The radiotherapy census: Improving UK cancer care

With the release of the Society’s Radiotherapy Radiographic Workforce Census, Synergy investigates the current state of play

Each year the Society of Radiographers undertakes a UK-wide radiotherapy radiography workforce census to understand the state of the workforce.

The Radiotherapy Radiographic Workforce UK Census 2023 was published last month, offering an insight into the Therapeutic Radiographer workforce to help inform policy, highlight challenges and ultimately improve radiotherapy in the UK.

This data is used by radiotherapy service managers across the country in their workforce planning, and provides important information to clinical boards, government departments, educators, commissioners and radiotherapy providers.

For this year’s census, 57 NHS radiotherapy providers responded to the online questionnaire, representing a response rate of 92 per cent.

Charlotte Beardmore, executive director of professional policy for the SoR, said: “The SoR will use the data to lobby government and stakeholders to ensure appropriate investment in services and the therapeutic radiography profession, and so support our members.

“This data will be important during the face-to-face discussions as we meet with government and the opposition to discuss our manifesto, providing evidence of the challenges being faced.

“We are very grateful to our service managers for working with us to ensure the timely submission, analysis and publication of this data which we share widely with stakeholders to demonstrate the continuing investment that is required to support and develop the skills of our members working within radiotherapy services.”

Each year the Society of Radiographers undertakes a UK-wide radiotherapy radiography workforce census to understand the state of the workforce.

For this year’s census, 57 NHS radiotherapy providers responded to the online questionnaire, representing a response rate of 92 per cent.

“This data will be important during the face-to-face discussions as we meet with government and the opposition to discuss our manifesto, providing evidence of the challenges being faced.

Key findings

The SoR 2023 workforce census captures data about the UK radiotherapy radiographic workforce at the census date of 1 November 2023. Data collection was performed between November 2023 and January 2024, ending in January 2024, by means of an Alchemer online questionnaire distributed to radiotherapy service managers.

According to the census, the total NHS radiotherapy radiographic workforce stood at 3,750 whole-time equivalent (WTE) staff, of which 3,611 were Therapeutic Radiographers and 139 assistant practitioners and trainees, or clinical support workers.

The workforce has grown by around 30 percent over the last ten years.

However, the current vacancy rate stands at 8.43 per cent, with 316 WTE positions vacant.

Across UK countries, this rate varies:

The North West and South West London/Surrey networks have the highest current vacancy rate of the radiotherapy NHS network partnerships, at 15 per cent.

This is the first time the workforce has seen the vacancy rate decrease since the Society began collecting data this way in 2012 – it fell by 3.8 per cent between 2022 and 2023. For assistant practitioners, trainees and clinical support workers, the vacancy rate stands at 11.6 per cent.

However, it still remains above the vacancy rate for Therapeutic Radiographers in 2020 and 2021.

Charlotte added: “There are significant concerns that growth of the therapeutic radiography workforce is not keeping up with demand and in 2023 there was a reported decrease in the numbers/ WTE working within the NHS from the data submitted.

“As the incidence of cancer continues to increase, and the number of patients who will benefit from radiotherapy is around 50 per cent of all cancer patients, the demand for access to the radiotherapy service is not lessening.

“Supporting development of the profession to work at advancing levels of practice is a priority to support workforce transformation. This is challenging when there are workforce vacancies.”

The average workforce turnover, which puts indirect pressure on resources by increasing the need for recruitment activities and induction training, was 12.9 per cent.

The most common reasons radiotherapy providers gave for Therapeutic Radiographers leaving their post are still ‘personal reasons’ and ‘promotion opportunities in another radiotherapy centre’, as they were in the 2022 and 2021 censuses.

Respondents recruited 2.4 per cent of their headcount internationally over the past year (to 1 November 2023), and planned to recruit a further 1.6 per cent internationally in the coming year. International recruitment drives are largely centred on Agenda for Change (AfC) Band 5. By headcount, 7.8 per cent of Band 5 staff were recruited internationally over the past year.

The survey also found that 41 per cent of respondents were using agency Therapeutic Radiographers. This compares with 40 percent in 2022, and 33 per cent in 2021.

