Strategic Objective 5: Workforce to transform the delivery of cancer care

10-year ambition

An engaged, capable, and future-focused cancer workforce that is culturally safe and responsive, well-equipped, well-supported and driven by collaboration, continuous improvement, and diversity to enable inclusive care for all Australians affected by cancer.

Current status

A broad range of medical, nursing, and allied health professionals are involved in providing cancer care services for Australians across the cancer control continuum. Given the involvement of numerous health professions, coupled with the complexity of cancer care, multidisciplinary care is considered best practice in the treatment, planning, and care for patients with cancer.[153]

There is increasing pressure on the cancer workforce due to the rising number of cancer cases, our ageing population, increasing complexity of cancer care and availability of treatments, and improved survival meaning more people will require follow-up and survivorship care.[154]

Health services, specialist medical colleges, health professional bodies, regional training organisations, universities, regulators, and advocacy groups will all contribute to developing the workforce needed to meet the Australian Cancer Plan’s Strategic Objective 5 10-year ambition.

To ensure a strong, engaged, and capable workforce now and in the future, it is critical to build the readiness and capacity of the workforce to meet the changing cancer control landscape. This requires a focus on education and training, and balancing workforce supply and demand, including:

  • addressing knowledge and skills gaps in relation to cultural responsiveness and safety, appropriate use of new and emerging diagnostic modalities, technologies, and treatments for both cancer treatment and supportive care
  • building readiness and enabling continuous improvement of the workforce through education and training activities, including:
    • improving training standards and accreditation processes
    • ensuring the workforce is diverse, aware of the need for, and supported to provide, culturally safe and responsive care to all Australians, including Aboriginal and Torres Strait Islander people and other priority population groups
    • expanding and strengthening multidisciplinary cancer care roles, including in primary care, Aboriginal Community Controlled Health Services and the rural and remote workforce
    • promoting interdisciplinary expertise which can better meet patient care needs
    • ensuring agility in adapting to new models of care
    • ensuring the satisfaction, wellbeing and career opportunities of cancer care staff.
  • understanding current and future workforce supply and demand through oncology workforce data projections to identify potential gaps and help determine strategies to address any gaps.[155] Oncology workforce data projections will guide activities such as:
    • development of relevant national health workforce plans
    • implementation of retention strategies
    • building workforce diversity
    • consideration of health system financing reforms
    • enabling innovative workforce approaches to support effective patient navigation.

Ambitions, Goals & Actions

10-year ambition

An engaged, capable and future-focused cancer workforce that is culturally safe and responsive, well- equipped, well-supported and driven by collaboration, continuous improvement and diversity to enable the best care for all Australians affected by cancer.

In achieving this ambition, all Australians will have access to a supported, engaged, diverse and well-equipped cancer care workforce that delivers optimal cancer care for people affected by cancer.

The workforce will be equipped and supported for technology advances and have agility to adjust to new models of care. The future state workforce will better reflect the diversity of Australians affected by cancer, enhancing the consumer experience across the cancer care continuum.

Similarly, the workforce will be supported to provide cancer care in a culturally safe and responsive environment, especially for Aboriginal and Torres Strait Islander people.

Importantly, there will be sufficient workforce to be able to respond to the changing cancer control landscape including increasing demand for cancer care. The cancer care workforce will enable equity of access to cancer care, particularly for those Australians who live in rural and remote areas and lower socioeconomic communities.

The ability to progressively transform the workforce is also critical to the successful achievement of the 10-year ambitions of the other five Australian Cancer Plan Strategic Objectives.

2 Years
5 Years

Goal

National strategies developed to enhance clinical and cultural safety training and accreditation processes, build workforce diversity, expand multidisciplinary roles and determine retention strategies.

In achieving this 2-year goal, necessary national cancer care workforce frameworks, policies and strategies that provide the basis for achieving the 5-year goal and 10-year ambition will be developed.

The 2-year goal will see the development of accreditation standards, workforce supply and demand models and role delineation.

In this 2-year timeframe, there will be a focus on strategies for:

  • strengthening multidisciplinary care
  • recruitment and retention of the cancer care workforce
  • enhancing workforce diversity and adoption of cultural safety training programs.

Actions

5.2.1
Identify current and emerging workforce undersupply in line with cancer workforce modelling and other national health workforce strategies, and initiate planning with the sector towards building future workforce capacity and capability.
5.2.2
Build on existing capability of the primary care workforce to collaboratively and sustainably support the needs of consumers.
5.2.3
Evaluate and extend cultural safety training programs to cancer service providers, including through community-based partnerships with priority population groups.
5.2.4
Identify priority areas of need for Aboriginal and Torres Strait Islander cancer care workforce and develop a plan to recruit, train and retain the Aboriginal and Torres Strait Islander cancer care workforce.

2 Years

Goal

National strategies developed to enhance clinical and cultural safety training and accreditation processes, build workforce diversity, expand multidisciplinary roles and determine retention strategies.

