National Cancer Workforce Strategic Framework - May 2013
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National Cancer Workforce
Strategic Framework
May 2013
National Cancer Workforce Strategic Framework | HWA 1© Health Workforce Australia. This work is copyright. It may be reproduced in whole or part for study or training purposes. Subject to an acknowledgement of the source, reproduction for purposes other than those indicated above, or not in accordance with the provisions of the Copyright Act 1968, requires the written permission of Health Workforce Australia (HWA). Enquiries concerning this report and its reproduction should be directed to: Health Workforce Australia Post | GPO Box 2098, Adelaide SA 5001 Telephone | 1800 707 351 Email | hwa@hwa.gov.au Internet | www.hwa.gov.au Suggested citation: Health Workforce Australia [2013]: National Cancer Workforce Strategic Framework The National Cancer Workforce Strategic Framework was developed by HWA with support from key national experts and consultants. 2 HWA | National Cancer Workforce Strategic Framework
Contents
Executive summary 3
Introduction 5
The case for cancer workforce change 11
The National Cancer Workforce Strategic Framework 15
Time for action – the National Cancer Workforce Strategic Framework domains 18
National Cancer Workforce Strategic Framework domain 1 20
National Cancer Workforce Strategic Framework domain 2 25
National Cancer Workforce Strategic Framework domain 3 30
National Cancer Workforce Strategic Framework domain 4 34
National Cancer Workforce Strategic Framework domain 5 39
Glossary 42
References 47
National Cancer Workforce Strategic Framework | HWA 3What would achieving this vision look like?
Executive summary
• T
he cancer workforce is planned on the basis of
consumer and community need.
National Cancer Workforce Strategic
Framework • T
he skill and capacity of the whole cancer workforce is
maximised to provide optimal care.
Health Workforce Australia’s (HWA) role has been • A
ll workforce innovation and reform activities add
to develop a National Cancer Workforce Strategic value to the successes and strengths of the current
Framework (NCWSF) that offers a course of action to system of cancer control.
address workforce issues for the cancer control sector,
and also identify key innovations and reforms with • M
ulti-disciplinary team care, clinical leadership, and an
potential national application. integrated team approach continue to be fundamental
to cancer clinical care, service delivery and workforce
The purpose of the NCWSF is to provide a set of planning.
strategic options for adoption at national, jurisdictional • T
he importance of consumers, volunteers and unpaid
and cancer organisation level, to add value to what carers is recognised in cancer workforce planning.
is already underway, and to facilitate shifts to a more
• T
he acknowledgement that cancer is largely a chronic
effective way of working.
disease.
Health Workforce Australia believes the NCWSF should • A
ll workforce innovation and reform activities include
be incorporated into national cancer care initiatives and ethical consideration regarding appropriateness of
established cancer control service delivery planning, treatment and seamless transition to palliative care for
including the Regional Cancer Centres. Cancer experts the ageing population.
consulted in the development of the NCWSF indicate it
• P
riority is given to Australia’s social and cultural
will add value to the considerable investment in cancer
diversity and the promotion of equity of access and
infrastructure by all governments.
outcomes across communities, geographic areas and
age groups, especially Aboriginal and Torres Strait
NCWSF vision Islander people and those from rural, regional and
remote areas.
A right-skilled cancer workforce delivering safe, effective,
consumer-centred care in the most appropriate setting • R
eform of the cancer workforce integrates with the
which: broader health and education reforms.
• Operates to its full scope of practice. • Innovation and reform is supported by robust
monitoring and evaluation processes.
• Is flexible to changing requirements.
• U
ses expert clinical staff in the most efficient and
effective manner.
• E
liminates unnecessary duplication of activities for
consumers at all points of care.
4 HWA | National Cancer Workforce Strategic FrameworkNCWSF priority recommendations
Introduction
1. D
evelop the cancer workforce in alignment with
agreed national best practice pathways of cancer care
Setting the scene
and current health reform initiatives.
2. B
uild workforce capacity to respond and adapt to HWA was established in 2010 as a national health
the rapid rate of change in cancer care, including the workforce agency through the National Partnership
impact of emerging technologies. Agreement on Hospital and Health Workforce Reform
3. S
upport leadership at all organisational levels 2008. HWA drives a strategic, long-term program
to ensure sustainability of the health system and which addresses the future challenges of providing a
responsiveness to the health needs of people with or skilled, flexible and innovative health workforce. The
affected by cancer. reforms are needed to address workforce shortages
and to ensure Australia’s health workforce can meet
4. Plan for the optimal use of skills and adoption of increasing demands for services resulting from an ageing
workforce innovation and reform, by developing population, increasing levels of chronic disease and
data and information based on the current gaps and community expectations.
perceived shortages in the cancer workforce.
5. S
upport work by governments, regulatory, funding The following key policy foundations form the context for
and policy bodies to deliver cancer workforce reform. HWA’s work:
NCWSF strategic actions 1. National Partnership Agreement on Hospital and
Health Workforce Reform (2009/10-2012/13)
To support attainment of the priority recommendations,
five strategic actions have been identified within each of The National Partnership Agreement (NPA) outlines the
the National Health Workforce Innovation and Reform workforce reform initiatives agreed by governments
Strategic Framework for Action (2011-2015) domains for to improve health workforce capacity, efficiency and
action. productivity. These include funding, planning and
coordinating clinical training across all health disciplines;
Implementation of the NCWSF supporting health workforce research and planning;
improving international recruitment efforts; and
HWA will work in collaboration with key stakeholders to progressing new workforce models and reforms.
drive the adoption and implementation of the NCWSF.