The most frequently selected reason for using agency staff is existing vacancies in the Therapeutic Radiographer establishment.

Just over eight in 10 (84 per cent) of the NHS radiotherapy radiographic workforce is employed in Agenda for Change Bands 5 to 7.

More data on job title usage, long-term vacancy rate, and apprenticeships can be found in the full census report.

The census from the ground

Synergy sat down with Shannon Johnson, a Therapeutic Radiographer specialising in palliative care at the Somerset NHS Foundation Trust, to ask how she saw the results of the workforce census.

She warned that, in her view, “the recruitment crisis is not going to get too much better, unless something drastically changes.”

However, there were bright spots in the census that Shannon saw reason to be optimistic about. In particular she described how helpful international recruitment had been at Somerset trust.

“We have quite a few international radiographers who have joined our team, and they’re so good,” Shannon explained.

“They bring in different skill sets, different ways of communicating. They’ve really moulded the team, they’re a real asset. To be able to showcase the differences in experience they’ve previously had, and how that can initiate change in our department, has been really nice.”

The census from the ground

Synergy sat down with Shannon Johnson, a Therapeutic Radiographer specialising in palliative care at the Somerset NHS Foundation Trust, to ask how she saw the results of the workforce census.

She warned that, in her view, “the recruitment crisis is not going to get too much better, unless something drastically changes”.

However, there were bright spots in the census that Shannon saw reason to be optimistic about. In particular she described how helpful international recruitment had been at Somerset trust.

“We have quite a few international radiographers who have joined our team, and they’re so good,” Shannon explained.

Having increased levels of international recruitment would be particularly helpful for radiotherapy departments, she continued, because the cohort is smaller than diagnostic radiography.

Shannon added: “There’s always going to be a vacancy rate, because the majority of departments are short staffed. I think international recruitment is a great way to help fill those vacancies.”

Agency workers were a significant bonus to radiotherapy too, Shannon said.

“They have the flexibility, they can adapt quite quickly to different departments and move around without the same ties,” she continued. “Compassion fatigue and burnout are big topics in the NHS, especially since Covid. Agencies give radiographers a little bit more flexibility with that.”

It is also a great way for departments to gain skills from different areas and expertise with different technologies to share across the NHS.

Having increased levels of international recruitment would be particularly helpful for radiotherapy departments, she continued, because the cohort is smaller than diagnostic radiography.

Shannon added: “There’s always going to be a vacancy rate, because the majority of departments are short staffed. I think international recruitment is a great way to help fill those vacancies.”

Agency workers were a significant bonus to radiotherapy too, Shannon said.

It is also a great way for departments to gain skills from different areas and expertise with different technologies to share across the NHS.

A perspective on radiotherapy

Alongside her role as palliative specialist, which Shannon has been doing for just over a year now, she is involved with career outreach work on behalf of the trust. This includes work experience, talking to students looking for electives, and more general recruitment efforts – Shannon visits schools to give talks and events on radiotherapy.

Shannon is also principal investigator on a College of Radiographers-funded research project as part of the College’s Industry Partnership Scheme (CoRIPS), and is working alongside three others - two of whom work in education, and another who specialises in research and trials - offering broad expertise behind the research. Shannon and her team are investigating how to raise awareness of therapeutic radiography as a career and how to recruit more Therapeutic Radiographers.

“Diagnostic radiography is great, because you get a bit more freedom, and you can work in any community hospital,” she added. “Therapeutic is very much centralised. You're in one location, and there's not another one for 50 miles, for example. If you want to move department, you pretty much have to move your whole life. I think that could put people off.”

During her time going out to careers fairs and talking to students, Shannon explained she would try to emphasise some of the benefits to becoming a Therapeutic Radiographer – including, for example, the lack of unsocial hours.

She continued: “If we made people just generally more aware of the profession, maybe that would spark interest. A lot of patients with children or grandchildren explain they aren’t sure what they want to do at college, or what job they want to do. I’ll ask to speak to them, email them about work experience. We get quite a lot of interest that way.”