In achieving this 2-year goal, necessary national cancer care workforce frameworks, policies and strategies that provide the basis for achieving the 5-year goal and 10-year ambition will be developed.

The 2-year goal will see the development of accreditation standards, workforce supply and demand models and role delineation.

In this 2-year timeframe, there will be a focus on strategies for:

  • strengthening multidisciplinary care
  • recruitment and retention of the cancer care workforce
  • enhancing workforce diversity and adoption of cultural safety training programs.

Actions

5.2.1
Identify current and emerging workforce undersupply in line with cancer workforce modelling and other national health workforce strategies, and initiate planning with the sector towards building future workforce capacity and capability.
5.2.2
Build on existing capability of the primary care workforce to collaboratively and sustainably support the needs of consumers.
5.2.3
Evaluate and extend cultural safety training programs to cancer service providers, including through community-based partnerships with priority population groups.
5.2.4
Identify priority areas of need for Aboriginal and Torres Strait Islander cancer care workforce and develop a plan to recruit, train and retain the Aboriginal and Torres Strait Islander cancer care workforce.

5 Years

Goal

Strategies implemented to enable a culturally safe, responsive, and capable multidisciplinary workforce that is working at the top of their scope of practice and ability to deliver high-quality cancer care.

In achieving this 5-year goal, strategies will be implemented to enable the cancer care workforce to provide optimal, inclusive, safe and responsive cancer care, with cancer care providers working collaboratively and at the top of their scope of practice. This will require consideration and implementation of best practice models of care and broader adoption of the Optimal Care Pathways (OCPs) across the cancer care continuum.

Actions

5.5.1
Implement a cancer care workforce pipeline that meets demand for optimal cancer care, with diversity measures in training, recruitment and talent management to ensure the cancer workforce represents the diversity of patient populations.
5.5.2
Assist the sector to support all cancer care practitioners to work at the top of their scope of practice, increase retention and ensure ongoing access to continuing professional development.
5.5.3
Routinely integrate cultural safety training programs for cancer service providers, including through community-based partnerships with priority population groups.
5.5.4
Support national coordination and implementation of a plan to recruit, train and retain the Aboriginal and Torres Strait Islander cancer care workforce

Stakeholder quotes

With the pandemic, there have been difficulties for nursing students to undertake placements which means that when they graduate they don't have the necessary skills. This has a flow-on effect for a skilled workforce.
Public Consultation Submission
With the pandemic, there have been difficulties for nursing students to undertake placements which means that when they graduate they don't have the necessary skills. This has a flow-on effect for a skilled workforce.
Public Consultation Submission
Primary care is facing a workforce challenge in which there is a decreasing proportion of students choosing primary care. We're winding up with a highly specialised workforce and we will miss these key steps (helping to respond to social determinants of health) without a primary care workforce.
Public Consultation Submission
[We need] education and training approaches that help ensure that health professionals can optimise and possibly grow their scope of practice.
Public Consultation Submission
Transformative change should be influenced by a national health workforce plan aimed at ensuring that all people, in all places, have access to a skilled cancer health worker who is equipped, motivated, and supported.
Public Consultation Submission

Stakeholder input

Stakeholders identified the need for a coordinated and national approach to cancer workforce planning that optimises workforce capability and capacity in care across the cancer control continuum. This approach should span both the healthcare services and cancer research sectors. It should also address retention strategies and workforce wellbeing, and support education and training opportunities for all health professionals involved in cancer care.

The need to establish accredited training pathways, particularly for capability gaps including palliative care, genomic testing, personalised medicine, and cancer survivorship was identified. Providing greater support for the existing cancer care workforce would ensure that these healthcare professionals can work at the top of their scope of practice.

The cancer care workforce needs to better reflect the diversity of all priority population groups.

Aboriginal and Torres Strait Islander people
People Living in Rural and Remote Areas
Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, and Asexual (LGBTIQA+) People
People from Culturally and Linguistically Diverse (CALD) Backgrounds
People living with Disability
People in Lower Socioeconomic Groups
People Living with a Mental Illness
Older Australians
Adolescents and Young Adults
Children

Stakeholders emphasised that health professionals providing cancer care to Aboriginal and Torres Strait Islander people need to be trauma-aware, healing-informed and culturally safe and responsive, to ensure that the delivery of cancer care meets the needs of Aboriginal and Torres Strait Islander people.

There should be greater integration of cancer care services with care provided by Aboriginal Community Controlled Health Services and other Aboriginal and Torres Strait Islander health bodies.

In terms of the Aboriginal and Torres Strait Islander workforce, the number of Aboriginal and Torres Strait Islander people working in cancer care should be increased through a focus on recruitment, retention, and building capability.

Stakeholders noted that there needs to be greater recognition of the existing Aboriginal and Torres Strait Islander workforce, including recognising their strengths and the role they play in cancer care.

