Bodies representing senior cancer experts warn that funding bureaucracy is restricting access to cutting-edge treatments in England, with consequences for equity and outcomes. In a briefing published on Thursday 11 September, the Royal College of Radiologists and the Society of Radiographers call for the Government to use the NHS Cancer Plan to remove unnecessary red tape that stifles innovation and creates a postcode lottery. The organisations argue that revising commissioning and reimbursement would enable faster, fairer access to advanced radiotherapy and new drugs closer to home. A clearer funding model, aligned with national plans to expand specialist care across settings, is presented as a route to improved patient experience, better resource use and more consistent adoption of proven technologies across the country.
Funding Barriers Limit Proven Innovations
Current commissioning and funding structures are described as misaligned with the goal of delivering world-class cancer care. Although the NHS pioneers leading treatments, the way those treatments are financed can discourage trusts from adopting them. The result is unequal access to innovations that could transform outcomes, with eligible patients in some areas missing out due to administrative hurdles and perverse incentives embedded in tariffs.
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Stereotactic Ablative Body Radiotherapy illustrates how an established technique can be held back by outdated mechanisms. SABR delivers precisely targeted radiotherapy from many directions to very small tumours in the lung, liver, lymph nodes, spinal cord and brain among other sites. By maximising dose to the tumour while sparing healthy tissue, it reduces side effects, shortens the number of treatment sessions and limits time in hospital. For patients, this can mean fewer appointments and a gentler experience. For the NHS, it can free beds and cut the need to manage complications, making care more cost efficient.
When introduced, SABR was subject to strict safeguards to ensure safe and effective implementation. While the technique has become well established, commissioning arrangements have not kept pace. Adoption can be slowed by a cumbersome application process and the funding available to trusts can fall short of the true cost of delivery. Faced with a deficit between tariff and expenditure, some providers choose less effective alternatives. This dynamic erodes consistency of care and entrenches regional disparities.
The organisations urge the Government to use the Cancer Plan to break this cycle. Making SABR and other innovative treatments routinely available to all eligible patients would reduce the postcode lottery and support a more coherent standard of care. Addressing the administrative and financial barriers that discourage uptake is presented as essential to ensuring that proven advances reach those who stand to benefit.
Aligning Commissioning with Patient Benefit
Reform is focused on commissioning rules and payment structures that shape clinical choices. The call is for the Cancer Plan to commit to rethinking how innovative treatments are funded so tariffs reward value and patient benefit rather than volume or legacy practice. Eliminating incentives that penalise the use of modern, cost-effective techniques would allow providers to adopt them without financial risk.
Funding should reflect the full cost of delivery, including the workforce needed to plan and provide complex radiotherapy. Where new approaches require additional expertise or training, innovation incentive payment could help bridge the gap from pilot to routine use. Service design should ensure access regardless of where people live, so that geography does not determine eligibility for advanced care.
A similar logic applies to drug treatments. Proper reimbursement would enable more therapies to be delivered in neighbourhood health centres, community pharmacies and, where appropriate, at home. This would align with commitments in the NHS 10 Year Plan to expand specialist treatments and improve access across settings. By shifting suitable elements of care closer to patients, the system could reduce pressure on hospitals while maintaining standards.
Professional consensus and clear guidance are also identified as critical. Medical royal colleges and other professional bodies are encouraged to work with regulators to agree frameworks that support safe, consistent adoption. By setting expectations on quality and pathways, national guidance can help providers scale innovations more rapidly and equitably once funding barriers are removed.
Professional Consensus Behind a Reset
The call for change is backed by expert leaders from the organisations involved. The Royal College of Radiologists highlights that, although the NHS delivers some of the most advanced cancer care globally, excessive bureaucracy is preventing equal access to innovative radiotherapy and new drugs. The Society of Radiographers emphasises timely access to the best care, with proper support for radiotherapy services and a focus on benefits wherever patients live. Both argue that the Cancer Plan offers a timely opportunity to rethink commissioning and encourage trusts to embrace innovation.
The UK SABR Consortium underscores the case through a decade of collaborative work with the NHS to expand access while maintaining safety and quality. Placing SABR on a level footing with other ablative therapies is presented as a pragmatic step that would allow expert clinical teams to make the best decisions for their patients within a solid funding framework. Redesigning the system is seen as a way for widening deployment, maintaining pace with emerging evidence and delivering fairer access across regions and nations.
Together, these perspectives converge on a practical agenda: remove the red tape that slows adoption, update tariffs so they cover real costs, provide targeted incentives for new capabilities and embed guidance that sustains high standards. With those elements in place, trusts would be better positioned to deliver innovations consistently and patients would be more likely to receive the most effective options available.
The message to policymakers is clear. Commissioning and funding should enable, not obstruct, the spread of proven cancer innovations. By reforming tariffs, covering full delivery costs, supporting training and ensuring access irrespective of postcode, the Cancer Plan could accelerate uptake of techniques such as SABR and extend the reach of new drug treatments into community settings and the home. For patients, that promises faster, fairer access to effective care closer to where they live. For services, it offers fewer side effects to manage, shorter pathways and better use of resources. Aligning funding with patient benefit would translate pioneering capability into consistent outcomes across England.
Source: Royal College of Radiologists (RCR)
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