This will involve building the evidence, including 2. Health Workforce 2025: Doctors, Nurses and
planning, research and evaluation. Providing this Midwives
information will assist governments and key decision
makers in cancer control to deliver the changes required Health Workforce 2025: Doctors, Nurses and Midwives
to meet the challenges facing this workforce. (HW2025) (Volumes 1 and 2) provides long-term,
national workforce projections and presents the best
If implemented, the NCWSF will prepare a sustainable, available planning information on Australia’s future
flexible, skilled workforce to support an integrated health workforce. HW2025 finds that without nationally
cancer control system delivering safe, effective, coordinated reform Australia is likely to experience
consumer-centred care. limitations in the delivery of high quality health services.
This is a consequence of workforce shortages and
maldistribution, inefficiencies and insufficient capacity
in the training system, and continued reliance on
poorly coordinated skilled migration to meet essential
workforce requirements.
National Cancer Workforce Strategic Framework | HWA 5HW2025 volume 3 examines individual medical Future directions
specialities in Australia and is the final volume in this
series. The key findings are: To build a heath workforce that is able to meet the health
• T
he number of medical specialists is increasing, but needs of the Australian community in a sustainable way,
the workforce is not evenly distributed. the next steps will involve seeking national agreement
on the actions identified, progressing outcomes through
• T
here are not enough general practitioners and some collaboration and consultation, and implementing the
other medical specialists in regional and rural Australia. results across the health and higher education sectors.
• S
ome medical specialties are more popular than
others from a career perspective. HW2025 identifies a range of policy directions
covering workforce reform, training, immigration and
• A
growing trend toward specialisation and sub-
geographical distribution that can be adopted to deliver
specialisation means there isn’t enough generalists.
a more sustainable health workforce.
HW2025 volume 3 identifies the issues and opportunities
Health Ministers have identified that the main policy
to build a medical workforce that is able to sustainably
levers to address the shortfall in the health workforce
service the health needs of the Australian community.
identified in HW2025 are innovation and reform,
Next steps involve seeking national agreement on
immigration, training capacity and efficiency, and
the actions identified, progressing outcomes through
workforce distribution.
collaboration and consultation, and implementing the
results across the health and higher education sectors.
In November 2012, Australian Health Ministers agreed to
the following comprehensive set of policy responses to
3. National Health Workforce Innovation and Reform
the findings of HW2025:
Strategic Framework for Action 2011-2015
• R
esponding to the projected nursing workforce
The National Health Workforce Innovation and imbalance.
Reform Strategic Framework for Action 2011-2015 has • Progressing workforce redesign.
been approved by Health Ministers and provides an
overarching, national policy platform to guide health • Aligning training and workforce need.
workforce reform. HWA aligns all its programs and • E
stablishing a National Medical Training Advisory
initiatives with the five domains for action identified Network.
within this framework. The five domains are the essential
• Driving efficient and effective training.
areas for activity for the development of a sustainable
health workforce for the future. • A
ddressing industrial barriers and enablers to
workforce reform.
To deliver national reform for a future health workforce,
• A
ddressing legislative barriers and enablers to
all stakeholders need to work together to provide the
workforce reform.
changes needed to deliver and support sustainable
reform. This requires work by governments, regulatory, • Streamlining clinical training funding.
funding and policy bodies, and is why the National • Considerations for achieving national self-sufficiency.
Health Workforce Innovation and Reform Strategic
Framework for Action 2011-2015 is a key policy guide for HWA will lead and/or support the implementation of
the health sector. This framework provides a national these policy responses, consistent with its approved
approach to guide all stakeholders in their actions work plan, budget and organisational principles of
to support the changes necessary to drive essential building evidence, providing leadership and working in
workforce reform. collaboration.
This work will underpin and influence the future adoption
and implementation of the National Cancer Workforce
Strategic Framework.
6 HWA | National Cancer Workforce Strategic FrameworkDevelopment of the NCWSF
National Cancer Workforce
Strategic Framework The NCWSF was informed by the following four
documents, which are available on the HWA website:
• A
cancer workforce planning data inventory across the
Outcomes for Australian cancer patients have improved cancer continuum.
dramatically over the past 20 years. Current survival rates
are equivalent to the best in the world. In 2006–2010 in • A
literature review identifying key national and
Australia, the five-year relative survival was 66 per cent for international directions of cancer care and cancer
all cancers combined1. This achievement reflects strong control workforce development.
public awareness of prevention, screening and early • A
n environmental scan identifying the workforce
detection messages, evidence-based clinical cancer impact of current and emerging programs, examples
guidelines and proven population screening programs. of innovation and change already underway, and
Fundamental to these improvements is the high-quality lessons learned.
work of health professionals in diagnosing and managing
• A
report, including 13 case studies, describing what
cancer, involvement of consumers in cancer control,
successful innovation and reform looks like in Australia.
effective new therapeutics and treatments, a robust
health system with universal access, and a history of
HWA appointed an expert reference group, a
significant investment in cancer control measures.
consultancy and a clinical advisor. Consultations were
held with clinical, jurisdictional and non-government
HWA’s task has been to develop a National Cancer
representatives in each state and territory. Specific
Workforce Strategic Framework (NCWSF) that offers
advice was sought from consumers and their carers.
a course of action to address workforce issues for the
A full day review of an early version of the NCWSF was
cancer control sector, and also identify key innovations
held with consumers and experts in cancer care, policy,
and reforms with potential national application.
planning and research. A later version of the strategy was
reviewed through a six-week consultation process with
The purpose of the NCWSF is to provide a set of
representatives from jurisdictions, the Commonwealth
strategic options for adoption at national, jurisdictional
Government, Cancer Australia and cancer expert
and cancer organisation level, to add value to what
groups. This process was complemented with a series of
is already underway, and to facilitate shifts to a more
discussions held with the cancer workforce community.
effective way of working.