Aboriginal and Torres Strait Islander people

Stakeholders emphasised that health professionals providing cancer care to Aboriginal and Torres Strait Islander people need to be trauma-aware, healing-informed and culturally safe and responsive, to ensure that the delivery of cancer care meets the needs of Aboriginal and Torres Strait Islander people.

There should be greater integration of cancer care services with care provided by Aboriginal Community Controlled Health Services and other Aboriginal and Torres Strait Islander health bodies.

In terms of the Aboriginal and Torres Strait Islander workforce, the number of Aboriginal and Torres Strait Islander people working in cancer care should be increased through a focus on recruitment, retention, and building capability.

Stakeholders noted that there needs to be greater recognition of the existing Aboriginal and Torres Strait Islander workforce, including recognising their strengths and the role they play in cancer care.

People Living in Rural and Remote Areas

Stakeholders emphasised that, compared to metropolitan locations, there are limited health professionals in rural and remote Australia, including specialists, primary care providers and nurses. The limited access to health services in rural and remote areas can act as a barrier to rural and remote Australians accessing timely and appropriate cancer care.

Investment in training, recruitment, and retention of the rural and remote workforce would increase the number of accessible cancer care services delivered in these areas.

In addition, increasing telehealth services was seen as an opportunity to increase accessible cancer care to this priority population group.

Cancer survivors in rural and remote areas can feel isolated, fearful, and disconnected from services when they return home from having treatment in urban centres.

Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, and Asexual (LGBTIQA+) People

Stakeholders identified the need for the cancer care workforce to better understand diagnostic and treatment needs of LGBTIQA+ people. Improved understanding of the needs of LGBTIQA+ people could reduce misinformation around screening participation (such as cervical screening for transgender people), stigma, and discrimination. Implementing regular LGBTIQA+ inclusion and diversity training for cancer care professionals would help to reduce such barriers and discrimination towards LGBTIQA+ people.

People from Culturally and Linguistically Diverse (CALD) Backgrounds

Stakeholders indicated that the cancer care workforce should reflect the cultural diversity of the cancer patient population. A culturally diverse cancer care workforce would allow for the delivery of culturally appropriate cancer care and the ability to improve communication with people with diverse backgrounds.

There are opportunities to partner with community-based organisations to train the workforce in cross-cultural communication and cultural safety. Such training would ensure that the cancer care workforce delivers culturally appropriate cancer care to patients with diverse backgrounds.

People living with Disability

Stakeholders emphasised the importance of the cancer care workforce involving people living with disability in conversations about their cancer care, to strengthen patient-centred cancer care and informed decision making.

Opportunities exist to upskill the cancer care workforce to ensure that health professionals understand the needs of people living with disability, such as disability awareness training.

People in Lower Socioeconomic Groups

Stakeholders stated that health literacy can be poorer for those in lower socioeconomic groups. As a result of poorer health literacy, people in lower socioeconomic groups may face challenges in communicating with healthcare providers and understanding their healthcare needs.

Opportunities exist to upskill the current cancer care workforce in complex communication skills, such as communicating with people who have poorer health literacy. In doing so, people in lower socioeconomic groups will face fewer challenges navigating their healthcare.

People Living with a Mental Illness

Stakeholders raised that having a cancer diagnosis while living with a mental illness can create added complexity that needs to be addressed within the health system. Significant challenges occur when the behaviours, thoughts, or feelings of a person with a mental illness overshadow the care being provided by healthcare providers.

Education and training for the cancer care workforce should include improved understanding of the additional cancer risk for, and challenges faced by, people living with a mental illness.

Older Australians

Stakeholders reported that age discrimination can be a barrier to receiving cancer care and to participating in research and clinical trials. Training to eliminate such age discrimination should be undertaken by all healthcare providers.

Nurses are playing an increasingly critical role in the age-related needs of older people with cancer. Increasing skills and competencies of the cancer and aged care workforce is needed to help meet the needs of the increasing number of older Australians with cancer.

Geriatricians should be included in the multidisciplinary care of older people with cancer given the complexities that need to be managed. Professional development opportunities in geriatric oncology should be promoted.

Adolescents and Young Adults

Adolescents and young adults may not feel directly involved in decision-making regarding their cancer care. Improving the skills of the cancer care workforce to communicate directly with adolescent and young adult cancer patients would support shared decision-making on cancer care and end-of-life choices.

Access to clinical trials needs a cultural shift, as trials and funding tend to only be available in adult or paediatric settings.

Children

The health workforce needs to be culturally competent in caring for children with cancer and their families. Increased training and awareness for cancer care practitioners working with children will assist health professionals to understand the importance of social support during a child’s cancer care.

Workforce planning for childhood cancer care needs to be improved to match workforce planning initiatives in adult cancer care.

The lack of funding in dedicated childhood cancer research was noted. This can impact the number of clinicians and medical scientists who might consider entering paediatric cancer research.

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