Scottish Government

ISBN 0 7559 4929 3

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CONTENTS

ACKNOWLEDGEMENTS

EXECUTIVE SUMMARY AND RECOMMENDATIONS

Chapter 1 INTRODUCTION
CONTEXT
BACKGROUND
METHODS
SCOPE

Chapter 2 PROJECTED PATTERNS OF DISEASE
METHODS
SUMMARY OF RESULTS

Chapter 3 HORIZON SCANNING
METHODS
INDICATIONS FOR RADIOTHERAPY
Current Versus Optimal/Appropriate Radiotherapy Utilisation
Potential Changes to Radiotherapy Indications
The Gap Between Current and Optimal Utilisation
RADIOTHERAPY FRACTIONATION SCHEDULES & TREATMENT TECHNIQUES
Current Fractionation Schedules and Treatment Techniques
Optimal Future Fractionation Schedules and Treatment Techniques
Issues and Sensitivities
Variation in Fractionation Schedules
TECHNOLOGIES
New and Emerging Technologies and Techniques
Streamlining Technologies
ESTIMATING REQUIRED RADIOTHERAPY SERVICE CAPACITY 2011-2015

Chapter 4 SERVICE MODELS
CURRENT SCOTTISH SERVICE CONFIGURATION
Highland issues
MODELS FOR PROJECTING LINAC REQUIREMENT
CURRENT SCOTTISH SERVICE MODEL
SERVICE MODEL VARIABLES
Number of Treatment Fractions Delivered per Hour
Working Hours a Day
Working Days a Week
Working Days a Year
PROPOSED SERVICE MODELS
Model A
Model B
Model C

Chapter 5 SERVICE MODEL APPRAISAL
SERVICE MODEL OVERVIEW
ADOPTING MODEL B AND/OR C - THE ISSUES
Transition of Core Oncology Service
Patient Attendance
Workforce, Recruitment, Training and Retention
Linac Life Expectancy
Optimising Service Workloads
ECONOMIC EVALUATION
SERVICE MODEL RECOMMENDATIONS
CONFIDENCE IN PROPOSED WAY FORWARD

Chapter 6 PATIENT & CARER INVOLVEMENT
OPTIMISING PATIENT TRAVELLING TIMES
PATIENT ACCOMMODATION & TRANSPORT
Accommodation
Transport

Chapter 7 WORKFORCE
KEY STAFF GROUPS
GENERAL ISSUES
CURRENT RADIOTHERAPY WORKFORCE
Clinical Oncologists
Radiotherapy Physicists
Therapeutic Radiographers
ESTIMATED FUTURE RADIOTHERAPY WORKFORCE REQUIRED
Clinical Oncologists
Radiotherapy Physicists
Therapeutic Radiographers
WORKFORCE SUPPLY
Clinical Oncologists
Radiotherapy Physicists
Therapeutic Radiographers
BALANCING THE WORKFORCE SUPPLY AND DEMAND

RECOMMENDATIONS & CONCLUSIONS
REFERENCES
GLOSSARY
ACRONYMS

APPENDICES
Appendix A Radiotherapy Activity Planning Group Membership & Remit
Appendix B Radiotherapy Activity Planning Report to the HDMB 2003
Appendix C Radiotherapy - A Multi Step Treatment Process
Appendix D Radiotherapy Horizon Scanning Working Group Membership & Remit
Appendix E Optimal Radiotherapy Utilisation Modelling - Methodology
Appendix F Clinical Decision Trees by Cancer Site
Appendix G Scottish Radiotherapy Modelling by Cancer Type
Appendix H Retrospective Audit of Radiotherapy Activity Scotland 2003
Appendix I Clinical Oncology Surveys - Examples
Appendix J Horizon Scanning Report - Technologies and Techniques
Appendix K Horizon Scanning Report - Streamlining Technologies
Appendix L The Radiotherapy Workforce - Description of Key Professional Groups

TABLE OF FIGURES

1 Projected Trend in Cancer Incidence 1996 - 2020
2 Head and Neck Cancer Clinical Decision Tree
3 Location and Geographical Area Served by Scottish Cancer Centres
4 Current Patient Pathway to the Five Scottish Cancer Centres
5 Patient Pathway to the 5 Scottish Cancer Centres Optimised by Travelling Time

TABLE OF TABLES
1 Projected Cancer Incidence in Scotland 2011-2015
2 Radiotherapy Indications & Estimated Patient Numbers for Scotland 2011-2015
3 Comparison of Current Radiotherapy Utilisation with Optimal Radiotherapy Utilisation
4 Optimal Radiotherapy Utilisation for Head and Neck Cancers
5 Future Optimal Fractions Required for Head and Neck Cancers
6 Estimated Fractions (Demand) for Scotland by Cancer Type 2011 - 2015
7 Current, Actual and Estimated WTE for Scottish Radiotherapy Service based on current Workforce Models