National radiotherapy plan

National Radiotherapy Plan for Scotland

A national plan for Scotland's radiotherapy service, with a view to curing more cancers, increasing access to the most modern treatments and embedding access to clinical research trials across Scotland's cancer services.

Aim

This plan has been produced with the aim of improving radiotherapy services and patient outcomes across Scotland. Along with improving technologies and equipment, we aim to ensure equitable access to radiotherapy treatment options wherever a patient may live. These improvements are important especially while the risk to COVID-19 persists and cancer patients are consistently prioritised.

1. National Radiotherapy Data-Set Training

We will ensure all radiotherapy staff who need to be are equipped with appropriate training to assure common understanding of new data systems and gain greater understanding of current services across the health workforce. This will ensure centres across Scotland can consistently monitor the delivery of their service and benchmark across Scotland and the rest of the UK.

2. Clinical Trials

Working alongside the Clinical Trials Resilience Group, we will look at and seek to overcome workforce barriers that may impact potential start up and access to clinical trials. Beyond that, we will regularly review the landscape with the aim of increasing radiotherapy trial participation in all 5 centres. This will lead to evidence-based service change, resulting in best outcomes for patients.

3. MRI in Radiotherapy

With clinical applicability already evidenced, and national service funding confirmed, this new technology will require new appropriate workforce with specialist training. The National Radiotherapy Programme Board will actively support developing the business case for revenue funding to support delivery of this service.

4. SABR for Oligometastatic Disease

This specialist service is currently minimally available in 3 of our 5 cancer centres. With national funding of up to £1.7 million we will develop sustainability for the service and support the development of a national framework around most appropriate management. Representatives from each centre will join a working group to oversee the delivery and implementation of the programme. This will ensure all patients have equitable access to treatment and build expertise across all cancer centres.

5. Optimising Workforce

To ensure continuity of current service delivery, in particular specialist services, we will need to begin using our workforce differently especially in centres where individual practitioners are operating on their own in a given tumour area(s). We will explore the potential of technology, for example AI for segmentation, to optimise efficiency. We will protect and aim to increase training numbers throughout Scotland across all RT disciplines. We will encourage practitioners to work across centres where feasible and increase the use of a skills mix approach to support service delivery. We will support and share best practice in managing RT services in context of COVID-19 requirements.

6. Patient Experience

With 'Near Me' technology replacing some face-to-face consultations for the foreseeable future, we will ensure a consistent approach is taken across Scotland with regards to consent requirements (in line with Ionising Radiation (Medical Exposure) Regulations), along with the aim of ensuring a positive experience of care for the patient. We will undertake work to further understand patient experience, including through a possible redeployment of the National Radiotherapy Patient Experience survey.

7. Brachytherapy

We will monitor existing services, identify any challenges, and collaborate nationally to ensure equitable access to this specialist treatment.

8. Peer Review

COVID-19 has seen some changes in peer review, with technologies enabling remote review. The Programme Board will work on a unified approach across Health Boards, and develop recommendations to continue progression, considering the implications for clinical time.

9. Recovery Data

We will regularly review the demand and capacity data for radiotherapy through the Radiotherapy Programme Board to identify and inform any risks to delivery, drive collaboration and inform workforce requirements.

10. RTDS

We will coordinate feed into the Radiotherapy Data Set with the Scottish Cancer Registry and Intelligence Service to enhance the Scottish Cancer Registry, promote national consistency, improve data quality, and increase utilisation of a national RT dataset.

11. NSS Cross Border Referrals

We will monitor which patients are being referred out-with Scotland for highly specialist services, to assess if any of these patients could have been treated within Scotland. We will work with NSS to ensure patients are being treated as close to home as possible.

12. Protons

Working with NSS, we will assess current evidence on use of photons vs proton beam and develop a long-term view of patient access in Scotland.

13. Common Protocols

We will identify opportunities to develop and agree common treatment protocols, including around hypofractionation and adaptive RT. We will agree common approaches to hypofractionation, ensuring all delivery is based on best evidence, and all patients receive the optimal treatment.

Milestones and Progress Monitoring

Tracking progress of the key actions within the National Radiotherapy Plan for Scotland will be key and help ensure continued development across all services. Where applicable, the below displays initial expected timelines for the completion of relevant actions. While some of the actions will already be underway, some will be completed beyond the timeframe of the National Cancer Plan (March 23).