Memorandum by the Royal College of Radiologists
(PEX 27)
1. The Royal College of Radiologists (RCR)
has approximately 8,300 members and Fellows worldwide representing
the disciplines of clinical oncology and clinical radiology. All
members and Fellows of the College are registered medical or dental
practitioners. The role of the College is to advance the science
and practice of clinical oncology and clinical radiology through
a range of activities, including setting and maintaining the standards
for entry to, and practice in, the specialties of clinical radiology
and clinical oncology, and arrangements for continuing professional
development (CPD) in both specialties.
2. This response outlines the impact and
implications within clinical oncology and clinical radiology of
the decisions being taken in the current public expenditure process.
STRATEGIC ASSESSMENT
3. What level of commitment is national government
making to the NHS, and how does it compare with long term trends
of demand, cost and efficiency?
Within clinical radiology demand is rising at
an average of 5% per annum and has been for 10 years despite much
effort to manage the demand. Stroke and head injury initiatives,
screening programs, NICE guidelines and the Government's own demands
for more community based management and faster cancer diagnostics
are unlikely to slow this down. The demands on radiology far outstrip
the tepid growth in service predicted.
The benefits of early diagnosis in the community
are cost effectiveness and a decrease in the demand for bed and
bed occupancy.
If a fair and equitable interventional radiology
service were to be provided to the patient population, this would
lead to a saving in beds, ITU and theatre time. An example of
this is Uterine Artery Embolization (UAE) where several studies1,2
have shown the cost benefit of UAE over hysterectomy which is
still the more frequently performed procedure for uterine fibroids,
despite NICE guidance.3 This cost effectiveness is a feature of
all minimally invasive procedures.
With cancer services, the government's focus
on a specific new cancer drug fund reinforces a sometimes misdirected
emphasis on drugs in cancer treatment as the main barrier to improving
cancer outcomes in the UK. Whilst drugs are very important, other
modalities such as Radiotherapy and Surgery require continued
investment and specific initiatives to ensure high quality outcomes.
Radiotherapy is a vital component of high quality modern cancer
care, and plays a key role in both curative and palliative treatments
for most cancer patients. It is one of the most efficient and
best options for treatment, being responsible either alone or
with surgery for curing 40% of all patients with cancer. The recent
publicity about inadequate access to the most modern technology
of radiotherapy in the UK such as intensity modulated radiotherapy
(IMRT) and image guided radiotherapy (IGRT) underlines a need
to fully implement the National Radiotherapy Advisory Group (NRAG)
recommendations.4
4. What are the implications of the "£15-20
billion efficiency challenge" described in the Revised Operating
Framework for the NHS as "absolutely critical for the future"?
It is likely to cost significant amounts of
money to achieve this. Many NHS workers are already giving freely
significant amounts of time. It is unlikely that such savings
can be made from management alone—in fact it is likely that
management costs will remain the same but will be contracted in
rather than part of the NHS.
5. What commitment is the government making
on capital expenditure as opposed to revenue expenditure?
In radiology, the previous government made a
large commitment to capital spending and equipment provision is
now at the level within NHS hospitals that it should always have
been. However, to keep equipment provision at that standard, continuous
capital investment will be needed. Also, capital equipment is
less likely to be used efficiently as revenue spending diminishes
and the NHS will not reap the benefits of the previous capital
expenditure. This can be seen happening already and is gathering
pace.
Within oncology, delivery of the 2008 Cancer
Reform Strategy has been hindered by inadequate capital funding
mechanisms, national level commissioning of equipment and services
in radiotherapy.
6. What level of commitment is national and
local government making to Social Care, and how does it compare
with long term trends of demand, cost and efficiency?
If social care spending is fundamentally reduced,
this will have major effects on healthcare as demand for beds
will rise to take cases that cannot be managed at home and bed
occupancy will also rise because patients cannot be discharged.
7. What are the implications of the government's
plans for the interface between the NHS and Social Care?
Due to the issues outlined in paragraph 6 above,
the plans appear highly aspirational.
LOCALLY COMMISSIONED
HEALTH SERVICES
Decisions regarding commissioning must be made
by informed commissioners who understand clinical pathways and
consult with the relevant professional body.
The RCR considers that local commissioning will
be entirely inappropriate for specialised services such as radiotherapy.
The provision of these and other specialised cancer services should
be under a higher commissioning body.
REFERENCES1 O
Wu, A Briggs, S Dutton, A Hirst, M Maresh, A Nicholson, K McPherson.
Uterine artery embolisation or hysterectomy for the treatment
of symptomatic uterine fibroids: a cost-utility analysis of the
HOPEFUL study BJOG 2007 114:1352-1362.
2 O'Grady EA, Moss JG, Belli AM, et al UK
uterine artery embolisation for fibroids registry 2003-2008.
The British Society of Interventional Radiology, 2009.
3 National Institute for Health and Clinical
Excellence. Uterine artery embolisation for fibroids. NICE
interventional procedures guidance 94 (2004).
4 Radiotherapy: developing a world class service
for England. Report to Ministers from National Radiotherapy
Advisory Group. DH, February 2007.
September 2010
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