Should the NHS purchase private radiotherapy provision for its patients to reduce the spread of Covid-19, release pressure on the NHS and save lives

Stay at home, protect the NHS, save lives” is the current, slightly authoritarian mantra of our new Boris Johnson led government, however it does seem to be working which is good news. The days of “get Brexit done” seem many eons ago and I am sure we would happily return to those days of “leavers and remainers”. That however is history now and at some stage soon so will this Covid-19 pandemic, at least for a period of time.

Private radiotherapy in the UK, a very brief history.

Things have changed dramatically in the provision of private radiotherapy since the Cromwell Hospital launched its innovative private radiotherapy service in the early 1980’s initially to offer treatments to the Abu Dhabi royal family. I recall being interviewed for a job as a radiographer there a few years after qualification and was impressed by the hotel feel of the place, carpets, lounges, free tea and coffee and award-winning food. This was far removed from the then concrete radiotherapy basement catacombs of some of the less exotic London based, ageing radiotherapy centres. The London Hospital in Whitechapel being one example that I recall, another being under the old cruciform building at the original University College Hospital site that were both foreboding places to train or work.

Where I trained at the Middlesex Hospital on Mortimer Street in trendy Fitzrovia, things were far better in my opinion but it was always thought then that due to the high cost of capital equipment and poor reimbursement rates, private radiotherapy would not catch on. We did see private cases at the Middlesex where we were also juxtaposed to Harley Street, either at the start or end of the day when the consultant radiotherapist would always be around and where the patient received entirely the same treatment and service as NHS cases but paid for the privilege.

Pic: London Hospital prior to the age of modern radiotherapy delivery.
Pic: An X-ray or Roentgen therapy bunker at the London Hospital in 1905 with little obvious shielding between patients. These days are long gone fortunately!
Pic: The Cromwell Hospital’s more modernist building in West London!

Now aside from the Cromwell, that has expanded its radiotherapy services over time, new commercial private providers have taken on the mantle: HCA innovating in Harley Street and now other locations nationally, The London Clinic, Aspen Healthcare in Wimbledon, Cancer Partners UK (now Genesis Care) and their very successful one Linac model radiotherapy centres in many easily accessible, provincial towns and now Rutherford Cancer Centres offering not only treatment on the latest state of the art Linacs, but also private Proton Beam Therapy added to MRI guided treatments at strategic national sites. There are others and more in the pipeline too.

Pic: The Rutherford cancer centres “advert” recently seen at Bristol Airport.

And so the main the point of my blog is this. Why is the NHS not subcontracting the private radiotherapy delivery sector at this critical time and not just private hospital beds and ventilators?

The NHS have started to prioritise patients for radiotherapy treatment, unheard of until now but is that action wholly necessary?

The national media have focused in on this issue now as it could be suggested that cancer services in general are now taking a back seat during the coronavirus crisis much to the anger of patients, radiotherapy professionals and service providers. This recent news item in the Daily Mail sums it up quite well.

Doctors tell patients to delay cancer treatment in case they catch coronavirus in hospital”

NHS England is telling doctors to group their cancer patients into ‘priority levels’ according to how crucial or effective their treatment is going to be, as coronavirus causes a delay to treatment.

Doctors have been told by NHS England to prepare for a ‘disruption of services’ in cancer units over the next few weeks due to staff sickness and shortages of drugs and equipment. They have been advised to group their patients into ‘priority levels’ according to how crucial or effective the treatment is likely to be.

Anyone whose chemotherapy or radiotherapy is expected to save their life – rather than just extend it or reduce symptoms – should be a priority one or two. Patients needing emergency surgery will also be in these top two categories.

You can read more here:

Private sector radiotherapy delivery

This sector is now vastly different to how it was towards the end of the 20th century. As discussed, state of the art equipment is used offering the latest, advanced treatment delivery and most importantly in the current climate the vast majority of the private radiotherapy centres are located far away from the busy NHS General and University based hospitals where you are most likely to come into contact with coronavirus and many other infectious diseases.

This is vitally important to you if you are in the vulnerable group according to the government guidelines and also have a supressed immune system, are elderly or have other concurrent illnesses like cancer for instance!

Pic: The latest state of the art Elekta Unity MRLinac

Many of the private radiotherapy centres are located on commercial business park or industrial estates, some located at quieter green-field private hospitals and others are stand-alone centres located on London high-streets or in larger, dedicated specialist cancer hospitals providing breathing space and both social and medical distancing from the extremely strained and what could be described now as a risky NHS hospital environment.

And so why prioritise or even cancel radiotherapy treatment for our UK cancer patients when there is likely to be plenty of capacity in the largely “risk-free” private sector just as there is with the private hospital beds the NHS have now commandeered. Surely it would make complete sense for all concerned?

NHS Scotland

Lastly, in Scotland where I am based, screening for breast, cervical and bowel cancer has now been stopped with no date published for its resumption and so this will lead to a delay in time-critical cancer treatment post Covid-19 especially important in the younger population, the demographic that paradoxically coronavirus seems not to be that harmful to.

Read more:

Added to the fact that cancer surgery is also being triaged so that only the most serious cases are being operated on presently and that the national death rate for cancer patients is around 165,000 people per year, far more than that predicted for people dying with coronavirus, these numbers need to be put into perspective and government policy needs to keep a sense of proportion. One could argue presently that cancer treatment is being sacrificed on the Altar of Covid-19, at least for the time being.

My last blog; “There is nothing so patient, in this world or any other, as a virus searching for a host.”- Mira Grant– however, we need to put Covid-19 into perspective and as radiotherapy professionals we are well positioned to do this…is available to read at where I take a longer look at cancer death rates and the modelling of the Covid-19 outbreak in the UK.

Duncan Hynd – April 1st 2020