Cancer specialists and leading professional bodies in England have issued a stark warning about a "deadly postcode lottery" within the NHS. They argue that a patient's place of residence can significantly determine their access to effective, innovative radiotherapy treatments, leaving many without therapies widely available in other countries. Organisations like the Royal College of Radiologists (RCR) and Radiotherapy UK highlight several core issues restricting access to cutting-edge techniques such as stereotactic ablative body radiotherapy (SABR), molecular radiotherapy (MRT), and surface-guided radiation therapy (SGRT). These advanced treatments offer greater precision and reduced side effects but are currently available in only a handful of NHS centres.
The primary barriers identified are systemic. Outdated funding models, particularly NHS England’s complex tariff system, often disincentivise many trusts from offering advanced therapies unless they are supported by charity or private funding. These bureaucratic hurdles, compounded by a lack of centralised support, contribute to the restricted availability. For instance, while SABR is widely used for some cancers (like certain lung tumours), its use for others (such as some liver, prostate, and kidney cancers) is limited to only a few hospitals, despite supporting clinical evidence. Furthermore, SGRT is available in only about half of specialist centres. These access issues are further exacerbated by inadequate staffing and workforce shortages in radiotherapy and oncology, particularly in under-resourced regions.
The problems with innovative radiotherapy are part of a broader access crisis. Analysis by Radiotherapy UK reveals that over 60,000 cancer patients each year do not receive the radiotherapy they need. Even those who do may face waits of up to six months before starting treatment, far exceeding recommended timelines. This variation means some regions meet national waiting time standards, while others fall significantly short. Advocacy groups are now calling for a statutory right to timely treatment, noting that in some areas, fewer than one in four patients begin treatment within the government’s 62-day standard from an urgent referral.
Leading bodies are therefore urging the government to use its national cancer plan to ensure equitable access to life-saving therapies and address these glaring regional inequalities. Advanced techniques not only improve patient outcomes but also reduce the number of treatment sessions and lessen long-term side effects, which benefits both patients and the sustainability of radiotherapy services. While NHS England maintains that advanced radiotherapy is available where strong clinical evidence supports its use and is preparing to address access issues in the forthcoming national cancer plan, campaigners remain sceptical.
The government has committed to investing in 28 new radiotherapy machines nationwide through a £70 million programme as part of its Plan for Change strategy, with Health Secretary Wes Streeting publicly supporting these upgrades. However, campaigners argue that the mere rollout of new equipment, without fundamental systemic funding reform, will not resolve the core postcode-based gaps in access that continue to persist.
