Organising Radiotherapy Services – what are the lessons from England

1. Organising Radiotherapy Services – what are the lessons from England Tim Cooper Associate Director – Radiotherapy National Cancer Action Team

3. Organising Radiotherapy Services – what are the lessons from England Tim Cooper Associate Director – Radiotherapy National Cancer Action Team

4. Vision Strategy

6. Workforce • Access • Capacity • Safety • Peer Review • Clinical Pathways • Clinical Trials and Research • New Technology Governance Service Delivery NRIG (NRAG / Cancer Reform Strategy) • Survivorship • Communication Skills • Leadership • Engagement • Contracting Framework • RTDS/RES • Tariff / HRG • Commissioning Toolkit Wider World Commissioning www.cancer.nhs.uk/radiotherapy

7. NRIG Subgroups NRIG - plus ‘press gang’ members • Workforce • Technology • Protons • Stereotactic • Radiotherapy Clinical Information Group • Raising the profile of radiotherapy Plus • Tariff (Costing and Coding groups) • R-PORT • Peer Review

8. Headlines • Relevant Key issues • Investment • Engagement • Leadership • Play to your strengths • Toolkits • Communication

9. Relevant Key Issues What does World Class look like?? • Access • Performance • Productivity • Workforce • Technology • IMRT • SBRT • IGRT

10. Workforce • Access • Capacity • Safety • Peer Review • Clinical Pathways • Clinical Trials and Research • New Technology Governance Service Delivery NRIG (NRAG / Cancer Reform Strategy) • Survivorship • Communication Skills • Leadership • Engagement • Contracting Framework • RTDS/RES • Tariff / HRG • Commissioning Toolkit Wider World Commissioning www.cancer.nhs.uk/radiotherapy

11. Relevant Key Issues What does World Class look like?? • Access • Performance • Productivity • Workforce • Technology • IMRT • SBRT • IGRT

12. Workforce Reconvened NRAG workforce subgroup (Jane Barrett chair) 4 tier structure - publishing the learning from the pilot sites HEI & operational managers – 25th Sept 09 - Developing the radiotherapy workforce –23rd March 10 - Building on success VERT now in 40 clinical centres Radiotherapy Physics - Modernising Scientific Careers - Meeting 5th March - Developing Solutions Dosimetrists - secured funding to support national early implementation training programme. Planned April intake.

13. Service Delivery Access 31 days - analysis of early returns - data completeness !! Process and pathways Capacity Network led planning in many areas ?? 25 satellites staged plans - ongoing work RTDS Missing patients Radiotherapy Site Visits National Purchasing Framework

14. IMRT • NRIG Technology Group – Chair Michael Williams. • IMRT at least one centre in each Network by 2012 • 30% of all fractions should be IMRT • Darzi Innovation Metric • Commissioner guidance • Generic business case • National Training programme • QA audit programme • Consensus document – publishing the evidence • Awarding training support contracts

15. Stereotactic • SBRT • Intracranial already done • Focus on Technique • Define Technology • National Specification to NRIG by end 2010 • Indications and body sites H&N; Lung; Liver; Pancreas; Kidney; Spine; Prostate; Mets and Oligometastases;

16. Headlines • Relevant Key issues • Investment • Engagement • Leadership • Play to your strengths • Toolkits • Communication

17. National Cancer Action Team Department of Health Payment by Results UNIT COST COMPARISONS – AVERAGE OF ALL COSTS PER FRACTIONS Radiotherapy Costing & Tariff Development

18. Leadership & Engagement • Clinical Leadership • Programme Leadership • Progress chaser • Engagement • Profession • Public • Political • Wider

19. Headlines • Relevant Key issues • Investment • Engagement • Leadership • Play to your strengths • Toolkits • Communication

20. Build on the strengths • Consensus • 5 centres not 50+ • Commissioning • No Linac fairy – so can push boundaries • Central programme – can move to meet need faster. • Programmes • NRIG programme already clear, so SRAG can use this and focus on other areas of importance • Programme engagement

21. Headlines • Relevant Key issues • Investment • Engagement • Leadership • Play to your strengths • Toolkits • Communication

24. R-PORT • Roll out underway • Complete by Spring 10 • Amanda Travis appointed to secure roll out • Demonstrate efficiency • Available to all HEI’s • Ongoing development • User Group

25. Commissioning Contracting Contracting Framework Service Specification Radiotherapy Pathway www.cancer.nhs.uk/radiotherapy/commissioning Cancer Commissioning toolkit – radiotherapy section Radiotherapy Commissioning Pilots x 4

26. Configuration: • Lots of very good work underway • 4 commissioning pilots • Anglia • Sussex • Merseyside and Cheshire • Lancs and S.Cumbria • N.Trent, Humber and Yorks • Greater Midlands

27. Governance • Peer Review • New Measures …almost complete ….. • Completely different • TSR is a recurring theme in peer review • What does a good evidence folder look like? • What information does the Network Radiotherapy Group need?

28. Other work • NRAG FAQ’s • Demystifying NRAG • Public profile • Engaging with Public; Patients; Health community and the wider world • Developing the evidence base • Supporting the argument • Enhanced Cross UK working • Working together and supporting each other.

29. Headlines • Relevant Key issues • Investment • Engagement • Leadership • Play to your strengths • Toolkits • Communication

31. Achieving a world class radiotherapy service across the UK Recommendation 1: Planning for the future • a rolling ten-year plan, setting out a vision and strategy for future radiotherapy services, Recommendation 2: Measuring success • datasets for the reporting of fractionation, waiting times, access, and patient outcomes. Recommendation 3: Ensuring equity in access • demand modelling based on differences in cancer incidence on a region-by-region basis. Recommendation 4: Training the radiotherapy workforce • A national career promotion strategy should be introduced across the four nations of the UK Recommendation 5: Integrating new technologies • NICE should provide national guidance on novel radiotherapy techniques, such as intensity modulated radiotherapy (IMRT) and proton therapy. Recommendation 6: Communicating with the public • formulate a strategy and proposal for awareness raising about radiotherapy.