This comprehensive consultation and resulting advice
has contributed to the development of the NCWSF.
HWA considers the NCWSF should be included
in national cancer care initiatives and established
cancer control service delivery planning, including the
developing Regional Cancer Centres and build on the
considerable investment in cancer infrastructure by all
governments.
This is the first time a National Cancer Workforce
Strategic Framework has been developed and HWA
has drawn on the limited, existing national information
about whole of cancer workforce planning, innovation
and reform, and national, jurisdictional and international
experiences and evidence.
National Cancer Workforce Strategic Framework | HWA 7Figure 1: National Cancer Workforce Strategic Framework development
Background documents
NCWSF planning NCWSF case studies for
NCWSF literature review NCWSF environmental scan
data inventory innovation and reform
Expert contributions
Expert cancer workshop Jurisdictional consultation
National Cancer Workforce Strategic Framework
Scope of NCWSF Policy levers
The focus of the strategic framework is the workforce, The NCWSF is aligned with the National Health
whose primary role involves early intervention, referral, Workforce Innovation and Reform Strategic Framework
treatment, care or support of people with or affected for Action. This framework, which has been approved
by cancer, in a cancer service or other health service by Ministers, forms the policy platform for all HWA
environment, including non-government, community program and strategy initiatives. The NCWSF identifies
and private health services. The NCWSF broadly follows a set of workforce actions arising from the development
the World Health Organisation (WHO) definition of of the strategic framework and complementary to the
cancer control: the continuum from research, primary WIR framework. The five domains for action in the WIR
prevention, secondary prevention and screening, framework are:
early detection, diagnosis, treatment, survivorship and
1. H
ealth workforce reform for more effective, efficient
palliation2. However, it was agreed the NCWSF would
and accessible service delivery.
specifically reflect the scope of the developing Council
of Australian Government (COAG) National Cancer Work 2. H
ealth workforce capacity and skills development.
Plan, which spans the continuum of care from diagnosis 3. L eadership for the sustainability of the health system.
through treatment and support, to management of
follow up care and survivorship. 4. Health workforce planning.
5. H
ealth workforce policy, funding and regulation.
Many people with a wide array of skills and competencies
participate in the cancer control workforce. It is
recognised that while some of these occupations are
specifically devoted to cancer care in one phase of
this continuum, most of the occupations contribute to
multiple phases of the cancer control continuum and also
to the broader general health workforce.
8 HWA | National Cancer Workforce Strategic FrameworkConsumers who were consulted during the The National Service Improvement Framework (NSIF4)
development of the NCWSF used the analogy of a for Cancer (2006) describes what is known about high
“train trip across Australia” to describe their cancer quality cancer care. This framework outlines what all
experience, emphasising that patients were the only Australians with, or at risk of, cancer should expect to
ones to complete the whole cancer journey. They receive though the healthcare system. The NCWSF
also spoke of the disjunction between the “stations” draws on the description of optimal pathways of
(cancer care services) and the people delivering those care in the NSIF, acknowledging the critical points
services. Consumers, in the main, perceive services for opportunity for cancer workforce innovation and
to be provider-centred and call for a shift in focus to reform. As services are organised and resourced very
patient-centered care and for future workforce design differently in different parts of Australia, the NSIF focuses
and planning to be based on consumer and population on what should be expected to happen for all people
needs. The development of the NCWSF was influenced with or affected by cancer, based on optimal pathways
by the established National Framework for Consumer of care. This framework indicates that people and
Involvement in Cancer Control3, produced by Cancer services range across a continuum from well people in
Australia and Cancer Voices Australia, which is designed their communities, through detection and diagnosis to
to strengthen consumer involvement to achieve better treatment, to people living with cancer.
care, beneficial policy and research to improve the lives
of people affected by cancer. The five critical points of cancer control follow:
1. Reduce risk.
In April 2010, the Council of Australian Governments
(COAG) agreed that “Victoria and the Commonwealth 2. Find the condition early.
would lead work under the auspices of Health Ministers, 3. H
ave the best treatment and support during active
to report back to COAG in 2011, on the most effective treatment.
cancer diagnosis, treatment and referral protocols, to
be developed with expert clinical input”. The National 4. Have the best treatment and support between and
Cancer Work Plan is a suite of initiatives, focused on after active treatment.
providing appropriate, efficient and well-coordinated 5. Have the best care at the end of life.
care for people affected by cancer and their families,
from diagnosis through treatment and support to the In collaboration with the cancer community, five priority
management of follow up care and survivorship. Effort in recommendations were developed in alignment with the
these areas fits with jurisdictional cancer plans and builds five domains of the National Health Workforce Innovation
on the recent investments of all governments in cancer and Reform Strategic Framework for Action.
control. The specific initiatives within the National Cancer
Work Plan are: pathways of cancer care; efficient and The NCWSF also reflects the continuum of cancer
effective cancer services; and evidence-based cancer care outlined in the NSIF for Cancer in each of the
treatment. five domains of the National Health Workforce
Innovation and Reform Strategic Framework for Action,
Both the NCWSF and the National Cancer Work Plan acknowledging the critical points for opportunity for
leverage off the existing work of the jurisdictional cancer workforce innovation and reform.
cancer plans and Commonwealth investments in cancer
infrastructure and programs. There is broad alignment These frameworks, HWA policy foundation documents,
of the NCWSF with the initiatives of the National Cancer the four background NCWSF development reports, and
Work Plan with particular reference to the second advice from stakeholders have guided the development
initiative which focuses on efficient and effective cancer of the specific workforce innovation and reform strategic
services and the innovative use of the cancer workforce. actions in each domain.
