Though NHS England plans to redesign radiotherapy services to improve access to cancer patients, it still needs to address several roadblocks such as lack of resources and workforce shortages, points out Emlyn Samuel

Late last year, NHS England launched a consultation on redesigning radiotherapy services. This was a welcome step towards developing a truly modern service for the 120,000 cancer patients that have this treatment each year.

But in some areas of the country the proposals have been misunderstood, leading to concerns that radiotherapy centres will be closed as a result. This is not the case, but it highlights how important it is that the NHS gets this redesign right, and works closely with patients along the way.

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The focus of the redesign is improving access to modern radiotherapy techniques, such as Intensity Modulated Radiotherapy. IMRT reduces side effects by sparing healthy tissue and provides the chance of a cure for many patients.

Around half of the people receiving curative radiotherapy would benefit from IMRT. However, while access has improved, patients still miss out and there’s wide variation across England. Some centres treat just 23 per cent of their radiotherapy patients with IMRT, whereas others nearly 70 per cent.

The 52 radiotherapy centres in England currently operate separately from each other. This has created a situation where too many centres try to provide all types of treatment – from standard to highly specialised types – affecting the quality of radiotherapy given to some patients. Ultimately, this way of working has driven the variation we are still seeing.

In a service with deficiencies in staff numbers and equipment, the NHS needs to be smarter about how to provide the best quality treatment to patients. While the recent £130m investment in new linear accelerators will go a long way to providing a truly modern radiotherapy service, it won’t solve all the issues. So reforms to the way radiotherapy is delivered is the necessary next step.

Next steps

NHS England’s proposals aim to organise the 52 centres into 13 Radiotherapy Networks, which will plan and deliver services across their patch, making the best use of available resources.

Part of this change involves minimum volume requirements to ensure that those patients needing specialist types of treatment – such as those with rarer cancers – are treated in centres with the necessary skills and equipment. This will then free up other centres to provide top quality radiotherapy for the many patients that will need more standard treatment.

NHS England’s proposals aim to organise the 52 centres into 13 Radiotherapy Networks, which will plan and deliver services across their patch, making the best use of available resources

The principles and ambitions are sound, and it’s very much in line with what we called for in the 2014 Vision for Radiotherapy: a networked approach, focusing on spreading best practice and reducing variation in access to modern treatments.

While the changes will mean a small number of patients need to travel further, they will receive better treatment when they do. So, we must ensure all patients get the support they need to access the right treatment for them, wherever that may be.

Concerns

But there are a few areas that must be addressed for this redesign to work. Our major concern is that these changes are not being backed up with the proper resources needed.

For example, there are significant practical issues. Many centres each have different IT software that can’t always talk to each other. How can centres effectively collaborate across a network to plan and deliver treatment without being able to share information?

While NHS England has invested in upgrading radiotherapy machines, there has been no money for a parallel upgrade in the IT infrastructure. If NHS England is serious about this new model, it must find a way of ensuring the right IT infrastructure is in place to support it.

Workforce shortages are also a key factor. Our recent report Full Team Ahead highlighted that shortages in radiotherapy staff are having a direct impact on patient care. This is an issue also being seen in other services important in cancer care, such as diagnostics.

As called for in the latest cancer strategy, the NHS needs to create a rolling programme of upgrades and replacements – and this must include IT

Networking may help alleviate some of the pressure associated with staff shortages, and help develop new ways of working, but it won’t solve this underlying issue. So Health Education England must focus on filling skills gaps it has identified in its recent cancer workforce plan.  

In the longer term, there’s still a need for a more sustainable solution to keeping radiotherapy up to date, rather than a recurring situation where a substantial cash injection is desperately needed to replace outdated machines.

As called for in the latest cancer strategy, the NHS needs to create a rolling programme of upgrades and replacements – and this must include IT. The national tariff should also be reviewed in this context, so it can better support adoption of innovation, and incentivise centres to work together.

Finally, there is a lesson from the coverage these changes have received in some areas of the country. Service changes are always meaningful to patients, but especially when the treatment involves multiple trips to a hospital, as is often the case with radiotherapy.

When the new Radiotherapy Networks are planning their services, it’s vital that they involve patients in those decisions. They must ensure every patient is supported to access treatment – whether that’s near or far. These changes are good for patients – but only if done properly and with patients’ best interests at heart.