SRAG 10/12
SCOTTISH GOVERNMENT HEALTH DIRECTORATES
SCOTTISH RADIOTHERAPY ADVISORY GROUP
Date: Friday 14th May 2010
Action Notes
Present:
Alan Rodger (Chair)
Jennifer Armstrong
Garry Currie
David Dodds
Rachael Dunk
Sara Erridge
Carrie Featherstone
Janice Fletcher
Sarah Grierson (SJG) (Secretariat)
Terry Kehoe
Ian Lees
AGENDA ITEM
1 WELCOME,
INTRODUCTIONS
AND APOLOGIES
Graham MacDonald
Alan Mcnair
Una Milne
Isobel Neil
Elizabeth Preston
Nicola Redgewell
Graeme Robertson
Lesley-Jean Rugg
Salam Souliman
Laura Steele (Secretariat)
Andy Wallace
By Videoconference:
Apologies:
Lesley Cairns
Diane Brawn
David Dunlop (DDun)
Gary Jenkins
Margaret Spalding
Steve Colligan
Tim Cooper
John Dewar
Peter Gent
David Linden
Carol MacGregor
Paddy Niblock
Michael Williams
In Attendance:
Neil McLaughlin
DISCUSSION
 Rachael Dunk, Head of Cancer Strategies, was
in attendance and hoped to attend at least two
SRAG meetings per year, as she does with other
advisory group meetings.
 Alan Rodger thanked Sara Erridge for fulfilling
her role as Acting Chair during his time in
Australia. Sara has also accepted Rachael
Dunk’s invitation to become Deputy Chair of
SRAG.
 Fraser Brunton has stepped down as Chair of
TSE and so no longer will be attending SRAG
meetings. Fraser was thanked for his sterling
ACTION(S) AGREED
LEAD(S)
DATE
1
SRAG 10/12





2 ACTION NOTES
FROM PREVIOUS
MEETING
contribution to TSE and SRAG. SGHD is
pleased that Garry Currie accepted the offer to
take on this role. Garry will attend SRAG with a
dual role and must advise when he speaks on
behalf of TSE or for his centre.
Isobel Neil, Programme Director - Cancer
Access, attended the meeting in the David
Linden’s (project lead for the Processes &
Pathways work) absence.
Alan McNair, Research Manager in the Chief
Scientist Office attended for the RT Research in
Scotland agenda item.
Although it was anticipated Ian Waugh (SG-Head
of Capital Planning) would be attending in
reference to agenda item 5, he was unable to
attend and it was noted that Jennifer Armstrong
would lead on this agenda item in his absence.
Neil McLaughlin attended in place of Peter Gent.
Apologies were received from John Dewar,
Graham MacDonald, Les Samuel, Steve
Colligan, Carol MacGregor, Peter Gent, Tim
Cooper and Michael Williams.
The action notes on SRAG 09/65, from 20th
The amended action notes will
be published on the Better
November, were approved with the following
amendment on page 14 (under the agenda item on Cancer Care web site.
In Vivo Dosimetry):
Helen Stewart noted that in Glasgow, there are not
the resources to put IVD on all their linacs.
to
Helen Stewart noted that in Glasgow, there is the
intention to introduce IVD on all their linacs.
SJG
June 10
2
SRAG 10/12
3
MATTERS
ARISING:
Proton Beam
4 TSE SUB GROUP
– REPORT FROM
CHAIR
5 CAPITAL
 Mike Winters from NSD is in the process of
finalising a paper on the Scottish Pathway for
Consideration of Funding of Proton Therapy,
which sets out an agreed pathway for use by all
Clinical Oncologists and others who would wish
to refer a patient for Proton Beam Therapy
funded by NHSScotland.
 Once finalised, this paper will be circulated to
SRAG for its ratification.
 Garry Currie updated SRAG on the earlier TSE
meeting, which was presented with three
business cases.
