Treatment, technology and workforce:
will the government’s National Cancer Plan work?
The long-awaited release of the proposals could be good news for radiographers – if they come with the right support. Synergy investigates the current state of cancer care and whether the targets go far enough
Cancer care in England is in crisis.
That was the damning conclusion reached by a 2024 independent investigation into the current state of the NHS, carried out by Lord Ara Darzi and commissioned by the then-newly elected Labour government. In his report, Lord Darzi, a consultant surgeon and a former health minister, found that cancer care in England lags significantly behind many other developed countries, with higher mortality rates, poor rates of early diagnosis and failures to meet treatment waiting times.
The report findings were then used to directly inform the government’s long-awaited National Cancer Plan, published in February 2026, which sets out how the government plans to improve the picture of cancer care in England by 2035. Under the new plan, the government’s ambition is for three quarters of patients diagnosed with cancer to survive for five years or more by 2035, through a combination of investment in technology, a new devolved operating model and measures to reduce health inequalities.
But what has been the response to the National Cancer Plan among the therapeutic radiography community? Is the plan doing enough to ensure capacity to meet demand for both diagnosis and treatment within the NHS?
Synergy spoke to experts in cancer care and research to find out more about the current state of the pathway, the impact of the National Cancer Plan and what needs to be done.
The state of play
The UK has appreciably higher cancer mortality rates than other countries. Half of all cancer patients receive radiotherapy at some stage in their treatment, and the NHS target is that 96 per cent of patients should begin radiotherapy within 31 days – but in May 2024, more than 30 per cent had been left waiting longer, according to the Darzi report. The target for 85 per cent of patients to wait no longer than 62 days from referral to first treatment has not been met since 2015.
Suzi Jordan, head of radiotherapy at University Hospitals Leicester and chair of the National Radiotherapy Managers Group, says prostate cancer patients referred to her department for treatment last year were waiting six months longer than this target. And some post-surgery breast cancer patients were waiting up to eight months longer than recommended.
The reasons for these stats are well known to radiographers, and referenced obliquely in the National Cancer Plan. Sustainable funding for equipment replacement and an appropriately trained workforce are mentioned as core reasons for the difficulties in improving cancer pathways, and workforce pressures from growing waiting lists have left workers vulnerable to stress and burnout. Meanwhile, there is an 8 per cent shortage of Therapeutic Radiographers nationally, and yet staff are vital to the function of radiotherapy departments.
The cancer plan also explains that, across the country, health inequalities mean there are huge variations in how cancer targets are met, creating a postcode lottery of healthcare.
International Cancer Benchmarking Partnership studies have laid out how cancer survival in the UK is still around 10 to 15 years behind leading countries (Norway, Australia and Canada). People living in Norway and Australia start chemotherapy and recover more quickly than in the UK, and survive across oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian cancers at higher rates. Survival in Norway stood at 70.7 per cent in 2024, and 70.1 per cent in Australia, compared to 63.3 per cent in the UK (overall averages).
“It’s really awful for patients. They feel stuck. They want to have their diagnosis and active treatment and then move on – but they’re not able to do that”
The UK Radiotherapy Board’s May 2024 policy briefing makes clear that radiotherapy involves several essential stages before treatment can begin, including imaging, contouring, multidisciplinary planning and in some cases neoadjuvant therapies such as hormone treatment. “It’s really quite awful for patients,” says Suzi. “They feel stuck. They want to have their diagnosis and active treatment and then move on – but they’re not able to do that.”
Changing approaches
National cancer plans in England have evolved from the foundational 2000 10 year NHS Cancer Plan. Throughout various updates, new plans and modernisation efforts, they have sought to save lives, reduce inequalities and improve care. Many of the targets referenced throughout cancer care pathways, including the 62-day referral to treatment target, were initially created by these earlier plans.
In 2011, the government released the ‘Improving Outcomes: A Strategy for Cancer’ plan; in 2015, the ‘Achieving World Class Cancer Outcomes (2015–2020)’ plan; and in 2019, the ‘NHS Long Term Plan’. Each of these has had its own specific focuses and impacts; for example, the 2015 plan introduced Cancer Alliances to integrate local services, while the 2019 NHS Long Term Plan set a target for 75 per cent of cancers to be diagnosed at stage 1 or 2 by 2028. All have consistently prioritised early diagnosis and increasing survival rates, with more recent strategies demonstrating a growing interest in reducing inequalities.
The 2026 National Cancer Plan is intended to be a “break from the past”, according to the government, as “none of these strategies has changed the blunt reality that our record on cancer simply isn’t good enough”. It intends to take the three healthcare shifts laid out in the 10 Year Health Plan – moving care from hospitals to community settings, transitioning from analogue to digital and focusing on prevention over sickness – and “hardwire” them into cancer pathways.
