The Department of Health must work closer with universities if the aims of its new cancer plan are to be achieved.

The plan places great emphasis on the benefits of radiotherapy as the second most effective treatment after surgery, and commits an additional£100m to the discipline. This move is expected to increase the quality and quantity of radiotherapy treatment for cancer patients in the coming years.

Yet the strategy neglects to take into account one of the major barriers to expanding radiotherapy treatment, namely that radiotherapy does not attract enough high-quality students to train in the profession.

For example, the diagnostic radiography course at City University in London attracts around eight applicants for every place each year, whereas the therapeutic course attracts fewer than three applicants per place, despite the course being half the size.

These courses tend not to be filled by applicants whose first choice is to study radiotherapy, meaning unsuitable applicants, as well as second and third choice applicants, also become contenders for the available places.

Consequently, radiotherapy courses recruit a large proportion of their students through the UCAS clearing process. Many of these students will have failed to get on their preferred university course, selecting radiotherapy training as their "back-up" plan.

Too many drop-outs

Some of these students have no intention of remaining on the course for the full three years. Instead, they plan to complete the first year only and use this training as a "stepping-stone" onto their original preferred course. This creates a high drop-out rate and wastes radiotherapy training resources. In 2006, the student drop-out rate, across the UK, was found to be as high as 39 per cent by the National Radiotherapy Advisory Group workforce subgroup report.

This problem is exacerbated by the changing student profile. Mature students account for a larger proportion of trainee radiotherapists than ever before. Typically, mature students require more university support services, but for many, access is severely limited due to the distance of clinical sites from the university.

The invisible profession

A major reason why radiotherapy fails to recruit enough students is its public image, or rather its lack of public image, particularly among school leavers - the age group we should be recruiting into the profession. Attempts have been made to raise the profile of the profession, but so far none have had success.

Media coverage often fails to mention therapeutic radiographers. In 2007, a newspaper ran a large feature detailing the different professions that contributed to a woman's treatment for breast cancer. It identified various specialist nurses and doctors, but not a therapeutic radiographer. This was despite the fact that the article said the woman received radiotherapy.

Even recent television adverts broadcast with the specific purpose of raising the profile of careers in the NHS failed to separate out therapeutic radiography from diagnostic radiography.

The onus is now on the government to overcome this image problem. Strategies must focus on a national awareness-raising campaign, specifically targeted at young adults and children. Without this, radiotherapy will continue to be an "invisible profession" among the public and the nationwide shortage of people wanting to do radiotherapy will remain high.

Relieving placement pressures

While the government's cancer plan highlights the importance of enhancing quality and quantity in the profession, it does nothing to relieve the pressures already impairing the standard of clinical placement training. Nor does it address the problem of shortages of clinical placements.

Radiotherapy education is based on a close partnership between universities and hospital clinical departments, with trainee radiotherapists relying on clinical placements for half of their training period. This merges together theory and practice and allows students to display clinical competence.However, other pressures exist for radiographers charged with training students. Treatment targets, the increasing complexity of treatment, and staff shortages all affect the quality of education that can be offered.

NHS budget cuts have seen a reduction in the number of clinical placements available over recent years, coupled with an increase in student contract numbers. Consequently, the clinical placement system is operating at, or near, capacity.

One possible solution that has been proposed to tackle this problem is to develop a small number of NHS clinical skills laboratories near universities that train radiographers. Currently, this has been proposed for three UK universities. This would introduce a two-tier training system, with a small number of universities offering students the advantage of specialist learning environments outside the clinical department.

Virtual training

A second solution is to increase the reliance on virtual environment radiotherapy training systems. The government has offered to install these in radiotherapy education centres. They are also being installed in some hospitals.

While it is doubtful that this technology could fully replace clinical training, it could reduce the placement length, enabling more students to obtain placements. The full extent to which it could do this is not yet known, as it is an untried system with very little evidence relating to its ability to train students to practitioner status. More funding is needed to maximise the benefit of this technology.

A third option is for the Department of Health and universities to work together with private hospitals to develop clinical placements in the private sector, as is common in diagnostic radiography training. Currently, private hospitals are draining NHS resources by tapping into its workforce. Generally, they are not willing to train students, particularly first-year students, where the placement issue is the worst.

Together, the government and the private sector could develop a mutually beneficial training package for therapeutic radiographers.