This also encompasses the development of agreed
cancer service capability frameworks and best practice
referral pathways.
National Cancer Workforce Strategic Framework | HWA 9The NCWSF provides advice on what is needed The cancer workforce is not immune from these
to address the immediate, medium and long-term challenges. Cancer is a complex disease requiring many
challenges facing the health system in the cancer separate treatments in different places by various health
control sector. The advice is provided for: professionals. The continuing growth in the number of
newly diagnosed cancer patients – combined with an
• C
ommonwealth, state, territory and local
increasing number of long-term cancer survivors (many
governments.
with additional chronic health problems) – is likely to
• Health service providers. overwhelm Australia’s available cancer workforce. The
• Employers, private and non-government sector. cancer workforce will need to continue to adapt as
the pace of scientific knowledge and emerging new
• Higher education. technologies increases.
• Training sector.
Overall, developing technology and science knowledge
• H
ealth professional registration and accreditation are moving much more rapidly than the training and
agencies. education sector, such as in the area of gene research
• N
ational agencies focused on health reform, or genomics. The risk is that the gap between research
information, efficiency, equity, quality and safety. and practice will open up further and faster, and existing
inequalities in access and outcomes could widen. It is
• Peak bodies.
critical that these challenges are addressed to ensure the
• Health advocacy bodies. sustainable delivery of health services that support the
• Consumers. health and wellbeing of Australia’s population.
• Professional bodies. Outcomes for Australian cancer patients have improved
• Unions. dramatically over the past 20 years. Current survival rates
are equivalent to the best in the world. In 2006–2010, the
• Student and trainee workforce. five-year relative survival in Australia was 66 per cent for
all cancers combined.
The NCWSF addresses national cancer workforce
innovation and reform strategic actions rather than Despite this progress, unacceptable variation in cancer
operational cancer workforce issues, organisational key rates and outcomes remains for certain communities,
performance indicators or cancer control service delivery. including Aboriginal and Torres Strait Islanders, people
in rural, regional and remote areas, low socioeconomic
groups and those with poor health literacy.
The case for cancer
workforce change Improved outcomes, measured by a reduction in
cancer incidence and mortality, will be achieved when
cancer is prevented, detected earlier and treated in
a timely manner with the most cost effective therapy.
Australia’s health workforce is facing significant
Improvements in data collection, continued investment
challenges. Such challenges are well documented and
in basic cancer research and the development of
include: an ageing population; increased demand for
a sustainable workforce are also critical factors to
health services and increasing expectations for service
improving cancer outcomes.
delivery; a changing burden of disease plus broader
labour market issues. In addition, health expenditure
Increasing cancer incidence alongside improving cancer
as a percentage of gross domestic products is rising
detection and treatments may mean there is opportunity
and is projected to increase significantly in the coming
to safely change the settings in which treatments are
decades.
delivered. Increasingly, primary care, community-based
centres and or homes will be safe alternatives to the
acute hospital setting. There is also a need for a much
greater focus on survivorship and consumer self-
management, with health professionals skilled in, and
comfortable with, a facilitator and enabler role.
10 HWA | National Cancer Workforce Strategic FrameworkAll governments and many non-government Australia’s health system is highly reliant on international
organisations have made a sustained effort and health professionals (IHPs) to provide health services to
considerable investment in promoting prevention the community. The proportion of international medical
programs and interventions to reduce preventable graduates is significantly higher in rural, regional and
chronic diseases, including cancer. Among other remote areas, where 41 per cent of all doctors have
measures, the National Partnership Agreement on trained overseas (up to 70 per cent in some communities).
Preventative Health5 provides for interventions in HW2025 highlights the likely ongoing demand for
schools, workplaces and communities to support employment of international health professionals, at least
physical activity, improved diets, healthy weight and in the short to medium term, as part of a comprehensive
increased quit smoking programs. While much successful strategy to meet projected health demands.
work has been done in cancer prevention, continued
effort is needed. Encouraging and supporting participation in the health
workforce by the Aboriginal and Torres Strait Islander
Cancer service capabilities in Australia are constrained population and focusing strongly in its development and
by many features including diverse geography and retention must be a priority in future health workforce
the inherent challenge of attracting and retaining a reform. HWA has recently undertaken work to strengthen
sufficient skilled workforce. Cancer treatments require and sustain the Aboriginal and Torres Strait Islander
highly technical and specialised health professionals. health workforce to deliver care in response to the known
Rural and regional areas have had particular difficulty in burden of disease in Aboriginal and Torres Strait Islander
attracting and retaining sufficient specialist cancer health communities. The final report on the HWA project
professionals. HWA is undertaking work around the rural makes 27 recommendations and HWA is facilitating an
and remote workforce; developing a strategy containing implementation plan based on these recommendations.
23 recommendations.