 A business case was submitted by NHS Highland
for a replacement linear accelerator. Although
the need for a replacement machine in NHS
Highland was approved, the preferred option of a
Tomotherapy machine, as specified in the
Highland business case, was not approved by the
majority of TSE members. TSE had agreed
Highland’s replacement machine, as with all
replacement equipment over the next two years,
should be procured by way of the national
strategic procurement project (see agenda item
#5).
 TSE had also approved the purchase of two
replacement simulators and a linear accelerator
for NHS Lothian, again, as part of the proposed
national procurement project.
Sarah Grierson to circulate
Mike Winters’ paper once
available for SRAG’s ratification
SJG/ALL
TBD
 SRAG agreed with TSE’s
recommendation to approve
the purchase of two
replacement simulators and a
linear accelerator for NHS
Lothian and a linear
accelerator for NHS Highland,
as part of the proposed
national procurement project.
ALL
n/a
 Jennifer Armstrong provided feedback from a
3
SRAG 10/12
PLANNING
meeting held on 31st March on RT Equipment
Procurement, involving TSE and financial
representatives from each centre. Paper SRAG
10/02 provides some background to this and is
an extract from a briefing that was submitted to
the Cabinet Secretary on this matter.
 At this meeting, a proposal was agreed by all
centres for rapid progression of national, strategic
procurement for all RT replacement equipment
specified on version 17 of the radiotherapy
replacement plan, for financial years 2010/112011/12.
 Due to the current financial climate and SG’s
commitment to continue to support all Scottish
cancer centres in replacing radiotherapy
equipment, a national procurement process will
ensure better value for money. It was confirmed
that project planning was underway to ensure the
speedy application of this process. The project
would entail the submission of one, national
business case for all equipment to be replaced
during 2010/11 and 2011/12, as per Version 17 of
the plan. This submission would strengthen the
negotiating position.
 John Slater, Health Facilities Scotland, had
written a paper with the following points being
agreed:
- approval from all sites on the outlined approach
- commitment to the single business case
approach
- commitment to exploring a turnkey approach
- commitment to provision of resources (i.e. Group
members)
- acknowledgement of tight timescales to achieve
 SRAG agreed to support the
national, procurement of
replacement equipment
exercise.
ALL
 Scottish Government were to
write to NHS Boards to
emphasis the importance of
SJG
4
SRAG 10/12
objectives.
6 UPDATE FROM
NRIG
7 REVIEW OF RT
ACTIVITY
PLANNING
REPORT
Development of
Agreed Data Set
(NATCANSAT
and Caldicott
Guardians)
their role in the national,
strategic
procurement
process, asking Boards to
ensure project arrangements
are in place to facilitate
timely sign-off of business
cases. SRAG will receive a
copy of this letter.
 John Slater would become the project lead, with
a project team being established with
representation from all centres. The project team
would be a subset of TSE and would report to an
overseeing project board.
 Although there were some concerns around
delays – including to the installation of NHS
Lothian’s and NHS Highland’s linacs – all
centres, TSE and SRAG gave its approval of this
proposal.
 It was noted at the meeting on 31st March that
TSE would receive outline business cases from
two centres in the meantime, in order to assess
the clinical and cost benefits.
Carrie Featherstone reported that the NRIG
SRAG to consider the NRIG
subgroup on complex technologies was looking at report once it becomes
clinical protocols for extra-stereotactic radiotherapy available.
and whether or not there is a need to commercially
engage with suppliers. A report is expected by the
end of the year.
 Jennifer Armstrong provided a verbal update on
the progress to date, including SGHD asking for
Caldicott Guardians’ consent to share data.
 Diane Brawn voiced her concerns on asking
every patient for consent and the (resourcing)
implications. In response, Jennifer noted that
ISD advice is as long as patients know about
data use and that they have the right to opt out,
there is no issue with seeking consent for each
individual database.