The role of radiotherapy
Cancer treatment is a complex and multifaceted aspect of healthcare – one that requires multidisciplinary engagement and collaboration between the many treatment modalities available, which may be used alone, together or following one another. Nonetheless, the SoR has emphasised that radiotherapy is a key and necessary aspect of any legitimate attempt to improve cancer care. Unfortunately, radiotherapy is a historically underfunded service in the NHS.
The UK Radiotherapy Board’s policy statement, Recovering radiotherapy services in England: Our plan for action, published in 2024, broke down the main drivers of lengthening waiting times and what action was needed at a national and local level to support services, and was set out to NHS England.
The society is clear – once radiotherapy has the support it needs, it can bring immense benefit to cancer patients across the country. Already, the system of governance and the frameworks it uses are comprehensive and well developed. If the National Cancer Plan wants to meet its many and various targets, it needs to pay greater attention to the service.
In England, each radiotherapy centre works on its own, within a trust, with NHS England working to ensure the departments operate within delivery networks – a system described by Spencer Goodman, radiotherapy officer for the SoR, as relatively efficient and cost effective.
SoR officer Spencer Goodman
SoR officer Spencer Goodman
The UK Health Security Agency’s (UKHSA) taxonomy for radiotherapy learning events, which helps identify solutions to treatment errors, is “world leading”, Spencer says, and the open reporting culture ensures people can see broader issues quickly. The UKHSA Patient Safety in Radiotherapy group collaborates to support the coordination of efforts to improve patient safety in radiotherapy across the UK. This work includes the collation, analysis and dissemination of learning from radiotherapy events. “We’ve got a strong safety record, but how do we make that better?” Spencer asks. “We’re world leading in the way that we report, and in our scope as practitioners. But we’ve got massive workforce pressures.”
Vacancy rates and health inequalities across the country mean there are huge variations in radiotherapy services meeting targets. More than 550 additional Therapeutic Radiographers are needed merely to eliminate the 8 per cent workforce shortage across England. “We’ve got amazing infrastructure,” Spencer says. “But in terms of the provision of the workforce, there are big challenges.”
The SoR’s position
At the SoR, attitudes towards the plan are generally positive. Charlotte Beardmore, executive director for professional policy at the SoR, has welcomed the fact there is now a cancer plan, glad for its help in focusing attention on the goal of improving outcomes for cancer patients. However, she says: “We are concerned that there is little detail about the implementation of the goals, and how the ambitious targets will be achieved. The focus on personalised care plans for patients is welcome, together with care closer to home where possible.”
Interventions raised by the plan, including improving radiotherapy productivity and reviewing sonographer title regulation, are expected to make significant progress on cancer outcomes, the SoR has said – but its true effectiveness can only be determined in conjunction with the upcoming NHS workforce plan.
“Where the cancer plan falls short is in its lack of workforce planning”
“Where the cancer plan falls short, however, is in its lack of workforce planning,” adds Richard Evans, CEO of the SoR. “The plan barely mentions radiographers, despite our key role in diagnosing cancer and planning and delivering radiotherapy.
“While we welcome moves to bring healthcare into the community, we have yet to see a fully funded staffing plan for community diagnostic centres. Opening more centres without investing in new radiographers will simply take existing radiographers away from acute hospital departments – which are already chronically understaffed.”
The National Cancer Plan, Spencer says, is “massively ambitious on diagnosis”, but a lack of detail is holding it back. “The plan feels a bit incomplete, if I’m honest with you,” Spencer continues. “There’s a plan, but you expected more details. It doesn’t really pin anything down. We’ve not had a sustainable equipment replacement programme. That is a core issue.”
Although tariff mechanisms are intended to support equipment replacement at trust level, in practice this funding can be redirected to meet short-term operational pressures.
The National Cancer Plan has 19 references to radiotherapy – an almost fourfold increase on the previous plan, which only mentioned the treatment five times. However, staff don’t have clarity yet on the radiotherapy tendering process for equipment provision under the Department of Health and Social Care (DHSC). “You need to have sorted that out,” says Spencer. “We need a sustainable equipment plan, but also sustainable, recurrent funding and workforce expansion.
“We know we don’t treat all the patients who would benefit from radiotherapy. If you pile in all the people who should have their referral pathways through radiotherapy who are not receiving it because of capacity issues, the picture gets even worse.”
In particular, clarification on how the equipment replacement plan will work, how AI will be integrated, how the DHSC intends to maximise productivity, how trusts will be expected to streamline and incentivise the use of advanced technologies, and where radiotherapy departments can look for detailed direction on these targets, is vital.
Research and innovation
Heidi Probst is a professor of radiotherapy and oncology at Sheffield Hallam University, where her area of expertise falls specifically into breast cancer radiotherapy.
Professor of radiotherapy and oncology Heidi Probst
Professor of radiotherapy and oncology Heidi Probst
As a researcher, her reaction to the National Cancer Plan is similar to that of the SoR’s position. However, Heidi also has concerns about the government deciding which topics of research should receive attention. “We need to be careful not to be blinkered by what the cancer plan is defining as the important technologies to focus on,” she warns. “We need to let the researchers and innovators do that work, because there might be other technologies that turn out to be useful as well. We can’t limit ourselves. It would be a shame to exclude anything that comes along in the future.”
