to undertake the wide range of laboratory and pathology services. There was a need to ensure all healthcare science staff were fully trained and competent and for them to be offered a career pathway once they were employed in laboratory roles. The Trust has taken advantage of the range of new apprenticeship standards and the apprenticeship levy to support staff training and progression for existing staff as well as to attract staff in hard to recruit to roles.
Health Education England (HEE) are supporting the pathology and histopathology workforce through the expansion of medical training posts and upskilling healthcare scientists in reporting and dissection. In addition, the microbiology workforce is being supported through the development of short courses and training grants for healthcare scientists on training programmes.
Cancer and Diagnostics Careers-Endoscopy
The Endoscopy Assistant role
Endoscopy has been a difficult area to recruit to within East Sussex Healthcare NHS Trust and is a busy service undertaking 14,500 endoscopy procedures in 2021 across the two units based in Eastbourne and Hastings. During the Covid pandemic in June 2020 the Trust lost 50% of its Endoscopy Nurses and at one point had to shut one of its treatment rooms due to a shortage of staff. This accelerated the implementation of the Endoscopy Assistant Role which was already in development to optimise skill mix. This was all in line with the Trust priority of ‘taking action on recruitment and retention’. As the new Band 4 Endoscopy Assistant Role was developed to work alongside a registered Endoscopy Nurse supporting the Endoscopist and this now requires one and not two registered nurses, this assists the Trust in staffing the Endoscopy Unit when B5 nurse recruitment is a challenge and is also more cost effective
Case Study HEE SE- The new Endoscopy Assistant Role-East Sussex Healthcare NHS Trust
Health Education England (HEE) support for endoscopy
Health Education England (HEE) has worked with the Joint Advisory Committee on Gastrointestinal Endoscopy (JAG) to develop a Clinical Endoscopist Training Programme to support workforce capacity and capability in response to increasing demand for endoscopy services. All academic modules are delivered online with minimal contact days away from the trust: Health Education England support for endoscopy
Cancer and Diagnostics Careers-Cancer Nursing and the Cancer Nurse Specialist Pathway
The cancer nursing role is essential in the care of the cancer patient on their pathway. Thames Valley Cancer Alliance (TVCA) aims to support the redesign of the cancer nursing pathway, make new and more attractive and alternative roles to attract and retain the best workforce. TVCA believes there needs to be a visible cancer nursing (and allied health professional) career progression route from pre-registration nurse through to registered, enhanced, advanced, consultant and strategic leadership.
The following case studies show the progressive career pathway role of the Cancer Nurse Specialist (CNS) through to Consultant Nurse which can both attract and retain the role in trusts in the Thames Valley and their valuable contribution to the cancer pathway.
Macmillan Cancer Support reports that
‘’Specialist cancer nurses reduce treatment costs, increase efficiency, drive innovation and provide valuable information for service re-design as well as enable multidisciplinary care and communication between different teams’’ (Cancer Clinical Nurse Specialists: An Evidence Review, Macmillan Cancer Support, 2012).
The Cancer Nurse Specialist and the Personalised Care Service
Great Western Hospitals NHS Foundation Trust have seen the need for more patient support and have set up a new ‘Personalised Care Service’ initially with two-year pump priming funding from Macmillan Cancer Support. This is run by two CNSs -a band 7 Team Lead and a CNS at band 6 who were recruited from the Trust and are passionate about holistic patient care and have initially been seconded to the service for the two years. They are also setting up a cancer buddying service to support newly diagnosed patients and those needing more help.
The Cancer Nurse Consultant
The Cancer Nurse Consultant role is offered in a number of TVCA trusts and although not all trusts have nurse consultants in cancer care, nurse consultants are a recognised role across the NHS in other specialties. It offers a progression route for Cancer Nurse Specialists (CNSs). This advanced role embedded in practice enables care of the patient as an independent autonomous level, with advanced clinical decision –making and a non-medical prescribing role. The case study demonstrates the role of the Cancer Nurse Consultant role and how it helps to free up Oncologist time.
The case study also explains how the Berkshire Cancer Centre has set up a new type of patient follow up-the Open Access Follow Up pathway (OAFU) which is a key administrative role managed by band 4 Cancer Support Workers and overseen by the Nurse Consultant to assist patient care, reducing appointments, helping the trust to meet the various cancer targets and frees up CNS and consultant time for the new referral and people with ongoing treatment concerns.
