The cost and benefits of the national health service acquiring two proton beam therapy (PBT) facilities hosted at University College London Hospital and Christie NHS Foundation Trust have been based on the best available international information and a market testing exercise. The approach taken has followed the Treasury guidance to mitigate financial risk while providing good value for money. The risk inherent in a project of this size and complexity has to be balanced against the loss of potential benefits to patients by not providing this treatment.

The modelling to demonstrate the benefits of PBT used the best available alternatives currently offered as a comparator, including intensity modulated radiation therapy (IMRT), if it was clinically indicated. PBT is fundamentally different to other forms of radiotherapy (including IMRT, stereotactic ablative radiotherapy and radiosurgery) in that the treatment beam can be focused deep within the body to an accuracy of less than one millimetre. This makes it particularly suitable for the treatment of tumours close to vital organs, especially in small children. The best expert evidence available has suggested that the benefit PBT will have over conventional radiotherapy for the tumour sites we have considered is unlikely to reduce, even with developments that are currently in the pipeline. Some countries, including Germany and Japan, have investigated using heavy ions as a form of radiotherapy. This approach uses PBT accelerator technology, but is still in the experimental stage. The NHS has not considered investing in this technology as the results are currently mixed. Benefits of heavy ion technology would be for a different group of patients.

The cost and benefits of the national health service acquiring two proton beam therapy (PBT) facilities hosted at University College London Hospital and Christie NHS Foundation Trust have been based on the best available international information and a market testing exercise. The approach taken has followed the Treasury guidance to mitigate financial risk while providing good value for money. The risk inherent in a project of this size and complexity has to be balanced against the loss of potential benefits to patients by not providing this treatment.

The modelling to demonstrate the benefits of PBT used the best available alternatives currently offered as a comparator, including intensity modulated radiation therapy (IMRT), if it was clinically indicated. PBT is fundamentally different to other forms of radiotherapy (including IMRT, stereotactic ablative radiotherapy and radiosurgery) in that the treatment beam can be focused deep within the body to an accuracy of less than one millimetre. This makes it particularly suitable for the treatment of tumours close to vital organs, especially in small children. The best expert evidence available has suggested that the benefit PBT will have over conventional radiotherapy for the tumour sites we have considered is unlikely to reduce, even with developments that are currently in the pipeline. Some countries, including Germany and Japan, have investigated using heavy ions as a form of radiotherapy. This approach uses PBT accelerator technology, but is still in the experimental stage. The NHS has not considered investing in this technology as the results are currently mixed. Benefits of heavy ion technology would be for a different group of patients.

In October we announced that there would be guaranteed access to innovative radiotherapy where it is clinically appropriate, safe and cost effective from 1 April 2013. From this date onwards, radiotherapy will be planned and paid for nationally by the NHS Commissioning Board (NHS CB), so the same commissioning policies will apply across the country and cancer patients will be considered for the most appropriate radiotherapy treatment regardless of where they live.

Funding compatible with the cancer drug fund will not be required to deliver this guarantee. We have committed to establish a £15 million Radiotherapy Innovation Fund, available until the end of the current financial year, aimed at helping radiotherapy centres that are not delivering treatment using intensity modulated radiotherapy (IMRT), or are not doing as much as they should, to develop the capacity and capability to deliver at the appropriate level from April 2013.

From that point onwards, the NHS CB will be responsible for commissioning radiotherapy services and will provide access to radiotherapy, including IMRT, stereotactic ablative radiotherapy and stereotactic radiosurgery where it is clinically appropriate, safe and cost-effective.

The criteria for allocation of the fund have not yet been finalised. There is likely to be a fixed sum allocated to all centres so all hospitals with radiotherapy centres will benefit. Bids will be sought for the remainder of the fund. While the priority for the fund will be IMRT, bids relating to preparing to deliver appropriate levels of other advanced technologies, particularly image guided radiotherapy, may be considered from radiotherapy centres where IMRT is already being delivered at appropriate levels.

The radiotherapy innovation fund is a revenue fund and cannot be used to purchase equipment that requires capital funding. Providers are responsible for maintaining and replacing high value equipment. Trusts need to prioritise their investments and ensure that they have sufficient equipment to provide high quality, safe and cost-effective services for patients.