Cancer care is most effectively delivered by a skilled
HW2025’s position is that the development and cancer workforce able to deliver multi-disciplinary team
implementation of a plan to close any gaps is the key to care in a range of settings, with effective role delineation
the creation of a sustainable workforce. There are three and coordinated treatment. Effective use of the whole
primary levers through which this can occur: spectrum of required health professionals across the
various stages of the cancer journey is essential for
• R
eform: this may include changes to scopes of
optimal outcomes, good support for people affected
practice, increased use of assistants, the introduction
by cancer and their families as well as the efficient use of
of new workforce or workforce models, and broader
a sparse workforce. It is widely recognised that the best
application of technologies such as e-Health and
workforce approach is health professionals working in a
telehealth.
structured team environment that enables appropriate
• T
raining: this may involve reforms to the education delegation of clinical activities and formalised
pathway, interventions to ensure particular skills are communication of treatment plans and decisions. In this
developed for the future or training new types of way, patients and people affected by cancer can access
workforce. the care they need in a timely manner without necessarily
• Immigration: this is often used as a short-term having to see multiple health professionals working in
demand-management strategy. Over a longer discrete and demarcated roles and settings.
planning horizon, better management of migration
pathways for international health professionals can The establishment of Regional Cancer Centres is one
occur in combination with training and reform. mechanism which will help to address the poorer
outcomes experienced by some cancer patients, provide
better support for people affected by cancer and their
families living in rural, regional and remote communities.
Services will align with state and territory cancer plans
and focus on identified patient treatment gaps through
a collaborative network of linked private and public
services, both locally and nationally, to provide quality
multidisciplinary care for patients.
National Cancer Workforce Strategic Framework | HWA 11Links between Regional Cancer Centres, primary care Stakeholders consulted during the development of
and designated specialised metropolitan care, and the NCWSF identified consumer expectations around
clearly defined standards of care will ensure that cancer survivorship, follow-up and palliative care as factors in
treatment is given at the most appropriate location, workforce planning. The increasing role of the consumer
depending on the type and complexity of the tumour, and carer as partners in the cancer care team with
the available specialty skills and specific circumstances. regard to their overall health choices needs to be fully
Strong links with regional and metropolitan cancer acknowledged and accommodated. One of the case
services and timely discharge summaries will help health study sites took a population-based approach in the
professionals provide support and information to aid development of its community palliative care model
cancer patients, their families and carers. to design a workforce with skills and capabilities to
meet community expectations of safe and quality
Managing efficient follow-up care and effective end-of-life care.
survivorship will be a major future workforce challenge to
achieve optimal cancer outcomes. It is now recognised Many jurisdictions have workforce plans and innovative
that some cancers can be managed as a chronic strategies to meet the growing needs for cancer services
disease. In the future, much of the responsibility for and the NCWSF takes account of these plans. At a
effective follow-up care will be with primary healthcare national level, HW2025 examined cancer workforce
professionals as cancer is increasingly managed in the modelling, limited to radiation oncology, medical
community setting. Effective quality care will demand oncology and diagnostic radiology, concluding the
better vertical integration of services and more workforce supply of these specialities is perceived to be
coordinated care across sectors. in shortage. It highlighted the importance of service and
reform scenarios in best addressing the gap between
Survivorship is now recognised as a distinct phase supply and expressed demand. HWA also undertook
of cancer control. In recognition of cancer survivors’ a study on medical physicists, which indicated this
ongoing physical and psychosocial needs, new workforce is vulnerable. Although the modelling for
models of care are evolving to improve follow-up and nursing is relevant, it is not able to be separated into
coordination of care and reduce demand on oncologists. what is directly devoted to providing cancer services
It has been suggested some needs could be addressed from more general nursing care.
by transitioning care of most cancer survivors to
primary care or community-based health professionals HW2025 volume 3 identifies geographic maldistribution
following treatment. Ensuring a smooth transition and of the total medical workforce, also present for general
meeting survivors’ complex care needs requires better practice and a number of other medical specialties.
communication and coordination of care between Under current policy settings, the future projected
all health professionals involved in post-treatment growth of medical graduates is unlikely to make
care, particularly cancer specialists and primary care significant inroads into relative geographic equity.
providers.6 7 While maldistribution usually refers to potential
shortages in rural and regional areas, it also includes
It is also recognised that demand for palliative care is potential oversupply in major metropolitan centres.
growing rapidly. This is due to various factors, including Until there is better coordination and matching
an ageing population, an increase in the awareness of of vocational training positions to health system
the benefits of palliative care, and an increase in non- requirements, these imbalances will continue and likely
cancer referrals to palliative care. worsen with the increasing supply of graduates from
Australian medical schools.
12 HWA | National Cancer Workforce Strategic FrameworkIt is timely, therefore, to develop a National Cancer Implementation of the NCWSF: Next steps
Workforce Strategic Framework that aligns with
increasing cancer incidence, new technology, a stretched HWA will work in collaboration with key stakeholders,
workforce and increasing consumer expectations. such as jurisdictions, the National Cancer Expert
However, effective workforce strategies have a long lead Reference Group, key cancer experts, and people
time and require considerable planning and investment. with or affected by cancer to drive the adoption
These strategies will need to address aggregated and implementation of the NCWSF. This will involve
workforce numbers as well as appropriate investigation building the evidence, including planning, research
of the workforce composition, new models of care and and evaluation. Providing this information will assist
role delineation. governments and key decision makers in cancer control
to deliver the changes required to meet the challenges
What would successful cancer workforce facing this workforce.
change look like?
