Radiotherapy commissioning and tariff-how can we deliver advanced, innovative, and personalised radiotherapy?

Radiotherapy practices have changed significantly over recent decades with the introduction of increasingly personalised approaches to preparation and treatment and the use of a wider range of imaging technology, treatment techniques and software such as Artificial Intelligence (AI). The lack of development of the radiotherapy tariff, which remunerates services for radiotherapy delivery, has contributed to poor adoption rates and inequitable access for patients to new advanced treatment technologies and software across England. The radiotherapy tariff has a potential to be a lever to drive innovation across the system, if it is routinely updated to respond to latest clinical consensus. The commissioning of radiotherapy services is being transferred from NHS England to Integrated Care Boards (ICBs), in their emerging role as 'strategic commissioners'. Along with wider reform to funding mechanisms set out in the 10 Year Health Plan, this presents an opportunity to reshape the commissioning and tariff structures for radiotherapy services to better reflect contemporary radiotherapy practice. This paper explores the limitations of current funding arrangements for radiotherapy. It proposes recommendations to ensure that providers are supported to deliver more productive, innovative and value-based radiotherapy.