To encourage the national health service to update the existing medical technology infrastructure, the Department established a £300 million fund in March this year to bulk purchase medical equipment and achieve better prices for the NHS. The fund is operated by NHS Supply Chain.

The radiotherapy innovation fund is a revenue fund and cannot be used to purchase equipment that requires capital funding. The fund is not accessible by patients, it is aimed at helping radiotherapy centres that are not delivering treatment using intensity modulated radiotherapy (IMRT), or are not doing as much as they should, to develop the capacity and capability to deliver at the appropriate level from April 2013.

The criteria for allocation of the fund have not yet been finalised. There is likely to be a fixed sum allocated to all centres so all hospitals with radiotherapy centres, including those in the north-east, will benefit. Bids will be sought for the remainder of the fund. While the

priority for the fund will be IMRT, bids relating to other advanced technologies, particularly image guided radiotherapy, may be considered from radiotherapy centres where IMRT is already being delivered at appropriate levels.

Providers are responsible for maintaining and replacing high value equipment. Trusts need to prioritise their investments and ensure that they have sufficient equipment to provide high quality, safe and cost-effective services for patients.

To encourage the national health service to update the existing medical technology infrastructure, the Department established a £300 million fund in March this year to bulk purchase medical equipment and achieve better prices for the national health service. The fund is operated by NHS Supply Chain.

As part of the national support also being provided to radiotherapy centres, teams of experts will be visiting those delivering IMRT at low levels to help them develop robust action plans for delivery from April 2013. During these visits, local teams will also be able to seek assistance from the experts in developing business cases for other appropriate equipment they may need.

We have committed to establish a £15 million Radiotherapy Innovation Fund from October 2012 to enable providers to prepare to deliver from April 2013 certain advanced radiotherapy to all patients who might benefit.

The radiotherapy fund is a revenue fund and cannot be used to purchase equipment that requires capital funding. The fund is not accessible by patients, it is aimed at helping radiotherapy centres that are not delivering treatment using Intensity Modulated Radiotherapy (IMRT), or are not doing as much as they should, to develop the capacity and capability to deliver at the appropriate level from April 2013.

The criteria for allocation of the fund have not yet been finalised. There is likely to be a fixed sum allocated to all centres so all hospitals with radiotherapy centres will benefit. Bids will be sought for the remainder of the fund. While the priority for the fund will be IMRT, bids relating to other advanced technologies, particularly Image Guided Radiotherapy, may be considered from radiotherapy centres where IMRT is already being delivered at appropriate levels.

Providers are responsible for maintaining and replacing high value equipment. Trusts need to prioritise their investments and ensure that they have sufficient equipment to provide, high quality, safe and cost effective services for patients.

To encourage the national health service to update the existing medical technology infrastructure, the Department established a £300 million fund in March this year to bulk purchase medical equipment and achieve better prices for the NHS. The fund is operated by NHS Supply Chain.

As part of the national support also being provided to radiotherapy centres, teams of experts will be visiting those delivering IMRT at low levels to help them develop robust action plans for delivery from April 2013. During these visits, local teams will also be able to seek assistance from the experts in developing business cases for other appropriate equipment they may need.

The Department has asked the National Radiotherapy Implementation Group (NRIG), which includes representatives of the professional bodies and Cancer Research UK (CRUK), to finalise criteria that will mean that funding is allocated proportionately and will be used to ensure that advanced techniques are available for patients. Based on this work, the Department will allocate the funding. NRIG is also developing a programme of national support including visits from expert teams and national training aimed at clinical teams. CRUK is providing project management support for this work.

Almost all radiotherapy machines in this country are able to deliver treatment using IMRT. However, a survey undertaken earlier this year reported that only four of the 50 radiotherapy centres in England were delivering inverse planned IMRT at the level recommended in NRIG guidance of 24%.

The National Cancer Director, Professor Sir Mike Richards, has commissioned NRIG to produce a report setting out the state of radiotherapy in England in 2012. This report, which will be published shortly, will include survey data showing the wide variation in IMRT activity around the country and identify the centres with the lowest activity.