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What is Radiotherapy?

Radiotherapy means the use of radiation, usually X-rays, to treat illness. Radiotherapy is an important part of overall cancer management and treatment and can be used on its own or in combination with other types of cancer treatment (including surgery and chemotherapy). Referral for radiotherapy treatment is made by a Consultant Clinical Oncologist who is a member of a tumour specific multi-disciplinary team. Most radiotherapy treatment is delivered on an outpatient basis.

 The Cancer Research UK website notes that radiotherapy destroys the cancer cells in the treated area by damaging the DNA within these cells. Although normal cells are also affected by radiation, they are better at repairing themselves than the cancer cells. The treatment aims to give a high dose to the cancer but as low a dose as possible to the surrounding healthy cells. This aims to give the highest chance of curing or shrinking the cancer while reducing the risk of side effects.


NHS England’s Radiotherapy Dataset shows that there were 103,348 radiotherapy episodes in England in 2020, a reduction of 9.3% from 113,851 in 2019.[1] In the first five months of 2021, the number of episodes was 12.4% lower than the equivalent period in 2019. In the most recent month of data (May 2021), activity was 9% below pre-pandemic levels. Data for later months is not yet available.

Most waiting times statistics for cancer are recorded for all types of treatment together, rather than for radiotherapy specifically. The percentage of patients waiting longer than the target time for cancer treatments has recently reached record levels. You can read a summary of this data in the Library briefing paper NHS Key Statistics.

Policies and guidance

The independent cancer taskforce’s five-year strategy for cancer, Achieving World-Class Cancer Outcomes: A Strategy for England 2015- 2020 (PDF, 4.9MB) noted the advances that have been made in radiotherapy technology have not always been consistently adopted across the NHS.

Advances in radiotherapy using cutting-edge imaging and computing technology have helped target radiation doses more precisely. As a result, they enable better outcomes, with improved quality of life for patients and reduced NHS costs in the long term, through patients suffering fewer side effects. Historically the NHS has not adopted new techniques into clinical practice in a consistent and equitable way across England. In 2014, NHS England and Cancer Research UK jointly published a Vision for Radiotherapy. This recommended that all patients should receive advanced and innovative radiotherapy that had been shown to be clinically and cost effective.[2]

The NHS Long Term Plan (January 2019) included a commitment to modernising radiotherapy services. The plan specifically promised “faster, smarter and effective radiotherapy”, supported by greater networking of specialised expertise. The Long Term Plan also set out that changes would be made to the radiotherapy payment system to incentivise the adoption of evidence-based best practice care and enable the appropriate replacement of equipment.

NHS England’s radiotherapy modernisation programme began in 2016 with the aim of implementing a long-term solution to equipment replacement; and increasing access to innovative radiotherapy treatments and modern care. Part of the programme includes the commissioning of 11 Radiotherapy Operational Delivery Networks across England. This programme is aimed at improving access to and reducing variation in the quality of radiotherapy services.

NHS England Specialised Commissioning is the responsible commissioner for all radiotherapy services across England. The exact scope of NHS England’s commissioning responsibility is set out in the Manual for Prescribed Specialised Services. In October 2017, NHS England launched a consultation on a new clinical model for radiotherapy services across England. The outline proposals were detailed in a draft Service Specification which focused on the provision of External Beam Radiotherapy for adults and set out the clinical, service and quality standards in Radiotherapy providers. The draft Specification also described the core purpose, responsibilities and arrangements of Radiotherapy Networks. In January 2019 NHS England published its response to the radiotherapy consultation. This document provides a summary of the key themes identified in the consultation and identifies how responses have shaped the new service specification. In particular, the report outlined that there would be two Service Specifications, one detailing the service requirements that each individual radiotherapy provider must and should deliver; the other setting out the Radiotherapy Network requirements.

In the November 2020 Spending Review the Government announced £325 million of investment in NHS diagnostic equipment. As part of the Spending Review, £32 million was made available to support the replacement of 17 linear accelerators (LINACs) over 10 years old, with a commitment to deliver these by 31 March 2022. £160 million was also invested from 2016 to 2018 to enable the replacement or upgrade of over 80 LINACs. A PQ answered on 26 July stated that as of 31 March 2021, approximately 63 LINACs in routine NHS use were aged 10 years or more and that “approximately two thirds of these have a locally agreed replacement plan that is due to be implemented in 2021-22” .

In an answer to a parliamentary question on 30 June 2021 the Government outlined what it was doing to provide additional capacity in response to the cancer backlog following the covid-19 outbreak. This stated that, as part of the cancer priorities identified in the NHS Long Term Plan and People Plan, Health Education England will be training 450 reporting radiographers. The full text of the response can be seen below:

Health Education England (HEE) is continuing to take forward the cancer priorities identified in the NHS Long Term Plan and People Plan, including the training of 450 reporting radiographers.

Cancer patients will continue to be prioritised within the National Health Service and will benefit from approximately £1 billion from the Spending Review to tackle the elective backlog.

NHS England and NHS Improvement have also offered radiotherapy providers the opportunity of participating in a centrally funded three-year evaluation programme of a cloud-based information technology solution called ProKnow. This system will enable clinicians to collaborate virtually within and across services to plan treatments, undertake peer review processes and participate in large-scale audit and quality improvement processes. The Spending Review also made £32 million available to support the replacement of radiotherapy equipment in 2021-22 and work has already begun with trusts to identify need and allocate funds.[3]

During the Westminster Hall debate on the Covid-19 Lung Cancer Pathway also on 2 December 2020 the Minister referred to support for supporting providers to accelerate the delivery of stereotactic ablative body radiotherapy for non-small cell lung cancer and oligometastatic indications, starting with the treatment of non-small cell lung cancer.[4] There was also a debate on Covid-19: Access to Cancer Diagnosis and Treatment on 2 December 2020.[5]

The Library prepared a briefing pack for the debate on non-invasive precision cancer therapies, which took place on 18 July 2019. This debate focussed on radiotherapy services, and the Library briefing pack (CDP-2019-0197, 17 July 2019) covered policy developments, and NHS and Government statements in this area.

In 2018 the All-Party Parliamentary Group (APPG) on Radiotherapy produced a manifesto which called on the Government to increase its investment in radiotherapy and improve access to treatment.

In May 2021 the APPG for Radiotherapy, supported by the APPG for Cancer, published Catch Up With Cancer – The Way Forward (PDF, 3.7MB). This followed a consultation and summit “to investigate the scale of the Covid-induced cancer crisis”. Based on views from across the cancer community the report highlighted a range of solutions to dealing with the backlog of cancer treatment. In particular, the report identified the need for investment in cancer services and new ways of working, and for a national strategy.

In September 2021 the Scottish Government published Collaborative and Compassionate Cancer Care, a five-year strategy for children and young people in Scotland. The Quality Statement for Cancer sets out the Welsh Government’s five year plan to improve the quality of cancer services and outcomes in Wales (March 2021). The Department of Health in Northern Ireland has published a Cancer Strategy for Northern Ireland 2021-2031 (PDF, 11.1MB)

[1] The definition of an episode is as follows: “…a continuous period of care for radiotherapy including all preparation, planning and delivery of radiotherapy. If that continuous period of care crosses multiple months the treatment activity will be recorded in the month that episode began.”

[2]      Achieving World-Class Cancer Outcomes: A Strategy for England 2015- 2020 (2015) (PDF, 4.9MB)

[3]      PQ19571, Cancer: Waiting Lists, 30 June 2021

[4]      Hansard, 2 December 2020, cWH194

[5]      Hansard, 2 December 2020, cWH131-153

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