National radiotherapy plan

Introduction

In December 2020, The Scottish Government published the National Cancer Plan 'Recovery and Redesign: an action plan for cancer services'. The plan includes an investment of up to £114.5 million until March 2023. Within the National Cancer Plan, the following action was committed:

Action 38 - We will work with the Scottish radiotherapy community to develop a national plan for the Scotland's radiotherapy service, with a view to curing more cancers, and increasing access to the most modern treatments. The plan will also seek to embed access to clinical research trials across all centres.

In May 2021, the National Radiotherapy Programme Board (RTPB) was convened with the intention of aiding the development of a National Radiotherapy Plan for Scotland. The programme board was formed with a wide range of key stakeholders from across all cancer centres and included a wide range of professionals, from clinical oncologists, radiographers and physicists to researchers and regional leads.

Along with driving the development of a national RT plan, the Programme Board was tasked with monitoring and delivering the actions contained within the National Cancer Plan and acting as a forum for national escalation from local & regional levels. The plan will be monitored by the RTPB and reported against to the National Cancer Recovery Group on a regular basis.

With the RTPB established, the development of this plan began in Summer 2021. Subsequently the plan underwent an extensive consultation process with the wider Radiotherapy community.

This plan will drive positive innovations, accounting for the new environment in which our services must operate, while seeking to introduce a range of new areas of development for our radiotherapy services. The actions aim to both ensure Scotland remains at the forefront of treatment quality for patients and increase our services' overall resilience to future challenges. Our actions will focus on infrastructure, research, patient experience and workforce in order to enhance the quality and availability of radiotherapy for every patient in Scotland.

COVID-19

Since March 2020, the COVID-19 pandemic has placed an unprecedented demand on NHS Scotland and all those working in our health services. The Scottish Government has recognised this by ensuring that cancer services have been prioritised throughout the pandemic, and with changes to clinical guidance, safe delivery of treatment and our wider hospital environments. These are just some of the necessary mitigations we have put in place to address emerging risks and allow continued delivery of services within Scotland. However, the challenges we have faced, and will continue to face, require a collective approach to improve and adapt our services.

Radiotherapy in Scotland

Radiotherapy is currently delivered across each of Scotland's five centres and one satellite site. All sites are equipped with state-of-the-art Radiotherapy equipment and deliver treatments in line with modern international clinical standards. Intensity-modulated radiation therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) are standard techniques for the majority of cancers alongside Image Guided Radiotherapy and Adaptive Radiotherapy in certain, appropriately selected cancers. Modern Brachytherapy is available in 4 of the 5 centres. This therapy is used mainly for Gynaecological cancers but also for Prostate cancer, both low and high-dose rate.

Over the past few years, stereotactic ablative radiotherapy (SABR) has become established as a standard method of treatment for appropriately selected lung cancer patients and some other cancer types. As its use for certain patients with metastatic disease is becoming more frequent, the Scottish Government has committed up to £1.5 million funding under the National Cancer Plan to improve access to this therapy and ensure equity of access across the country.

We have a £45 million rolling programme of ring-fenced capital funding for replacing Radiotherapy equipment, which is unique in UK and reflects our commitment to providing the best treatment for our patients.

Over the next couple of years, MRI will be introduced as part of imaging for radiotherapy planning, with Glasgow poised to begin in early 2022.

Isotope treatments such as radioactive Iodine, Radium 223, Lutetium, and MIBG are available across Scotland. However, due to the very specialised nature of some of the treatments, these are delivered on specialist sites. These treatment options continue to grow with a view to increasing their availability to all patients.

While it is an encouraging landscape in Scotland, with several pioneering initiatives and a willingness to incorporate new technologies, there is further progress that can be made. The development and implementation of the National Radiotherapy Plan for Scotland is another step in maintaining and improving these services across the whole country.