 Many NHS Boards produce standard leaflets
CF/ALL
2010
5
SRAG 10/12
Radiotherapy
Demand And
Capacity
Modelling and
Waiting Times
Progress from
the Pathways &
Processes Group
which inform patients how personal information is
used/disclosed and the reasons behind sharing
their information within NHS. All centres had
therefore been asked to ensure that patients
attending radiotherapy received an information
leaflet on data use. Information should also
advise how refusals are acted upon.
 The identification of patients in England has not
been an issue, since any rare tumours are
extracted from the data
 A Scottish representative on NATCANSAT would
be useful. It was felt that an ISD colleague could
represent Scotland and Jennifer will propose this.
 Isobel Neil’s team provided funding to five NHS
Boards to provide data to NATCANSAT so that
all centres should be ready for 20th June, which
is when the first download is to take place. There
may still be a software issue in NHS Tayside,
however.
Jennifer will liaise with
NATCANSAT and ISD to seek
Scottish representation.
 The final version of the Modelling Work on Future  Centres to contact Sara
Erridge / Carrie Featherstone
Demand was provided on paper SRAG 10/04 and
if data on page 10 of the
Carrie Featherstone and Sara Erridge were
report requires updating. If
thanked for the large amount of work to produce
no updates were provided by
this report.
31st May 2010, the report
 This piece of work will inform the Pathways &
would be considered to be
Processes Group’s work.
the final version.
 The C-PORT Project Manager, Christina Lilley,

SRAG will receive the report
has had her contract extended to work on the
in the autumn for
production of a report based on the modelling
consideration..
work and cancer incidence, looking at capacity
 Laura Steele to coordinate
issues and the feasibility of satellite centres.
and circulate details of the
 It was felt an additional meeting should take
September meeting.
JA
June 10
ALL
31 May 10
ALL
autumn 10
LS
June 10
6
SRAG 10/12
place in September, to focus discussions on the
demand and capacity work, including satellite
centres. This meeting will be for TSE and SRAG
members.
Secretary’s Note:
A meeting date for this half-day
meeting has been set for 23rd
September 2010.
 In David Linden’s absence, Isobel Neil joined the
meeting to provide an update (paper SRAG
10/05), including the group’s workplan and the
outcomes from the February workshop.
 There were 12 areas of work that relate to the
key themes emerging from the workshop, some
of which SRAG agreed to take forward (please
note, numbers relate to numbering on SRAG
10/05) i.e.
4. Consider recommendations for service
provision for lower volume radiotherapy
treatments. It would be helpful to determine a
definition of ‘lower volume’ for this strand of work.
8. Facilitate discussions with NES around role
development and career progression that helps to
address recruitment and retention issues. This
area is being looked at by the working group
chaired by Arthur Johnston (Short Life Working
Group on Physics Staffing for Radiography,
Radiotherapy and Nuclear Medicine in Scotland)
and it was agreed that to avoid duplication, SRAG
would consider the short life working group’s
discussions. However, SRAG would be interested
to learn NES’ view.
Carrie Featherstone to write a
paper proposing a definition of
what lower volume is.
CF
Aug 10
 Jennifer Armstrong to
provide feedback on the
JA
Aug 10
7
SRAG 10/12
working group.
9. Facilitate systems for regular and widespread
 Lesley-Jean Rugg and Diane
use of patient experience surveys in radiotherapy
Brawn to liaise and provide
centres. Consultation is undertaken with patients in
an update on staff surveys,
cancer centres and it would be useful to learn what
to include input from all five
surveys entail and how the results are used for
centres.
service improvement.
 SRAG to receive a
presentation at its next
meeting on what surveys
involve (i.e. methodology,
questions asked, how results
are used, how feedback is
given).
10. Increase profile of SRAG and TSE e.g.
 Any good practice or
through regular communication to staff working in
common themes should be
radiotherapy centres.
fed back to the SG
Healthcare Quality Strategy
team via Sarah Grierson.