Addressing the challenges facing the cancer workforce
• A
ll workforce innovation and reform activities add cannot be achieved in isolation. It will require national
value to the successes and strengths of the current coordination across levels of government, higher
system of cancer control. education, regulatory bodies, employers, industry, the
professions, the private and the not-for-profit sector.
• T
he cancer workforce is planned on the basis of
consumer and community need.
HW2025 identifies a range of policy directions
• T
he skill and capacity of the whole cancer workforce is covering workforce reform, training, immigration and
maximised to provide optimal care. geographical distribution that can be adopted to deliver
• M
ulti-disciplinary team care, clinical leadership, and an a more sustainable health workforce.
integrated team approach continue to be fundamental
to cancer clinical care, service delivery and workforce Health Ministers have identified that the main policy
planning. levers to address the shortfall in the health workforce
identified in HW2025 are innovation and reform,
• T
he importance of consumers, volunteers and unpaid immigration, training capacity and efficiency, and
carers is recognised in cancer workforce planning. workforce distribution.
• P
riority is given to Australia’s social and cultural
diversity and the promotion of equity of access and Almost all health systems are dealing with costs growing
outcomes across communities, geographic areas and at unsustainable rates which are not being matched
age groups, especially Aboriginal and Torres Strait by a rise in revenue. Adoption and implementation of
Islanders and those from rural, regional and remote the NCWSF will support increased capacity through
areas. productivity gains, workforce redesign and, where
identified, increased workforce numbers. HWA
• T
he recognition and importance of appropriate recommends current and emerging cancer workforce
cancer follow-up care and the seamless integration of and workplaces adopt the NCWSF.
palliative care services.
• R
eform of the cancer workforce integrates with the If implemented, the NCWSF will prepare a sustainable,
broader health and education reforms. flexible, skilled workforce to support an integrated
cancer control system delivering safe effective consumer-
• Innovation and reform is supported by robust
centred care.
monitoring and evaluation processes.
National Cancer Workforce Strategic Framework | HWA 13The enablers to achieving the NCWSF vision include:
National Cancer Workforce • S
ustaining the productive change that is already
Strategic Framework vision occurring in the cancer workforce across jurisdictions
and cancer organisations.
• D
eveloping the cancer community’s understanding of
The vision for the NCWSF is a right-skilled cancer
the current status of the cancer workforce, of where it
workforce delivering safe, effective, consumer-centred
needs to move to; and promoting an appreciation of
care in the most appropriate setting which:
why change is necessary.
• Operates to its full scope of practice.
• S
upporting change in health workforce policy,
• Is flexible to changing requirements. regulation and funding.
• U
ses expert clinical staff in the most efficient and • Implementing the National Cancer Work Plan
effective manner. initiatives to develop efficient and effective cancer
• E
liminates unnecessary duplication of activities for services.
consumers at all points of care.
Figure 2: Required shift in the cancer workforce
Current status Future workforce
Roles-based Skills-based
Vertical and hierarchical professional System-wide, multi-disciplinary,
decision making consumer-focused care
Discretionary use of information Universal uptake of information and
and communication technology communication technology
Individualistic practice based System-wide, evidence-based practice
on interest and skills subject to benchmarking
Change is embedded in a flexible,
Change is optional
adaptive workforce
Health professsionals as
Health professionals as experts
facilitators of self-care
14 HWA | National Cancer Workforce Strategic Framework• M
eeting the needs of people from culturally and
The cancer workforce – linguistically diverse backgrounds.
two scenarios • Improving the coordination and integration of service
delivery.
• Increasing equitable access to health services for
There is a clear alternative facing Australia’s cancer
vulnerable communities.
control workforce:
If we do nothing Time for action –
At the macro level, the NCWSF exists in an environment introduction to the National
where, without nationally coordinated reform, Australia is
likely to experience limitations in the delivery of high-
Cancer Workforce Strategic
quality health services as a consequence of: Framework domains
• W
orkforce shortages – highly significant in the case of
nurses and less so for doctors. HWA has developed a National Cancer Workforce
Strategic Framework (NCWSF) that offers a course of
• M
aldistribution of the medical workforce resulting action to address workforce issues for the cancer control
in less accessible services in rural, remote and outer sector, and also identifies key innovations and reforms
metropolitan regions. with potential national application.
• B
ottlenecks, inefficiency and insufficient capacity in
the training system, especially for doctors. The purpose of the NCWSF is to provide a set of options
for adoption at national, jurisdictional and cancer
• C
ontinued reliance on poorly coordinated skilled
organisational level, to add value to what is already
migration to meet essential workforce requirements
underway, and to facilitate shifts to a more effective
– with Australia having a high level of dependence on
way of working in the future. The NCWSF, if adopted
internationally recruited health professionals, relative
and implemented, will prepare a sustainable, flexible,
to most other OECD countries.
skilled workforce to support an integrated cancer control
system delivering high quality services.
If we act now
The NCWSF draws on the description of optimal
The vision embodied in the NCWSF addresses the
pathways of care in the National Services Improvement
challenges facing the cancer control sector. The rationale
Framework (NSIF) for Cancer, acknowledging the critical
for implementing the NCWSF strategic actions includes:
points for opportunity for cancer workforce innovation
• Increasing the capacity to retain the existing workforce. and reform.
• Easing pressure on acute care services.
The NCWSF is aligned with the National Health
• Improving productivity and efficiency of services. Workforce Innovation and Reform Strategic Framework
• M
atching the needs of consumers to the mix of health for Action 2011-2015. This framework forms the policy
professional skills available and the setting in which base for all HWA program and strategy initiatives.
treatment is provided.