The Nursing Associate Role in cancer services
The Nursing Associate is a new role to bridge the gap between health and care assistants and registered nurses. It is a stand-alone role that can also provide a progression route into graduate level nursing. It’s intended that the role will enable registered nurses to focus on more complex clinical duties and be able to work at the top of their licence. East Sussex Healthcare Trust have introduced the role of Nursing Associate (NA)and although initially in small numbers, the numbers continue to increase and are making an impact in the Trust with a service-led approach.
Case Study- HEE SE-The Nursing Associate Role-East Sussex Healthcare NHS Trust
There is also a Nursing Associate Apprenticeship Standard (NMC 2018) to support this role.
The Nursing and Midwifery Council have developed a case study ‘Terry’s Story’, about a Nursing Associate on an oncology and haematology ward.
Cancer and Diagnostics Careers- Physician Associate
The Physician Associate (PA) role is a growing and evolving profession and is being successfully implemented in trusts across the South East and increasingly within cancer tumour sites, including urology, colorectal, breast, Ear, Nose and Throat and haematology. PA posts have been evaluated under Agenda for Change at Band 7.
Physician Associates (PA) are healthcare professionals with a generalist medical education who work alongside doctors, GPs and surgeons to provide medical care as an integral part of the multidisciplinary team.
The case study looks at the role of the PA, their tasks and responsibilities and how they are helping to free up Oncologist Consultant time in Urology, Colorectal and Breast Services at East Sussex Healthcare NHS Trust.
The case study also articulates how the implementation of the PA role continues to be rolled out in cancer services in the South East as Wessex Cancer Alliance (WCA) is utilising NHSEI Elective Recovery Funds to enable trusts across the Alliance to recruit to new PA posts based in urology and breast departments.
Case Study HEE SE -The use of the Physician Associate role in cancer sites in the South East
A Physician Associate Apprenticeship Standard is also available:
Physician Associate (PA) Apprenticeship FAQs
Cancer and Diagnostics Careers-the Doctors’ Assistant Role
East Sussex Healthcare NHS Trust have set up and employed the Doctors’ Assistant role and their research has shown that doctors spend 44% of their time on administration and that 78% of doctors’ overtime and exception reports are tasks that Doctors’ Assistants can undertake. The evaluation undertaken in 2017 with Brighton University initially involved time and -motion studies (of doctors and Doctors’ Assistants) and qualitative studies including feedback from doctors saying how helpful and useful the Doctors’ Assistants were). The trust next looked at patient flow and how moving Doctors’ Assistants into an area could improve discharging and get treatments to patients sooner
The band 3 Doctors’ Assistants work alongside Junior Doctors to support their inpatient/ward work. The new role combines a range of clinical and administrative competencies.
Case Study HEE SE- The Doctors’ Assistant Role East Sussex Healthcare NHS Trust
Cancer and Diagnostics Careers-Pathway Navigator
The South East Region of Cancer Alliances was aware of the success of the role of Pathway Navigator (PN) and how it was assisting trusts with ensuring that patients met the 28 day new Faster Diagnosis Standard (FDS) and the various nationally set cancer waiting times.
The four South East Region Cancer Alliances: Wessex, Surrey and Sussex, Kent and Medway and Thames Valley compiled and submitted a successful joint high-level bid for funding to Health Education England (HEE) South East in October 2020 for a coordinated approach of implementing up to 19 additional new Pathway Navigators within trusts in each of the Cancer Alliances.
Cancer and Diagnostics Careers-HEE South East -Allied Health Professionals
Allied Health Professionals (AHPs) make up the third largest professional group in the NHS workforce and as such, they make a significant contribution to the care of people affected by cancer.
The Health Education England Exploring the role of Allied Health Professionals in the care of people affected by cancer-the patient and practitioner voices project explores the role of AHPs who provide care in the multi-disciplinary cancer care teams and the experience of people affected by cancer who have received care from AHPs. The work hopes to:
- raise public and professional awareness of AHP roles across the entire cancer care pathway
- stimulate interest in AHP careers and help expand the AHP training pipeline
- inspire existing AHPs to develop the knowledge, skills and behaviours (competencies) required deliver high quality care for people affected by cancer
- inspire local NHS service leaders to consider further how AHP roles and multidisciplinary teamworking can help meet the needs and expectations of an increasing number of people being diagnosed with and surviving cancer.
