Cancer workforce focus

Cancer is the leading cause of death in Aotearoa New Zealand, making up 31% of all deaths in 2020. Age-standardised mortality rates from cancer are highest for Māori and Pacific peoples.

Cancer death rates have dropped over the past 20 years because of better treatments, medicines, and care. We can expect to continue to see such improvements into the future. But to keep improving care, we need more cancer specialists.

Several factors drive a need for growth in our cancer workforce:

• cancer rates are rising as the population ages
• new treatments and technologies need more staff with new skills
• slow growth in key cancer specialties like medical, radiation and gynaecological oncology.

Cancer care varies by type, so different kinds of specialists are needed.

To better understand and plan for this, we have grouped the cancer workforce into 4 categories based on the type of care they provide.

• Medical oncology and haematology.
• Radiation oncology.
• Surgical oncology.
• Generalist and cross-functional cancer workforces.

Over the past 5 years we have made great progress understanding how to improve cancer care. This is due to expert leadership, and national coordination by the Cancer Control Agency | Te Aho o te Kahu. This gives us a great opportunity to strengthen our cancer workforce over the next 3 years.

• Getting training volumes right for specialist workforces. Current training levels for cancer specialists have not kept up with demand. Increasing training to match future needs will help close this gap.
• Focusing on model of care change. Blending our cancer care workforces can make better use of staff. This will allow people to work at their best, and make better use of roles that are quicker to train, like cancer nurses and kaiāwhina.
• Supporting specialisation into cancer. For generalist roles like nurses and healthcare assistants, there is potential to support more of them to focus on cancer care.

The plan focuses on smart, future-proof investments in the cancer workforce. Over the next 3 years we will likely see significant shifts in where and how we provide different kinds of cancer care as we shape a national network. This will make common treatments available closer to home, while specialist centres will care for rarer, complex cases.

Medical oncology, haematology and stem cell are different specialties, but they have similar opportunities.

• Medical oncology treats cancers in solid organs.
• Haematology focuses on blood and related cancers and disorders.

Our long-term outlook for medical oncology is good, with a growing workforce. More specialists will be needed to handle rising cancer rates and new treatments.

To build a sustainable cancer workforce, we need to:

• train the right number of specialists to meet future demand
• expand nursing and support roles to let doctors focus on complex cases
• provide training opportunities in private settings like labs.

Workforce plan priorities over the next 3 years

1.9 Improve national workforce planning

Develop a national map and adopt national planning of medical training volumes, so we can align future increases in training numbers to specialties where need is greatest.

4.5 Create private training capacity

Reach agreement with our major private providers of public health services, for example private hospitals delivering public surgical lists, to allow training in private settings, with consistent terms.

Surgical oncology spans many types of surgery and are supported by the same staff as other surgical care. This makes it hard to track as a separate group and overlaps with the wider surgical workforces. Surgical specialties are generally better staffed than other cancer areas, but:

• gynaecological oncology faces serious shortages across Aotearoa New Zealand
• more surgeries are happening in private hospitals, which could weaken public staff if not managed well.

To improve surgical cancer care over the next 3 years, we need to:

• collect better data to understand current and future workforce needs
• grow the gynaecological oncology workforce through international hiring and right-size training
• use private-sector training to support public training capacity.

Over the medium-term we will likely need shifts in how we deliver surgical oncology care. To make sure we have the surgical workforce and facilities needed for excellent cancer care, these shifts need to be:

• clinically-led
• aligned to how we plan operating theatre capacity across the country.

Workforce plan priorities over the next 3 years

4.2 Expand medical training in vulnerable specialties

Establish a pool of funding for small, vulnerable specialties to support training sustainability — including gynaecological oncology.

4.5 Create private training capacity

Reach agreement with our major private providers of public health services, for example private hospitals delivering public surgical lists, to allow training in private settings, with consistent terms.

Around 1 in 3 cancer patients have at least one course of radiation therapy as part of their care, and demand for it is growing. New linear accelerators (LINACs) are being added in Hawkes Bay, Taranaki, and Northland to help meet this need.

We have relatively acute shortages of radiation oncologists.

We only have a moderate shortage of radiation therapists. But we will need growth to meet future demand for care, especially in rural areas.

We are also over-reliant on international talent to staff workforces such as medical physicists.

To improve care, we need to:

• grow specialist allied and nursing roles to make better use of staff
• strengthen local training pathways for radiation oncologists and medical physicists
• explore new models of care that make better use of our nursing and allied workforces.

These shifts will help improve access to radiation therapies in rural communities.

Workforce plan priorities over the next 3 years

1.1 Secure educational training capacity

Secure 100 new training places for students in tertiary training programmes where we need growth — including for radiation therapy.

1.9 Improve national workforce planning

Develop a national map and adopt national planning of medical training volumes, so we can align future increases in training numbers to specialties where need is greatest.

4.4 Establish advanced practical roles

Establish new advanced scope practice pathways to make the most of allied and nursing capabilities, starting with radiation therapy.

Nurses, allied health workers, and support staff play a key role in cancer care. Some opportunities for these workforces cut across cancer streams and care pathways. Pathways for these professionals to specialise in cancer are currently inconsistent. For example, there is no standard path for nurses to train as clinical nurse specialists in cancer care, then as cancer-specialist nurses. And we have few oncological nurse prescribers.

Many allied health workers are based in non-government organisations. So there are opportunities to make better use of allied workforces in public cancer care.

To strengthen the cross-setting workforce we need to:

• create clearer, consistent pathways for nurses and kaiāwhina to specialise in cancer care
• shift models of care to better use these workforces, guided by clinical leadership
• support staff to take part in service improvements and advanced therapies through training and decentralised trials.

These changes will help build a stronger, more capable cancer care workforce for the future.

Workforce plan priorities over the next 3 years

1.2 Boost Health NZ's placement capacity

Expand and improve Health NZ capacity for allied and specialist nursing placements, including for cancer nursing.