For students who were interested in therapeutic radiography, or who were unsure of what they wanted to study at university, Shannon advised they focus on staying open-minded.

“Radiotherapy is a very niche profession,” she said. “But you get a bit of everything – if you’re interested in science, you get biology, chemistry and physics all merged together. It opens so many doors for you – you get the patient-centred care, seeing patients every day for up to seven weeks, and you really build a rapport with them.

“You develop so many skills in this way. Also, you get the evolving technology – there’s massive learning opportunities for everybody here. It’s a role for someone that’s willing to learn, that’s open-minded, caring and compassionate, and really wants to get stuck in.

“We know the job is hard. But it’s so rewarding, it outweighs any of the cons. It's a really good way of stimulating the mind, you’re always learning, you have a big team you spend all of your time with – it’s a bit like a family, really.”

Difficulties in recruitment

Her work with recruitment in radiotherapy has given Shannon a perspective on the unique struggles faced by the department in seeking out new trainees.

She said: “Our profession sometimes can struggle, because people think of cancer and they think it must be such a depressing job – you're working with cancer patients. What I want to do with my research is change the perception and help people understand this job is really, really important for so many people, and it's incredibly rewarding.

“Like in every job, there's aspects that are sad, but actually the positives completely outweigh that. For someone that wants to do something in healthcare, but they're not really sure what, or they don't want to study for six years to be a doctor, radiotherapy is a good mix of science, technology, and patient care.”

Shannon also emphasised that progression in the field was better than some other parts of the NHS, so therapeutic radiographers have opportunities to move up the AfC bands.

Shannon’s research found the majority of people come into radiotherapy due to someone they know, often a family member or friend who has undergone radiotherapy. People were also getting into the course via virtual platforms which were being held, while work experience was less of an attracter, due to the pandemic difficulties.

Moreover, Shannon’s data found that, due to the workforce crisis afflicting the profession, Therapeutic Radiographers interested in improving education for students to get into the profession didn’t have the time or funding to conduct it.

“It’s a bit of a downfall,” Shannon said. “People aren’t getting to know what the profession does, which isn’t helping out with the recruitment crisis.”

Difficulties in recruitment

Her work with recruitment in radiotherapy has given Shannon a perspective on the unique struggles faced by the department in seeking out new trainees.

Shannon also emphasised that progression in the field was better than some other parts of the NHS, so therapeutic radiographers have opportunities to move up the AfC bands.

“It’s a bit of a downfall,” Shannon said. “People aren’t getting to know what the profession does, which isn’t helping out with the recruitment crisis.”

About the SoR workforce census

The census asked for the total numbers of therapeutic radiographers, assistant practitioners (APs), trainee assistant practitioners (TAPs) and clinical support workers delivering radiotherapy (together referred to as the ‘radiotherapy radiographic workforce’) within the budgetary control of the radiotherapy service manager.

Radiotherapy helpers and administration staff are not included in these numbers. Notably, starting from 2021, the census has been expanded to include clinical support workers in its data collection.

Respondents were asked about:

• Their contact details and job title

• The name of the radiotherapy provider on whose behalf they were responding

• Number of treatment machines and total daily number of clinical hours

• Establishment numbers by AfC band – WTE

• Numbers of staff in post by AfC band – WTE

• Number of staff in post by AfC band – headcount

• Number of staff in an apprenticeship role by AfC band – headcount

• Vacancy WTE numbers by AfC band – current and three-month and job titles

• WTE establishment by site and career progression level

• Long-term absence headcount numbers by AfC band – career break, long-term sickness absence and parental leave

• Headcount predicted to retire in the coming year, subsequent year and further three years by AfC band

• Headcount of leavers in the previous year by AfC band and reasons for leaving

• Job titles in use

• Recent and planned international recruitment by AfC band

• Support of return to practice radiographers and students

• Use of agency Therapeutic Radiographers

• Therapeutic Radiographers employed in dosimetry and other cancer services not within the budgetary control of the radiotherapy service manager

Read the full census here.

Image credit: Povozniuk / iStock / Getty Images Plus / Eva Slusarek

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