Heidi is also disappointed by its commitment to give a fixed amount of money to trusts for the replacement of old radiotherapy equipment, with a view to increasing capacity. So far, the government has invested £70m to deliver 28 new radiotherapy machines. Through the Spending Review, radiotherapy providers have been allocated £15bn in operational capital for local priorities and £5bn to support a return to constitutional standards – from April 2026, systems are expected to use this capital to deliver further investment in state-of-the-art radiotherapy machines. “That [equipment replacement funding] shouldn’t be in the National Cancer Plan,” she says. “That should be normal practice. There are challenges, too, because you need the staff to go with it.”
While the SoR supports the investment in Community Diagnostic Centres (CDCs), bringing services to patients in the community, it has been campaigning to raise notice of the workforce challenges in support delivery across the CDCs and acute services, as there isn’t sufficient workforce to go around.
The focus on increasing capacity for CDCs through equipment is also misguided, she says. The government has invested £1.65bn in CDCs since 2021, with a total of 170 CDCs up and running across the country. Over the next three years, the plan says, it will invest £2.3bn in diagnostics transformation, including building “many more” new CDCs and extending operating hours. Heidi insists there isn’t enough detail around the workforce to deliver that promise – while there is a brief mention of increasing headcounts, the focus is on using technology such as AI to make up the difference.
In rural and coastal areas, trusts have significant difficulties in retaining staff, and there are high vacancy rates that need to be addressed. Without workforce support, CDCs will have little impact, she adds.
Fortunately, the plan has other merits – Heidi is delighted to see the words ‘patient empowerment’ mentioned in the plan. “As a researcher, the team I work with has been focusing on supporting patients with a breast cancer diagnosis to be empowered throughout their radiotherapy process. Seeing that acknowledged means a greater opportunity for patient involvement and partnership. Those words were really welcome,” she says.
Commitments to patient empowerment included ensuring every patient has a named carer to guide them through the pathway, and that every patient will get a personalised end-of-treatment summary. Heidi explains that the issues of personalisation and supportive care for cancer patients are currently not being given enough consideration. As cancer survivorship rates rise, there needs to be a greater effort to modernise cancer care to address and reduce side effects, she says.
Cancer diagnoses have a huge impact on mental wellbeing, but treatments can have just as much of an impact, she explains. “We must improve how we deliver our treatment so that people come out of that process feeling supported, feeling they were treated with dignity and feeling well enough to go back into the workforce. We’ve got to find a way to reduce side effects.”
“We must improve how we deliver our treatment so that people come out of that process feeling supported, that they were treated with dignity, and well enough to go back into the workforce. We’ve got to find a way to reduce side effects”
For the future
The changing role of radiographers in the cancer pathway must also be acknowledged, Heidi points out, because the profession is so wellplaced to take on additional responsibilities. Expanding advanced practitioner and consultant practitioner roles to take on additional activity, and help deliver and transform care as part of the multi-professional team, will free up clinical oncologists and other staff to provide the care that only their profession can provide, for example.
Heidi also wants to see greater access to big data, she says. Not all radiographers are eligible to access clinical trial data – and what’s needed is information on people going through the system now, so it can be interrogated for inequalities. Making the process of recording and retrieving data easier will ensure processes are optimised for patient-reported outcomes, which will directly contribute to the cancer plan’s aims, she explains.
But ultimately, Heidi sees the National Cancer Plan as an opportunity. Not just for the government to listen to what’s needed to achieve these aims, but for anyone involved in the cancer pathway. For researchers, for example, the emphasis on digital access is an opportunity to increase health and health literacy, because funding will have an enormous impact on care and providing high-quality information for patients. “There are pockets of excellent activity around the country,” she says. “It’s not everywhere, it’s not without challenges. But there are opportunities to develop services and maximise outcomes.
“We need to continue to innovate, improve patient experience, preparedness and empowerment and – ultimately – patient outcomes.”
The promises made by the National Cancer Plan are certainly capable of inspiring hope that the government will make serious investment into radiotherapy, and cancer as a whole, to improve patient outcomes and address the difficulties facing the service. Commitments to equipment funding in particular are a welcome relief. But a lack of detail on the methods and specifics will have started alarm bells ringing for many readers. Without these additional details, how can radiographers be confident their departments will receive the support they need?
Ultimately, only time will tell. The SoR has emphasised that staff should be on the lookout for the forthcoming workforce plan, expected to be released this summer. Once the government has clarified its intentions there, the degree to which its commitments can be taken seriously will become clear.
Find out more about support for Therapeutic Radiographers
The SoR provides a wealth of resources related to radiotherapy on its website, including details on its political support and lobbying, resources for service managers, access to special interest groups and more details on the continuing development of high-quality radiotherapy services throughout the UK.
