Progress with Implementation of the National Radiotherapy Advisory Group recommendations: A Society of Radiographers perspective Charlotte Beardmore and Sarah James Professional Officers for Radiotherapy RIP5 Sheffield Hallam University 9-10 October 2010

Overview to presentation BackgroundBackground National Radiotherapy Advisory Group recommendationsNational Radiotherapy Advisory Group recommendations National Radiotherapy implementation GroupNational Radiotherapy implementation Group Progress to dateProgress to date Ongoing workOngoing work QuestionsQuestions

Background 1990’s Calman –Hine report – – centralisation of RT services Increasing use of Chemotherapy Radiotherapy would decrease in its effectiveness in treatment of cancer Investment decreased in Radiotherapy apart from “almost emergency” central funding for Linac equipment – –Funded via New Opportunities Fund – 2000 replacement equipment

DH National Radiotherapy Advisory Group (NRAG) - England Formed 2004Formed 2004 Asked to advise Ministers on:Asked to advise Ministers on: –the current position of radiotherapy services in England; –how to ensure current resources are deployed to best effect; –how to plan for a world class service in the longer term.

Capacity

Capacity Radiotherapy Access NRAG report International practice =52% access

Capacity % of Patients Treated within 4 Weeks Maximum = 100% Median = 36%Minimum = 6% (Data received from 22 centres, Source: RCR Audit of Waiting Times 2005)

Overview to presentation BackgroundBackground National Radiotherapy Advisory Group recommendations (NRAG)National Radiotherapy Advisory Group recommendations (NRAG) National Radiotherapy implementation Group (NRIG)National Radiotherapy implementation Group (NRIG) Progress to dateProgress to date Ongoing workOngoing work QuestionsQuestions

2007 NRAG – Key points “The need for radiotherapy was underestimated in the past Demand is set to grow over the next ten years There is currently a 2.5 fold variation in radiotherapy activity between cancer networks which cannot be attributed to differences in levels of need On average 30,000 fractions are currently being delivered per million population, with a range of 17,000 to 48,000 fractions per million between networks By 2016 it is estimated that there will be a need for around 54, 000 fractions per million population requiring more staff and linear accelerators The NHS needs to make best use of existing staff and equipment. Across a radiotherapy department an average output of 8,000 fractions per linac per annum should be achievable immediately working towards at least 8700 fractions by 2016 There is a clear need to collect better data on radiotherapy activity.” Cancer Reform Strategy

Tim Cooper, 2010 NRAG Report Deliver 40,000 fractions per mil pop by 2010; and (around) 54,000 fractions by 2016 Deliver 8,300 fractions perLinacby 2010/11; 8,700 perLinacby days wait time standard achieved by December 2010 Robust capital replacement programmes in place. All new & replacement machines capable of image guided IGRT National data collection is fed back to stakeholders at agreed intervals. Development of a workforce strategy that will deliver the required skills mix Implementation of the 4 tier model. Fast track career progression. A business case for a modern proton treatment facility in England Centres offer full service where operate weekends & Bank Holidays Extended days on 50% of machines Set throughput/ efficiency benchmarks. National overview of plans maintained.

Cancer Reform Strategy,

Overview to presentation BackgroundBackground National Radiotherapy Advisory Group recommendations National Radiotherapy Advisory Group recommendations National Radiotherapy implementation Group -2007/8National Radiotherapy implementation Group -2007/8 Progress to dateProgress to date Ongoing workOngoing work QuestionsQuestions

National Radiotherapy Implementation Group 2007 Oversight group - provide co-ordination & support – identify gaps Chair Michael Williams Key person: Tim Cooper, Associate Director for Radiotherapy NCAT, NHS NCAT report to Sir Mike Richards, National Cancer Director Professional bodies, User representatives, Clinical Experts, Commissioners, Cancer Networks, HPA……… Expert subgroups – membership wide NRIG response to Cancer Reform Refresh 24 September 2010

Tim Cooper, 2010 Associated Director,- Radiotherapy NCAT

Overview to presentation BackgroundBackground National Radiotherapy Advisory Group recommendationsNational Radiotherapy Advisory Group recommendations National Radiotherapy implementation GroupNational Radiotherapy implementation Group Progress to dateProgress to date Ongoing workOngoing work QuestionsQuestions

NRIG subgroups – experts from the service Radiotherapy Clinical Information GroupRadiotherapy Clinical Information Group Workforce & subgroupsWorkforce & subgroups TechnologyTechnology –IMRT –Stereotactic –Protons Raising the profile of RadiotherapyRaising the profile of Radiotherapy –Plus TariffTariff R-PORTR-PORT Peer ReviewPeer Review Technology IMRT IGRT Adaptive Stereotactic clinical guidelines Tariff Workforce National Radiotherapy Awareness Radiotherapy Clinical Information Group Protons

