BMJ  2007;334:381 (24 February), doi:10.1136/bmj.39128.707569.3A

Letters

Radiotherapy harm

Service delivery should be funded centrally

Donaldson does a considerable disservice to the work of the multidisciplinary members of radiotherapy departments, including radiographers and physicists, and misleads the more general readership of the BMJ, in implying that these errors are not being actively addressed.¹

Following the incident at the Beatson Oncology Centre, Glasgow, every department in the United Kingdom was asked to evaluate its service in the light of the report.² Fourteen separate action points were identified by our team, the first and most important of which is chronic understaffing in the treatment planning section. Even though processes are robust, most of the checking procedures are manual, and rely on staff working efficiently at a reasonable work rate; we compare unfavourably with the Beatson in terms of staff (especially physicists), linear accelerators, and patient ratios.

There are, undoubtedly, process flaws, but they lie less in the processes and standard operating procedures staff use in radiation treatment, and more in the processes involved to secure the funding to redress deficiencies. Most departments in the UK are based in district general hospitals, and any bids for service improvements are considered in direct competition against other services, in an atmosphere of two week cancer waits, and other "must do" performance targets (some of which have associated financial incentives).

While the ultimate accountability for clinical governance sits with provider organisations, the performance management sits with commissioners. However, in the 12 months since our last submission for increased resources in radiotherapy was made, we have become part of a new cancer network; the five main primary care trusts whose patients we treated no longer exist, and nor does the strategic health authority. To whom, therefore, should we be putting forward our business cases? And what are their funding decisions likely to be in these financially challenged times?

Glasgow is a wake up call, not only for individual departments but for the NHS as a whole: this is a national issue, not a local one.

Essex County Hospital, Colchester CO3 3HY

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Competing interests: None declared.

References

1. Donaldson L. Reducing harm from radiotherapy. BMJ 2007;334:272. (10 February.)[Free Full Text]
2. Unintended overexposure of patient Lisa Norris during radiotherapy treatment at the Beatson Oncology Centre, Glasgow in January 2006. Report of an investigation for IR(ME)R.

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Reducing harm from radiotherapy

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