In collaboration with the cancer workforce community,
• Implementing more broadly successful local five priority recommendations were developed to
innovations, with the potential to improve capacity and align with the five domains of the WIR framework.
quality of care. Each chapter of the following section of the
• S
upporting the supervision capacity needed to NCWSF is introduced through the five domains of
develop the next generation of the cancer workforce. the WIR framework and the five NCWSF priority
recommendations.
• Reaping the benefits of new science and technology.
• E
nsuring culturally appropriate services for Aboriginal In each of the chapters, five specific NCWSF strategic
and Torres Strait Islander people in urban, rural, actions are identified for adoption and implementation.
regional and remote areas. HWA will work in collaboration with key stakeholders to
drive the adoption and implementation of the NCWSF.
National Cancer Workforce Strategic Framework | HWA 15Domain 1
National Workforce National Cancer Workforce
Innovation and Reform Strategic Framework priority
Framework domains recommendations
Develop the cancer workforce in
Health workforce reform for more
alignment with agreed national best
effective, efficient and accessible
practice pathways of cancer care and
service delivery.
current health reform initiatives.
Build workforce capacity to respond
Health workforce capacity and and adapt to the rapid rate of change
skills development. in cancer care, including the impact of
emerging technologies.
Support leadership at all organisational
Leadership for the sustainability levels to ensure sustainability of the health
of the health system. system and responsiveness to the health
needs of people with or affected by cancer.
Plan for the optimal use of skills and
adoption of workforce innovation and
Health workforce planning. reform, by developing data and information
based on the current gaps and perceived
shortages in the cancer workforce.
Support work by governments, regulatory,
Health workforce policy, funding
funding and policy bodies to deliver cancer
and regulation.
workforce reform.
16 HWA | National Cancer Workforce Strategic FrameworkStakeholders consulted during the development of the
National Cancer Workforce NCWSF identified some inefficient practices such as
Strategic Framework: extended follow-up in the specialist acute care setting
and unnecessary duplication of tests. This highlights
preamble for domain 1 the need for improved information flow, best practice
referral pathways and implementation of shared models
Reform cancer workforce roles to improve of cancer care between hospital and community
productivity and support more effective, efficient settings. Stakeholders recommended the development
and accessible service delivery models that better of expanded scopes of practice, support or assistant
address population health needs. roles to address challenges in meeting demand in acute
care settings, and increasing the capacity of the primary
Emerging evidence indicates there are four broad areas healthcare sector.
where workforce reform and innovation are needed to
support improvements in productivity and to support Optimal use of health workforce occurs when all health
effective, efficient and accessible services for consumers: workers are enabled to work at the top of their scope,
as this boosts overall productivity and maximises
• C
hanging roles and scopes of practice of the existing retention. A range of skills are required, including
workforce, while ensuring the existing cancer advanced practice for health professionals, such as
workforce is working to its full scope. nurses, technicians, radiation therapists, social workers
• T
aking into account the setting where treatment is and Aboriginal and Torres Strait Islander practitioners.
delivered in line with best-practice. There is also capacity for assistant level workers (diploma
and certificate level IV) to support health professionals,
• C
hanging models of care in response to advances in such as medical oncologists, radiation oncologists and
research and technology. medical physicists, to work to their full scope, and in
• T
ransforming the service delivery model using many cases, this can also be supported by technology.
enablers such as eHealth HWA reports have identified the workforce supply of
medical oncologists, radiation oncologists and medical
The NCWSF expert cancer workshop held in Melbourne physicists as in perceived shortage or vulnerable, and
in 2012 resolved an optimal future cancer workforce highlighted the importance of service and reform
needs to allow for flexibility as a key workforce scenarios in best addressing the gap between supply
principle within the multi-disciplinary team model. and expressed demand. The Commonwealth is
While acknowledging the specialised nature of much supporting a program addressing the workforce
of cancer care, many stakeholders consulted during pressures in radiation oncology through a review of
the development of the NCWSF advocated for the advanced practice for radiation therapists.
development of more generalist allied health and
cancer nursing roles for outpatient settings, Regional Current health reform initiatives emphasise a refocus
Cancer Centres and community settings. Describing on wellness, prevention, screening and primary
the need for functions or skill sets within teams creates healthcare. The National Primary Healthcare Strategy3
the opportunity to apply new ways of thinking about provides a roadmap for the establishment of Medicare
workforce composition. Locals. Medicare Locals are a key component of the
Australian Government’s health reform agenda, and
HW2025 identifies significant geographic maldistribution have been established as regional primary healthcare
of the medical workforce, including specialists. Current planners to drive improvements in primary heath care.
policy settings are unlikely to make significant inroads Medicare Locals are working collaboratively with general
into this geographical inequity. The expanded scope of practitioners, other primary healthcare providers, Local
practice nurse endoscopist project is a workforce model Health Networks, and communities to better integrate
that complements the medical workforce and will give and coordinate the delivery of healthcare services.
safe, quality options to regional patients who might This aligns with change in cancer services and workforce
otherwise have to travel long distances for the service. models, including an increased focus on coordinated
patient-centred care, interdisciplinary practice and
multi-disciplinary teams, a shift to ambulatory and
community care settings, and an increased emphasis on
psychosocial support needs and palliative care8.
