Cancer Outcomes in the UK

Baroness Rafferty Excerpts

Tuesday 21st April 2026 Grand Committee

[Baroness Rafferty (Lab)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Watkins, a fellow nurse. I add my congratulations to the noble Lord, Lord Patel, on securing such a timely debate. There is a lot to commend in the National Cancer Plan for England, but, speaking as a nurse and a workforce researcher, I think that there are definitely challenges, as we have heard, to be met in ensuring that services meet the physical, psychological and social impact of cancer care.

Cancer detection rates are increasing alongside survival rates and complexities of diagnostics as well as care pathways in a population with growing co-morbidities. The national cancer plan advocates for every cancer patient to have access to a clinical nurse specialist, as we have heard. However, it is uncertain how likely it is that this will be achieved with the lack of nurse specialists currently available in the workforce, as the noble Lord, Lord Patel, highlighted.

There is strong evidence that specialist and advanced practice nurses are cost-effective and clinically effective. These highly skilled and educated nurses lead clinical services and the administration of complex chemotherapy protocols. Anyone in contact with chemotherapy services will be aware that this is nurse-led and stressful work, as the pressure is on to ensure that high volumes of patients are treated safely. Burnout rates for chemotherapy nurses remain high. Specialist and advanced practice nurses are a precious human resource that needs to be supported.

One of the challenges to accessing treatment is the availability of training and education for specialist nurses, as highlighted by the noble Baroness, Lady Watkins. According to a recent survey by the UK Oncology Nursing Society, training and education is patchy across the country. Two factors constrain the expansion of this highly skilled cancer workforce: the limited supply of supervisors to support advanced practice nurses and funded opportunities to develop their capacity. Access to training and education is essential to build the necessary confidence and competence in delivering ever more complex care. Core to these skills are expertise in advanced communication, psychological support skills, which the noble Baroness, Lady Watkins, highlighted, and symptom assessment and management.

Nurses are also integral to cancer research, especially the running of clinical trials, as the noble Baroness, Lady Bottomley, highlighted. The MRC trials infrastructure demonstrates a high reliance on research nurses for patient recruitment, and the review conducted by the noble Lord, Lord O’Shaughnessy, into commercial trials showed a worrying decline in the number of such trials conducted in the UK. This has profound implications for our standing as a life science destination and the part that that plays in our economic growth.

Oncology nurses are also researching patient outcomes and filling important gaps in the evidence base of symptom management through their research. I shall provide some examples from my experience as a supervisor of doctorates—one of my students happens to be here today, which is brilliant. One student undertook a co-design study with patients who had developed peripheral neuropathy from chemotherapy, which is a horrible side effect. She was intent on mitigating some of the further complications of this painful—terribly painful, in fact—and debilitating condition. Another is currently examining the sexual recovery of women after bladder removal for cancer. It is quite staggering that this remains largely a hidden problem yet has profound impacts on the women concerned and their partners, often traumatising women in the process. Another student pioneered a new way of measuring workload for cancer nurses. Strong evidence links patient mortality and education in acute care, so it is not inconceivable that the same principles might apply to cancer patients.

Despite the value placed on specialists and advanced practice nurses, it is worth noting that the British Medical Association has recently raised concerns about the expansion of advanced practice nurses substituting for medical roles, arguing that some employers are using them to replace doctors and that that poses a threat to patient safety. It is unclear what the specifics of this evidence might be but, based on my own and colleagues’ research, nurse autonomy poses no threat to multidisciplinary teamwork. On the contrary, it is an essential underpinning for enhanced interprofessional working between nurses and doctors.

Turning the plan into a reality requires a workforce that is supported, skilled and enabled to work differently. The Government’s forthcoming NHS long-term workforce plan refresh will be a pivotal moment to set the direction for cancer care. It must set out how nursing roles will be funded and supported to deliver the plan. Can the Minister confirm what support the Government are putting in place to enable the professional career development of cancer nurses?