There is also a need to focus on nursing and allied health professionals for advanced clinical practice roles in cancer care:
- Strategic Framework for the Cancer Workforce, 2018
- HEE Multi-professional Framework for Advanced Clinical Practice, 2017
The workforce needs to be supported by good access to education and development on cancer care for nursing and allied health professionals who provide cancer care in non-specialist settings
Developed by Health Education England (HEE) the Allied Health Professions’ Support Worker Competency, Education and Career Development Framework supports organisations to maximise the contribution of the Allied Health Professionals (AHPs) support workforce to the delivery of safe and effective care and illustrates opportunities for career development and progression.
Cancer and Diagnostics Careers – New Roles
In an attempt to recruit and retain staff and offer new and exciting careers and opportunities for progression, new roles based on their own education and curriculum have been developed such as the Physician Associate and the Nursing Associate, along with locally developed roles to meet service need. These are being utilised in cancer and diagnostic services.
There are many positive examples of new roles and approaches to the delivery of skills which have been developed and rolled out by individual trusts and cancer alliances across the South East which will be helpful for other employers to explore:
Cancer and Diagnostics Careers-Workforce Planning
The UK is facing increased demand for cancer treatments based on the growing number of cases of cancer diagnosed each year and the fact that people are living for longer with cancer. Cancer care is one of the Five Year Forward View’s key priorities and the NHS Long Term Plan – focussing on prevention, earlier diagnosis, better treatment and living with cancer. Having access to more skilled staff in the right areas will be key to delivering on that strategy. Health Education England and the Cancer Workforce Plan provides some additional information about the cancer workforce.
The NHS needs to effectively plan its workforce so that there are not only staff to sustain current cancer and diagnostic services but also develop a pipeline of staff for the future to meet increasing service demand and to keep pace with staff turnover which is an increasing challenge with an aging workforce. This will require ’thinking out of the box’ about how staff are recruited, trained and developed, as well as looking at new ways of working and how skills are used.
Formal workforce planning methodologies can be supported by the Skills for Health Six Steps to Integrated Workforce Planning
This is a practical approach to workforce planning to ensure a workforce of the right size with the right skills and competences.
The Methodology identifies those elements that should be in any workforce plan, taking into account the current and future demand for services, the local demographic situation and the impact on other services, whilst helping employers, managers and departments work to the budget they can afford. It is a :
- a systematic practical approach that supports the delivery of quality patient care, productivity and efficiency
- assurance that workforce planning decisions taken are sustainable and realistic
- a scalable approach, from small ward-based plans to large organisations
- a joined-up approach with social care, where the same approach has been adopted.
A South East Workforce approach to strategic workforce planning
Surrey and Sussex Cancer Alliance (SSCA) recognised that there was a recruitment and retention issue in some staff groups in cancer and diagnostics services and that workforce supply and demand is challenging across their footprint. One particular shortage area was diagnostic imaging with an aging workforce, location/lack of appeal of sites, and a disproportionate allocation of recruits with some trusts more successful than others. The Alliance recognised that the need for a strategic system-wide approach to workforce planning had become imperative across the patch they cover and adopted an Optimal Workforce Planning Project. The overarching purpose was to provide recommendations for an optimal cancer workforce establishment across SSCA with the aim of reducing variation in patient experience and supporting performance improvement across the footprint
The case study demonstrates an excellent example of approaching the diagnostic imaging recruitment issue in the South East by reviewing skill mix and competencies.
Case Study HEE SE-A Strategic approach to workforce planning-Surrey and Sussex Cancer Alliance
Cancer and Diagnostics Careers-HEE South East New ways of working Case Studies
Health Education South East commissioned Skills for Health to undertake research to develop a number of case studies to support HEE SE, employers, cancer alliances, education and training providers as well as managers in supporting cancer and diagnostic careers. The following case studies demonstrate a variety of different approaches to workforce solutions across the South East.
Health Education England (HEE) Information and resources on Cancer and Diagnostics Careers.
Health Education England (HEE) captures, monitors and develops projects which aim to deliver cancer and diagnostic workforce to reduce waiting times and increase the likelihood of early diagnosis leading to better care and outcomes for patients nationally.
HEE provides a number of resources for the cancer and diagnostics workforce.
