Beating bowel cancer together

What we want to see in the final People Plan for the NHS workforce in England

What we want to see in the final People Plan for the NHS workforce in England

In June, NHS Improvement’s Chair, Baroness Dido Harding, published the Interim People Plan which set out the organisation’s immediate vision for England’s NHS workforce in 2019/2020 to support the delivery of the NHS Long Term Plan. The final People Plan, expected later this year, will be a five-year plan and will carry forward and build on the interim recommendations to make improvements across the whole NHS workforce in England. This blog gives an overview of what the Interim People Plan proposed and outlines our top three tests for what the final People Plan must include to adequately address workforce challenges in bowel cancer.

Key ambitions of NHS Improvement’s Interim People Plan

Although we welcomed the broad ambitions of the Interim People Plan, it failed to address issues highlighted by our Capacity Crisis campaign in endoscopy and pathology services. Its overarching aims are:

  • Making the NHS the best place to work: Making the NHS an employer of excellence – valuing, supporting, developing and investing in their people.
  • Improving leadership culture: Positive, compassionate and improvement focused leadership.
  • Prioritising urgent action on nursing shortages: Acknowledging there are shortages across a wide range of NHS staff groups, but that the most urgent challenge is the current shortage of nurses.
  • Developing a workforce to deliver 21st century care: Growing the overall workforce with a more varied and richer skill mix, and with new types of roles and different ways of working.
  • Developing a new operating model for workforce: Continuing to work collaboratively and to be clear what needs to be done locally, regionally and nationally, with more people planning activities undertaken by local integrated care systems.
  • Taking immediate action in 2019/20 while a full five-year plan is developed.

With the NHS’ ability to recruit and retain sufficient workforce being the biggest risk to achieving a sustainable cancer services – and particularly diagnostic services – we have three tests for the final People Plan which it is vital are addressed for people with, or at risk of, bowel cancer. We will be calling for these throughout the development of the final People Plan.

Our three tests for the final People Plan

1. An action plan on how shortages in endoscopy and pathology workforce will be addressed both in the immediate future and long-term

Diagnostic tests can both prevent bowel cancer and detect it at the earliest stage of the disease, but endoscopy and pathology services are struggling to cope with an increasing demand for tests as many do not have the staff to meet this need. Figures show that demand for endoscopy is rising at a rapid rate – at the very least nearly a million more procedures a year will need to be undertaken by 2020. Furthermore, a survey of histopathology departments (which are responsible for diagnosing bowel cancer through examination of cell and tissue samples taken during a colonoscopy) found that only 3% said they have enough staff to meet current demand. 

With an overstretched workforce, waiting time targets for tests that diagnose bowel cancer are increasingly being breached. According to NHS figures, nearly 60% more patients each month waited more than six weeks for endoscopy tests in 2018 compared to 2017.

The final People Plan therefore must include an action plan to tackle staff shortages in diagnostic services for bowel cancer. This should include how additional staff will be trained, recruited and retained to carry out these procedures, as well as ensuring sufficient support staff, such as endoscopy nurses, are available. The plan must also address pathology capacity to ensure bowel cancer cases, as well as cases of pre-cancerous growths known as advanced adenomas, are diagnosed quickly and efficiently.

2. The need for staff upskilling and development opportunities to support the current workforce

As part of our recent Capacity Crisis campaign, over 500 NHS staff signed our open letter to the Secretary of State for Health and Social Care and the Chancellor calling on them to address the workforce capacity crisis. Of these 500, a number completed a follow-up survey on the impact of insufficient staff capacity. They reported impacts including: a reduction in staff morale; delays to patients’ treatment; extended working hours; breaches of national cancer waiting time targets, and; impacts on the quality of patient care.

“The Government has quite rightly prioritised early cancer diagnosis but it needs to invest in the workforce involved in delivering this. At the moment we are overstretched and under-appreciated.” – NHS Histopathologist

We strongly welcomed the Interim People Plan’s aspirations to increase job attractiveness within the NHS and renewed commitment to continued professional development (CPD). The final People Plan however must expand on these opportunities to support career progression of staff and job attractiveness so that those with, and at risk of, bowel cancer can access the care they need from an effective workforce that is supported to deliver this.

3. Workforce ambitions are backed with committed funding

A number of the NHS Long Term Plan’s ambitions – which the Interim People Plan and the upcoming full People Plan seek to support delivery of – are underpinned by reforms to workforce, whereby commitments to expanding the nursing and medical workforce are crucial to realising the wider goals set for cancer.

The Government announced last year that the NHS will receive an average 3.4% a year real-terms increase, equivalent to £20.5 billion in funding over the next five years, to support the Long Term Plan. However, this funding boost does not extend to the health arms-lengths bodies, including NHS Improvement and Health Education England (HEE), which are responsible for the workforce. Furthermore, funding available for this additional investment in the workforce has yet to be set by Government, and is not expected to be until the next Comprehensive Spending Review (CSR), when the budget for training, education and CPD will be confirmed with HEE, as well as decisions on capital investment for public health and social care. The final People Plan is therefore expected to be published post-CSR, with its capacity to support the ambitions of the NHS Long Term Plan explicitly contingent on additional investment being confirmed.

One recent report by the Nuffield Trust, in partnership with The Kings Fund and The Health Foundation, estimated an extra investment of £900 million per year by 2023/24 is required for HEE to create a sustainable workforce for the NHS. It is therefore critical that appropriate funding must be allocated to HEE in the upcoming CSR in order to support the workforce reforms proposed in the final People Plan. Without a fully-funded plan, future and current staff shortages cannot be addressed as well as the cultural, leadership and training challenges facing the NHS workforce.



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