We need the right mix of skills and effective working across teams and care settings to better meet the changing needs of people affected by cancer.

Cancer nursing on the line

UK cancer services are slowly recovering from the devastating blow caused by Covid-19, but the pandemic has exposed the terrible strain the cancer workforce has been under for many years.

Macmillan’s new research, Cancer Nursing on the Line (PDF), highlights that there aren’t enough specialist cancer nurses, and those we have are being stretched too thin. Too many people with cancer are missing out on vital one-to-one support.

Macmillan is calling for Governments across the UK to invest around £170 million to fund the training costs of creating nearly 4,000 specialist cancer nurses required in 2030 to provide the care people need.

Addressing the cancer workforce gap

Macmillan’s most recent workforce census demonstrated that there are worrying vacancy rates across specialist cancer nurse roles in England, with significant geographic variation. Subsequent patient and workforce reported data still demonstrates unmet need amongst people living with cancer.

The Government must provide a multi-year funding settlement to support a comprehensive plan to grow the NHS workforce. This should include plans to reverse the current and increasing gap in the specialist cancer nurse workforce.

You can find out more about how we’ve modelled the future specialist cancer nursing workforce in our Addressing the gap report (PDF).

Voices from the frontline

The cancer workforce is struggling to meet current requirements, let alone prepare for increasing future demand.

As more people are being diagnosed with cancer, and more people are living longer with more complex conditions, the role of the specialist cancer nurse in supporting them navigate complex care and support pathways cannot be underestimated. But this is a workforce under strain.

Our latest report Voices from the frontline: challenges facing cancer clinical nurse specialists right now, draws on the experiences of specialists and lead cancer nurses to explore the barriers nurses face in accessing continuing professional development and the impact this has on patient care and the sustainability of the specialist nursing workforce.

The way forward

We want to see a strategic approach to workforce planning, training and education; so that everyone with cancer has the highest standard of coordinated care and support during and after treatment.

Our key recommendations

  • The Secretary of State for Health must ensure that the NHS has the sustainable nursing workforce required to deliver the care people living with cancer need.
  • NHS England, NHS Improvement and Health Education England must urgently deliver a costed cancer workforce plan. This must be based on realistic estimates of the workforce numbers that will be required to meet the needs of people living with cancer.
  • The Chancellor must support this plan by providing the long-term investment needed in the next multi-year spending review.
  • NHS England, NHS Improvement and Health Education England must act urgently to boost the supply and retention of the general adult nursing workforce. This is necessary to ensure all nurses have backfill for their clinical commitments to undertake CPD; and to ensure a pipeline for specialist nursing roles.
  • Health Education England’s CPD budget should be restored, as a minimum, to its former highest level of £205m.

An illustrated map of England with the text 'England' on a purple background. More info


The urgent need to think strategically about how the cancer workforce is planned and managed long term, was recognised in the Cancer Strategy for England when it called for ‘the development of a vision for the future shape and skills mix of the workforce required to deliver a modern, holistic patient-centred cancer service’. This was then followed by a commitment to delivering the review in the Cancer Strategy implementation plan published by the NHS in May 2016.

In order to truly transform the cancer workforce so that it is fit for the future, national leadership and a strategic vision for the future cancer workforce is needed. Health Education England has a critical role to play in leading the development of this strategic vision for the cancer workforce.

Our report, ‘Thinking differently: Macmillan’s vision for the future cancer workforce in England’ uses examples of projects and programmes we have led or been involved in to illustrate the need to think differently about the workforce. It also makes recommendations at both a national and local level, recognising that both are vital to achieving lasting and sustainable change.

Northern Ireland More info

Northern Ireland

We are proud to have contributed £7 million of an £11 million investment to fund around 60 cancer nurse specialists (CNS) and Support Worker posts, in order to help fill the gap in specialist nurses in NI. We continue to work with the Department of Health to deliver these new posts.

Even with these new roles, our cancer workforce is struggling. It needs adequate investment in the right places. That way, our health service can retain, develop and employ enough health care professionals with the right skill to mix to ensure that, as demand continues to increase, people living with cancer receive high quality, person-centred care.

We are calling on the Department of Health to ensure that a costed cancer workforce plan is at the heart of the NI cancer strategy which is currently in development.

Scotland More info


In Summer 2019, we announced our £18 million partnership with the Scottish Government. This partnership introduced link workers into the cancer workforce across the country, in order to support the spread of the Transforming Cancer Care programme. This ensures that everyone in Scotland is offered support with emotional, practical and financial needs following a cancer diagnosis.

We continue to campaign for the implementation of the commitment in the 2016 Scottish Cancer Plan to workforce planning. This ensures 'that every person with cancer in Scotland who needs it has access to a specialist nurse during their care and treatment'.

Despite these very welcome measures, Macmillan believes that the NHS and social care system in Scotland simply do not have enough of a workforce to cope with the growing numbers and needs of people with cancer. We want the Scottish Government to publish a national health and social care workforce plan, which must include projections based on patient numbers, needs and complexity to ensure we have the cancer workforce in Scotland needed to deal with the growing cancer population.

Wales More info

Wales / Cymru

The Wales Cancer Patient Experience Survey (CPES) published in 2017 surveyed more than 6,000 people affected by cancer. The survey revealed that a key success factor for good experience is having access to a Clinical Nurse Specialist (CNS). For almost every question in the survey, people who had a CNS felt they had a more positive experience, compared with those who did not have access to a CNS. The survey showed us that nearly 1 in 5 (19%) were not given the name and contact details of a CNS to support them through their treatment.

Our Cancer Workforce in Wales (2018) report builds a comprehensive picture of the significant challenges facing the cancer and palliative care nursing workforce. In our census of clinical nurse specialists (CNS), Macmillan identified 74% of breast CNS’ were within 10 years of retirement. It also presented evidence that the vacancy rate for chemotherapy nurses and CNS’ in Wales was higher than the UK average. 

Bu Arolwg Profiad Cleifion Canser Cymru (CPES) a gyhoeddwyd yn 2017 arolygu dros 6,000 o bobl a effeithiwyd arnynt gan ganser. Datgelodd yr arolwg mai ffactor allweddol o ran cael profiad da oedd cael mynediad at Nyrs Glinigol Arbenigol (CNS). Ar gyfer bron bob cwestiwn yn yr arolwg, roedd y sawl a oedd wedi cael CNS yn teimlo eu bod wedi cael profiad mwy cadarnhaol o'i gymharu â'r sawl nad oedd wedi cael mynediad at CNS. Dangosodd yr arolwg bod bron 1 ym mhob 5 (19%) heb gael enw a manylion cyswllt CNS i'r cefnogi trwy eu triniaeth.

Mae ein hadroddiad Gweithlu Canser Cymru (2018) yn adeiladu llun cynhwysfawr o'r heriau arwyddocaol sy'n wynebu'r gweithlu nyrsio canser a gofal lliniarol. Yn ein cyfrifiad o nyrsys clinigol arbenigol (CNS), bu Macmillan adnabod bod 74% o nyrsys clinigol arbenigol y fron o fewn 10 mlynedd o ymddeol. Roedd hefyd yn dangos tystiolaeth bod y gyfradd swyddi gwag ar gyfer nyrsys cemotherapi a nyrsys clinigol arbenigol yn uwch yng Nghymru na chyfartaledd y DU.


Key reports

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