The HEE Cancer and Diagnostics Programme helps to support the implementation of national cancer and diagnostic strategies, building on the commitments within HEE’s Cancer Workforce Plan (Phase 1 Delivering the cancer strategy to 2021) and the NHS Long Term Plan, as well as on subsequent policy such as the Diagnostics: Recovery and Renewal of Diagnostic Services for NHS England, known as the ‘Richards Review’ (2020)
The Aspirant Cancer Career and Education Development programme (ACCEnD) will provide transformational reform in the education, training and career pathways for nurses and AHP’s supporting people affected by cancer. The ACCEnD programme overview demonstrates how this work will seek to address and provide solutions to key issues that challenge the cancer workforce both now and into the future. The work which will complete in 2024 aims to:
- Develop a nationally approved career pathway and education framework for nursing and the allied health professions providing care to people affected by cancer in general and specialist services
- A national career and education development programme for: – Pre-registration nursing associates, nursing and allied health professional students – Post-registration Professionals, enhanced, advanced and strategic/consultant level nursing and allied health professionals providing cancer care in specialist roles/services
- A digital individualised portable e-portfolio which aligns to the knowledge, skills and capabilities for the different levels of practitioner and their selected career pathway.
Community Diagnostic Centres (CDCs) aim to allow patients to access planned diagnostic care nearer to home without the need to attend acute hospital sites. These services would be separate to urgent diagnostic scan facilities, which means shorter waiting times and a reduced risk of cancellation which can happen when more urgent cases take priority. Therefore, this would lead to improved patient experience and outcomes. Health Education England (HEE), in collaboration with NHS England and NHS Improvement (NHSEI), has identified a collection of suitable resources which have been collated for an e-learning programme which aims to support the multi-disciplinary workforce in Community Diagnostic Centres across England
Cancer and Diagnostics Careers Funding and support
Health Education England
Cancer and diagnostic careers, like all NHS workforces require funding and support to enable new roles, different ways of working and the development of the current and future workforce.
Health Education England’s mission is to ‘work with partners to plan, recruit, educate and train the health workforce’ and over 90% of its budget is allocated to educating and training the future workforce through universities and health providers. The HEE Recovery and Delivery Business Plan 2021/22 sets out how the budget will help to plan and deliver its main priorities which, in terms of the cancer and diagnostic workforce includes increasing the nursing supply to help deliver 50,000 more nurses in the NHS by March 2024 and tackle AHP workforce shortages in a managed way that supports the NHS Long Term Plan. Targeted growth of pre-registration training, alongside placement recovery will drive innovative expansion of placements and apprenticeships, support worker development, a national programme of ethical international recruitment and career development.
Many of the new and developed roles and services in the various HEE South East case studies highlight the innovative use of direct funding from HEE, as well as the use of the Apprenticeship Levy to fund training and education and engage with local colleges and universities to help invest in and develop new and existing staff to assist recruitment and retention including cancer and diagnostic careers
Many cancer nursing and support roles and services are also supported by pump-priming from Macmillan Cancer Support as well as offering a range of training and support via Macmillan Cancer Support Healthcare Professionals for qualified professionals
Cancer and Diagnostics Careers-Other helpful support
Macmillan Cancer Support
Macmillan has an important role in developing and supporting the future cancer workforce but reports that it can not make the transformational change alone. Their report Thinking differently: Macmillan’s vision for the vision for the future cancer workforce in England published in 2017 uses examples of projects and programmes they have led on or been involved in to illustrate the need to think differently about the workforce. For example, they have been exploring trained support staff to work alongside registered practitioners to support people with non-complex needs.
They offer a range of training and support via Macmillan Cancer Support Healthcare Professionals for qualified professionals including Cancer Nurse Specialists, nurses, doctors, GPs and allied health professionals who wish to increase their knowledge, skills and professional confidence in cancer care.
Macmillan Cancer Support’s research report Cancer Nursing on the Line, published in 2021 looks at the increasing demand for cancer services and the need for supporting and recruiting the required cancer workforce, particularly of specialist nursing roles and of a predicted shortfall in numbers of over 3000 in England alone.
Examples of Macmillan pump-primed Clinical Nurse Specialist roles and cancer services in the South East:
Conclusion
We hope you have found these resources useful to assist your cancer and diagnostic workforce planning and have looked at the many examples of good practice to be found across the South East and elsewhere.
There is much ongoing activity in progress to support the cancer and diagnostic workforce including the ACCEnD programme to help provide workforce solutions to key issues that challenge the cancer workforce both now and into the future. The work which will complete in 2024 will provide numerous needed resources for the cancer and diagnostics workforce to include nursing and allied health professionals.
Cancer will affect 1 in 2 of us, is the most common cause of death and is on the increase with the number of people living with a cancer diagnosis in the UK set to double from more than 2 million in 2010 to 4 million by 2030.
Never has there been a greater need nor a greater priority for developing the cancer and diagnostics workforce