Bodies representing senior cancer experts say funding bureaucracy means some patients in England struggle to access the latest, best cancer treatments that could save their lives.
In a recent briefing, the Royal College of Radiologists (RCR) and the Society of Radiographers (SoR) have warned that current commissioning and funding structures are stifling innovation and causing unequal access to innovative cancer treatments, and have urged the government to seize the NHS Cancer Plan as an opportunity to change this.
Cutting the unnecessary red tape will give patients faster and fairer access to the best cancer treatments closer to home, improving health outcomes. The problem with the current funding model, they argue, is that Trusts are not incentivised to offer world-class cancer treatment. These innovative treatments include cutting-edge types of radiotherapy and new drugs.
One example is Stereotactic Ablative Body Radiotherapy (SABR), a method of accurately targeting radiotherapy to a tumour from many different directions. It is typically used to treat very small tumours in the lung, liver, lymph nodes, spinal cord and brain, among other locations. It maximises the radiation given to the tumour while minimising damage to healthy tissues. Compared to conventional radiotherapy, patients require fewer sessions, spend less time in hospital and experience reduced side effects. This is more cost efficient for the NHS as well as being beneficial for the patient – helping to free up hospital beds and reduce time and resources spent managing side-effect symptoms.
When it was first introduced, SABR was subject to strict safeguards to ensure it could be implemented safely and effectively. Despite the treatment becoming well established, the way in which it is commissioned has not evolved in parallel. This means access to SABR has been limited, and patients are missing out as a result.
The current funding model requires a cumbersome application process which can delay NHS trusts adopting SABR. The funding that trusts receive for delivering SABR can be less than the cost of delivery, so some choose not to adopt it. This perverse financial incentive means some trusts give people less effective cancer treatments instead of this world-class treatment.
To stop patients missing out in this postcode lottery, the Government should use the Cancer Plan to make SABR and other innovative cancer treatments available to all eligible patients who should benefit.
For new drug treatments, properly reimbursing providers would allow more to be offered in neighbourhood health centres, in community pharmacies, and even at home.
This would align with the NHS 10 Year Plan commitments to deliver more specialist treatments and to help people access healthcare wherever they live.
How the funding model needs to change
The RCR and SoR propose that the Cancer Plan should include a commitment to reconsider how innovative cancer treatments are commissioned and funded. Any new approach should consider the following factors:
- Treatment funding tariffs should eliminate perverse financial incentives and promote the use of cost-effective, patient focused innovative treatments
- Funding should include the full cost of treatments such as SABR, including workforce costs
- An innovation incentive payment would help trusts to facilitate new treatments that require additional expertise or training
- Services should be designed to enable patients to access them no matter where they live
- Medical royal colleges and other professional bodies should work with regulators to produce consensus and guidance
Patient case study: the benefits of SABR
In 2019, Mr RH, a 79-year-old man, was diagnosed with a cancerous tumour in his right kidney. Because of his existing health conditions (including lung disease, heart problems, and previous surgeries) traditional treatments like surgery or other invasive procedures weren’t considered safe options.
Over time, the tumour grew, and doctors felt it needed to be treated to prevent it from growing further or spreading. Mr RH was referred to a specialist team to explore SABR, a newer, non-invasive treatment which shows incredibly promising results in clinical trials. Treatment of this disease with SABR, however, is not funded by NHS England and so costs had to be absorbed by the local NHS department and staff.
The clinical team proceeded to deliver SABR in three short treatments in 2021. It was very well tolerated by Mr RH, and follow-up scans in June 2025 – four years later – show that his cancer remains under control. This case highlights how SABR can offer a safe and effective alternative for patients who cannot undergo surgery for this disease, and why a reformed approach to funding and access to SABR is urgently needed.
Dr Nicky Thorp, Vice-President for Clinical Oncology at the Royal College of Radiologists, said: “Our NHS pioneers and delivers some of the most cutting-edge cancer treatments in the world. However, red tape is preventing equal access to innovative types of radiotherapy and new drugs that can transform lives.
"The upcoming Cancer Plan presents a fantastic opportunity to commit to reconsider how these are commissioned and funded. This would shift the dial by encouraging trusts to embrace innovation and helping more patients benefit from the latest treatments. We urge the Government to use the Cancer Plan to fix a funding system that is stopping some from accessing the best possible cancer treatment. We stand ready to support them to ensure no patient is left behind.”
Charlotte Beardmore CBE, Executive Director of Professional Policy at the Society of Radiographers, said: “Our shared goal is to ensure every patient has timely access to the best cancer care. The Cancer Plan is a vital opportunity to ensure radiotherapy is properly supported, professionals are empowered, and patients can benefit wherever they live.”
Dr Christopher Dean, Chair of The UK SABR Consortium, said: “For more than a decade, the UK SABR Consortium has worked with the NHS to expand patient access to this highly effective advanced radiotherapy while maintaining the highest standards of safety and quality. But we must now go further, and the National Cancer Plan provides a key opportunity to unlock SABR’s full potential. We have already written to NHS commissioners offering our full support for re-designing the system to allow expert clinical teams to make the best decisions for their patients, putting SABR on a level playing field with other ablative therapies.
"This change, within a properly funded framework, would allow SABR to be deployed more widely, maintaining pace with the latest clinical evidence and delivering fairer access to precision SABR treatment across UK regions and nations which fully aligns with the ambitions of the Government’s Plan.”
Read the briefing: Proposals for the reshaping of cancer services in England: funding for innovative cancer treatments
