Referral and Activity in Specialist Psycho-Oncology Services: A Survey of Provision in England and Scotland.

Abstract

Distress is a common, clinically significant response to cancer, yet specialist psycho-oncology provision varies across the UK, and national service-level data on staffing, access and activity are lacking. To provide an updated picture of referral, access, workforce and activity of specialist psycho-oncology services across the UK. A cross-sectional service survey distributed UK-wide via professional networks used an 18-item questionnaire capturing staffing, referrals, waiting times, activity and outcome measures for 2022/2023. Activity was expressed per specialist whole-time equivalent (WTE); reporting followed STROBE. Twenty-five psychology-led NHS psycho-oncology services participated, all in England and Scotland. All had Level 4 provision but only 40% had Level 3. Each WTE served a mean of 1530 new cancer diagnoses, saw 83 new patients and delivered 446 attended appointments (mean 7 sessions per patient). 8.4% of patients were referred for specialist support, below the ∼25% estimated to need it. Eighty-three percent of services judged their referrals to under-represent need. Mean waits were 21 days (urgent) and 3.4 months (routine); services without a dedicated senior leadership post tended to wait longer (median routine 4 vs. 3 months; urgent 30 vs. 10 days). Specialist psycho-oncology services in England and Scotland are understaffed, with long waits and inequitable access, even among psychology-led services. Senior leadership may support shorter waits but must be matched by balanced staffing across Levels 3 and 4. Workforce investment, inclusive referral pathways, a cancer-specific psychological wellbeing measure, and embedding specialist support where it is absent are needed to deliver equitable care.