This article appears as part of the Inside the NHS newsletter.
Cancer services are struggling to cope with increased demand.
More patients are being referred for tests and more people are being diagnosed with the disease, but the NHS has not kept pace either in terms of staffing or equipment.
The gravity of the situation within oncology was detailed in a report from the Royal College of Radiologists (RCR) on June 13, which looks at the picture in each of the four UK nations.
So what does it tell us about Scotland?
Workforce
According to the RCR, the gap between the number of clinical oncologists NHS Scotland has compared to the number it needs to meet demand was 16% in 2023. This shortfall is projected to widen, to 21%, by 2028. Both figures are the same in England.
Recruitment is stagnating, however. Between 2022 and 2023, the number of whole-time equivalent clinical oncology consultants in Scotland remained unchanged at 88.5, while rising by 3.5% in England and 12.4% in Wales.
Meanwhile, NHS Scotland also experienced a net loss of four consultant medical oncologists, while England and Wales gained 40 and eight respectively.
This continues a trend that has seen Scotland growing its oncology workforce more slowly over the past five years than the UK average.
Cancer patients in the north of Scotland face some of the lowest oncologist rates – just five consultants (excluding locums) for every 100,000 residents over 50. Only the West Midlands is worse, with 4.9 per 100,000.
In contrast, South-East Scotland (which includes Edinburgh) has 8.2 per 100,000. Only London is higher, with 11 per 100,000.
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Locums
Reliance on locums to fill gaps in the consultant clinical oncology workforce is growing UK-wide, and there is a "huge issue" with the disparity in rates of pay for permanent staff versus locums.
The RCR notes that this may go some way to explaining a trend over the past five years which has seen a growing number of consultant oncologists under-40 opting to work as locums, from 29% in 2019 to 42% in 2023.
In both Northern Ireland and Wales, locums make up around 20% of the clinical oncologist consultant workforce. In England, the figure is 9%, and in Scotland it is 5%.
Patient care
When staff shortages are severe, patients may be sent to cancer centres in other regions so that they can access treatment more quickly. The report found that this had occurred within 60% of Scottish cancer centres in 2023, compared to 27% for the UK as a whole.
It added that this could be "particularly difficult" in Scotland "given the significant distances" patients would have to travel.
Workforce shortages were resulting in "decreased quality of patient care" in every cancer centre in Scotland, according to feedback from the heads of these services, with 80% concerned that it was also impacting on patient safety.
On cancer waiting times, however, Scotland is faring less badly than other parts of the UK.
In 2023, 72% of cancer patients in Scotland began treatment within 62 days of an urgent referral for diagnostic tests. That remains well below the target of 95%, but it compares to 63% in England (where the target is 85%), 56% in Wales (where the target is 75%), and just 34% in Northern Ireland.
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The problem extends beyond oncology shortages, reflecting "limited capacity in the whole pathway, including radiology, pathology, oncology, and surgery".
In addition, patients also "face hidden delays" not captured in the waiting times data.
The report states: "Services report that patients who need subsequent cancer treatment (such as radiotherapy following surgery) are facing long waits to see an oncologist to sign off the second treatment, limiting the value of both treatments".
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