Radiotherapy Clinical Information Group Service DeliveryService Delivery Radiotherapy Data Set (RTDS) – update of returnsRadiotherapy Data Set (RTDS) – update of returns RTDS –analysis and micro site reportingRTDS –analysis and micro site reporting Information Flows and Cancer Data – updateInformation Flows and Cancer Data – update R-PORTR-PORT Cancer Waiting TimesCancer Waiting Times Key metric: 31 day accessKey metric: 31 day access CommissioningCommissioning Missing Patients Modelling / Capacity PlanningMissing Patients Modelling / Capacity Planning Radiotherapy Commissioning ExemplarsRadiotherapy Commissioning Exemplars Training to support radiotherapy leaders in commissioning and information analysisTraining to support radiotherapy leaders in commissioning and information analysis Process and PerformanceProcess and Performance Peer ReviewPeer Review

Service delivery Capacity and access Progress with the 31 day target “Reported performance on radiotherapy has generally been close to the 94% operational standard but this is not considered to be an accurate reflection of where we actually stand. Estimated data completeness is improving but is yet to consistently top 80%”. “Latest reported national performance (June) is 91.6% with 82.3% data completeness".

Service delivery : Capacity and access Increasing An increase An increase –Smarter working ? –Implementation New technologies – Quality +++ –Geographical access »But where? Relatively constant

National Cancer Action Team

Service delivery : Workforce Reconvened NRAG workforce subgroup (Jane Barrett chair) Radiotherapy Physics - Modernising Scientific Careers Developing Solutions Dosimetrists - secured funding to support national early implementation training programme.Sept intake. Radiography Workforce HEI & operational managers – 25 th Sept 09 - Developing the radiotherapy workforce 23 rd March 10 - Building on success – 4 tier structure - publishing the learning from the pilot sites VERTnow in 40 clinical centres & HEIs Joint thinking – bringing the workstreams together “again” 2011

Implementation of the career progression framework “ For example, on average 20% of radiotherapy practice is complex and requires the higher level skills of the Clinical Oncologist, the remaining 80% of practice could be managed by non medical advanced/consultant practitioners who have the necessary knowledge and skills and are based entirely within the radiotherapy centre” NRAG- A report from the National radiotherapy Advisory Group – Workforce Subgroup, to NRAG Radiotherapy : Developing a world class service for England, February 2007

Service delivery : Technology National IMRT programmeNational IMRT programme 14 centres deliver a “substantial “amount of IMRT14 centres deliver a “substantial “amount of IMRT NRAG expectationNRAG expectation –30% all radical fractions –Consistent with international best practice –97% of Linacs are IMRT capable

Service delivery :Technology National Training Programme –Goal Minimum standard -at least one centre in each of the 28 cancer networksMinimum standard -at least one centre in each of the 28 cancer networks Train professionals within their centresTrain professionals within their centres Their equipmentTheir equipment Their patientsTheir patients Sustainability keySustainability key –Tender for bid to offer training –add date Awarded to 3 providersAwarded to 3 providers Covers Linacs and Radiotherapy planningCovers Linacs and Radiotherapy planning 3 centres have started3 centres have started DH e learning project for IMRT – ongoing funding approved 8 October 2010DH e learning project for IMRT – ongoing funding approved 8 October 2010 –Completion March 2011

Technology – special edition of Clinical Oncology Radiotherapy Development Board (Professional body led) UK survey (Professional body led) UK survey Review of Clinical Evidence Education and training IMRT planning and delivery process Volume 22, Issue 8, Pages (October 2010) The Technical Aspects of Radiotherapy Edited by Philip Mayles

Technology IGRTIGRT – % centres have one unit IGRT capable –SoR Guidelines – April 2011 –Programme for implementation essential

Service delivery : Technology Stereotactic Body RadiotherapyStereotactic Body Radiotherapy –NCAT developing guidance – multiprofessional team –Report to NRIG end Introduction 2.Clinical Reviews of Evidence for SBRT 3.SBRT- Physics and Quality Assurance 4.SBRT- Equipment appraised 5.SBRT-Commissioning Guide/Workforce Issues 6.Strategy for Implementation of SBRT

Service Delivery E stro T eaching C ourses 2010 New CoursesE stro T eaching C ourses 2010 New Courses September ›› September ›› 2010 Zurich, SwitzerlandZurich, Switzerland Protons –Framework for overseas treatment –Announcement 4 October 2010 UK proton centre/s –Investment from the government –Business cases from selected partners Kate Burton Consultant Radiographer- Neuro Oncology

Overview to presentation BackgroundBackground National Radiotherapy Advisory Group recommendationsNational Radiotherapy Advisory Group recommendations National Radiotherapy implementation GroupNational Radiotherapy implementation Group Progress to dateProgress to date Ongoing workOngoing work QuestionsQuestions

Tim Cooper, 2010 Associated Director,- Radiotherapy NCAT

24 September 2010

Radiotherapy Radiotherapy cures cancer and we need sufficient resource to deliver it: Radiotherapy is more targeted than chemotherapy and less invasive than surgery: as it is a more directed form of treatment than chemotherapy there are fewer side effects on the rest of the body; radiotherapy is a highly effective local treatment which can spare patients from radical surgery. Radiotherapy is the most cost effective way of treating cancer: radiotherapy Radiotherapy is cutting edge (‘innovation-led’)

` Thank you for listening Charlotte Beardmore Sarah James Professional Officers for Radiotherapy For publications For further information