Written evidence submitted by the APPG for Radiotherapy (ICS0069)

The current system for the delivery, commissioning and planning of lifesaving radiotherapy cancer services is not fit for purpose. There is a chronic lack of understanding among ministers and healthcare leaders of this high-tech cancer treatment. As a result, the service is on its knees and is held back by unnecessary bureaucracy, and is monumentally underfunded. If decisions are taken to devolve budgetary, commissioning and delivery of radiotherapy services to Integrated Care Systems (ICS) without a radical new national vision the majority of ICS will be set up to fail when it comes to delivering cancer services for their local populations. We have deep concerns that without an appropriate re-evaluation of how radiotherapy equipment and technologies are funded, services will continue to be developed in isolation and UK cancer patients will not benefit from the advances other countries are currently implementing in this field.

Radiotherapy is a vital tool in our arsenal of cancer treatments, needed in 50% of cancer patients and involved in 40% of cures. Radiotherapy is also incredibly cost-effective.  Typically, the cost of a radiotherapy cure is between £4-£7k, a mere fraction of the costs of other cancer treatments, like surgery and chemotherapy. It is vital in early-stage cancer treatment, so as the country moved towards meeting its ambitions of diagnosing more cancers early, the demand will only increase. NHS planning guidance for 2023 states that cancer treatment capacity needs to increase by 13%, and this will include radiotherapy. There has been a technology revolution in radiotherapy that allows for more precise and curative cancer treatments, and IT that boosts the capacity of the workforce to cure more patients. If ever there was a moment to invest and plan for better access to modern, world-class radiotherapy, it is now. However, despite the benefits of radiotherapy and the clear need for more, it is not well understood by NHS leaders and commissioners. It is currently only available to 24-27% of patients despite international standards being that 53 – 56% should have access.

We understand that under current plans radiotherapy is being considered within the “Roadmap for integrating specialised services within Integrated Care Systems” as one of the services that may have commissioning responsibilities handed over to Integrated Care Boards (ICBs). In 2022/23, NHS England is expected to complete a capacity and demand review of external beam radiotherapy capacity. To date we have no knowledge of any significant attempts to involve or consult the radiotherapy professionals, industry or, through no lack of effort on our part, the All-Party Parliamentary Group for Radiotherapy. 

We urge the committee to consider the below points when evaluating the appropriateness of plans to devolve planning and funding of radiotherapy to ICBs:

• The existing funding and approval systems in place for radiotherapy cancer services are not fit for purpose.  Cancer patients in England have missed out on the technological revolution that has occurred in other countries. There are 272 radiotherapy treatment machines (LINACs) in use in England. 55 (20%) of those are over the 10 year recommended lifespan and will need replacing by the end of 2023, and that is still 125 short of the number needed to meet international standards for machines per head of population.
• The most effective way to address this growing gap in radiotherapy equipment is with a central rolling programme for machine replacements so ICS’s have access to innovative radiotherapy. This needs to be accompanied by new central funding for ‘off the shelf’ IT technologies that can speed up and manage workflow, remote working, quality assurance, and peer review thus increasing capacity and improving outcomes. Radiotherapy machines are expensive (approx. £2M each) which can make them hard to plan for with overstretched local budgets, but the benefit of doing so is huge. Radiotherapy machines treat thousands of patients and last ten years, so cost in the region of £400 a patient.

It is crucial that the ICS’s have oversight and governance of integrated care systems to deliver the urgent and radical action needed to improve radiotherapy services and cancer care. A radical national plan for cancer needs to be delivered by central government that delivers for cancer patients, with investment in vital MedTech services like radiotherapy, but it is also vital that local leadership, understanding and prioritisation is given to radiotherapy services. 

We have long highlighted the need for a radical new plan for radiotherapy to address the problems with the way the service is currently delivered. There is a very real risk that the lack of understanding of this vital cancer treatment may fail to tackle the current crisis we see as unfolding in radiotherapy and lead to the creation of a system that is worse, not better than we currently have.

We urge the committee to strongly consider the following points in any future recommendations made on this subject.

Jan 2023