National Cancer Workforce Strategic Framework | HWA 17In addition, the nature and place of post-acute follow-up As the National Broadband Network (NBN) is
is changing. In consultations relevant to the development implemented, technologies such as telehealth and
of NCWSF, there was widespread support for a greater telemedicine should facilitate improved communication
role for primary care, particularly in prevention, follow- and support for both health professionals and people
up, survivorship and palliative care. However, it was also with cancer. The National E-Health Transition Authority
observed that further work is needed to formalise the (NEHTA) is developing national eHealth infrastructure.
role of GPs, pharmacists, nurses, psychologists and other Meanwhile stakeholders highlight the need and
health professionals across the continuum of cancer care. support for interim eHealth initiatives ahead of the
implementation of the fully operational Personally
People affected by cancer have diverse survivorship Controlled Electronic Health Record (PCEHR).
needs and stakeholders report that they require flexible
models of follow-up care across acute and primary Advances in cancer detection and treatment
healthcare settings. For example, the Australian technologies, such as stereotactic radiosurgery, genetic
Cancer Survivorship Centre (ACSC), based at the Peter and genome testing and oral chemotherapy agents,
MacCallum Cancer Centre, aims to improve survivorship may necessitate an increased focus on survivorship,
outcomes for people affected by cancer. Using the rehabilitation and the management of long-term side
perspective that survivorship begins at diagnosis, the effects within the community. Such advances may also
ACSC aims to develop a range of resources to support require additional workforce skills such as ensuring health
professionals and consumers to improve survivorship professionals are suitably equipped to refer people to
experiences and outcomes9. genomic services that will provide appropriate testing
in a quality assured, ethical and clinically supported
Population screening programs perform a vital role in environment.
early detection of cancer. At present, national population
screening programs exist for cervical, breast and bowel HW2025 consultation identified an increased expressed
cancers and there is international research underway demand for anatomical pathology beyond that expected
into the feasibility of screening for other cancers such through an ageing population. Contributing factors to
as prostate and lung cancer10. Any additional programs this demand include the incidence of cancer combined
would require assessing workforce capacity. with the increased complexity per case, and genetic
technology. HW2025 reported some perceived difficulty
Most cancers, however, are detected by people in filling positions, either through maldistribution or
presenting to health professionals with suspicious insufficient workforce. HW2025 indicates the service and
symptoms of cancer. Improved pathways of care workforce reform scenario has the greatest impact on
from initial suspicious symptoms of cancer through to reducing the existing gap, and minimising a potential
assessment and accurate diagnosis would assist both future gap between supply and demand. This aligns with
health professionals and patients. Practical navigational NCWSF stakeholder feedback.
aids and better psychosocial support are much needed
for people affected by cancer. The NCWSF uses the critical intervention points outlined
in the National Service Improvement Framework for
Stakeholders identified several effective cancer Cancer. The following table acknowledges, within this
workforce innovations, such as extending the scope of domain, the critical points for opportunity for cancer
the general pharmacy workforce to deliver oncology workforce innovation and reform.
pharmacy services. Stakeholders also highlighted
that inefficiencies can flow from fee-for-service
funding models, and that the current restructuring of
primary care through Medicare Locals could provide
opportunities to consider different funding models to
support revised models of cancer care.
18 HWA | National Cancer Workforce Strategic FrameworkCritical points for cancer control – National Service Improvement Framework for Cancer
People will be able to: Domain 1
Reduce risk ü
Find the condition early ü
Have the best treatment and support during active treatment ü
Have the best treatment and support between and after active treatment ü
Have the best care at the end of life ü
Domain 1 strategic actions
1.1 Adopt national service capability frameworks, referral protocols and cancer care pathways that will:
a) Promote shared care between specialists and primary care sectors.
b) Ensure efficient use of the time and skills of all service providers.
c) Increase the use of specialist nurse practitioners and advanced practice nurses.
d) D
evelop patient navigator functions within a team to help people with or affected by cancer with
continuity of care, reduced duplication, and improved access and treatment completion.
e) Progress the assignment of non-clinical tasks to the non-clinical workforce to optimise productivity in
patient care.
1.2 Support the primary healthcare workforce to enable the safe transfer of appropriate services from
specialist and hospital based services.
1.3 Build workforce capacity and capability to deliver cancer care, through supporting the effective
implementation of a national roll-out of shared care follow-up care in specific cancers, initially in early-
stage breast and bowel cancer.
1.4 Review the medical laboratory workforce to better match tasks undertaken and skills required to address
the workforce pressures generated by increasing demands and adaption to new technologies.
1.5 Address the perceived gap in access to specialist pharmacy, psychosocial, follow-up, survivorship and
rehabilitation services through role redesign.
National Cancer Workforce Strategic Framework | HWA 19Domain 2
National Workforce National Cancer Workforce
Innovation and Reform Strategic Framework priority
Framework domains recommendations
Develop the cancer workforce in
Health workforce reform for more
alignment with agreed national best
effective, efficient and accessible
practice pathways of cancer care and
service delivery.
current health reform initiatives.
Build workforce capacity to respond
Health workforce capacity and and adapt to the rapid rate of change
skills development. in cancer care, including the impact of
emerging technologies.
Support leadership at all organisational
Leadership for the sustainability levels to ensure sustainability of the health
of the health system. system and responsiveness to the health
needs of people with or affected by cancer.
Plan for the optimal use of skills and
adoption of workforce innovation and
Health workforce planning. reform, by developing data and information
based on the current gaps and perceived
shortages in the cancer workforce.
Support work by governments, regulatory,
Health workforce policy, funding
funding and policy bodies to deliver cancer
and regulation.
workforce reform.
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