This work will feature in the
Scottish Cancer Taskforce
newsletter.
11. Establish Radiotherapy research and trials
network to maximise opportunities and capacity for
patients to participate in trials across Scotland.
Secretary’s Note:
Following the meeting, it was
confirmed that:
 Alan McNair can put SRAG
members in contact with
relevant people from the
Scottish Cancer Research
Network (SCRN) to help
develop links.
 CSO can advise SRAG if a
more formal network is
L-JR, DB
Aug 10
L-JR, DB
Aug 10
ALL/SJG
n/a
SJG
Newsletter
due to be
published
in Sep 10
SJG
Aug 10
Alan
McNair
TBD
8
SRAG 10/12
proposed and if requested,
Alan McNair can organise a
discussion between SCRN
and SRAG to see if there is
any 'common ground'.
 Alan McNair will extend an
invitation for SRAG
representation to the next
SCRN annual meeting (date
will be confirmed).
12. Review current patient and generalist health
professional awareness about radiotherapy
practice. Janice Fletcher is coordinating a
conference for patients around the promotion of
radiotherapy in October. Nurses are attending the
event, who are often the ones who disseminate
information to patients. A questionnaire can be
circulated at the beginning and end of the event, to
determine and compare the level of information
learned at the event. The initial questionnaire can
be used as a baseline.
The Pathways & Processes Group will take
forward the following pieces of work:
1. Commission a survey of outcomes for patients
who have had radiotherapy (using an approach
modified but similar to the NCEPOD chemotherapy
study of 2009) There was a discussion around if
the benefits of an analysis of radiotherapy patients
dying 30 days after treatment would merit the
resources required for such an exercise, since it
would not be possible to ascertain which patients
 Sara Erridge to attend the
NRIG Awareness Day on
11th June and will feedback
to SRAG at the August
meeting (under Matters
Arising).
 SRAG members to suggest
questions to be included in
the survey to Una Milne (via
Sarah Grierson).
 Janice Fletcher to provide
feedback from her event.
In order to provide feedback on
the Pathways & Processes
Group, David Linden/Isobel
Neil and Christina Lilley to be
invited to future SRAG
meetings, including the
extraordinary meeting being
held in September.
SE
Aug 10
ALL/SJG/
UM
Sept 10
JF
Oct 10
SJG
ongoing
Secretary’s Note:
9
SRAG 10/12
died as a direct result of their treatment within such
a limited timescale. However, the group felt the
exercise would be beneficial to explore the number
of patients who may not have required
radiotherapy. The Pathways & Processes Group
would take forward this piece of work, with support
provided by SRAG.
Jennifer Armstrong, Isobel Neil
and David Linden to explore
data linkage with David
Brewster, ISD.
JA, Isobel
Neil and
David
Linden
July 10
2. Undertake assessment of current capacity and
efficiency using site visits to ensure that measures
are comparable across centres. The working
group is visiting Sheffield in June, as
recommended by Tim Cooper.
3. Recommend feasibility study around
acceptability and cost effectiveness of extended
working hours and weekend working.
5. Benchmark current improvement methodology,
the impact this has made on ways of working and
potential for further work.
6. Explore patient transport issues and how these
impact upon radiotherapy capacity.
7. Establish national clinical working groups to
review and implement clinical management
guidelines
R-PORT
 Jennifer Armstrong informed the group that as
part of her extended work to support the
Pathways & Processes group, Christina Lilley,
the C-PORT Project Manager, will also be
facilitating the introduction of R-PORT to
10
SRAG 10/12
Scotland. Liz Preston is the R-PORT lead for
SRAG.
 Christina Lilley was unable to attend today, but
will attend a future SRAG as an observer.
 It would be helpful for an R-PORT lead to be
identified for each centre.
Workforce
Planning
Expected Radiography Establishments
 Lesley-Jean Rugg originally provided the
information outlined in SRAG 10/06 to help inform
the February workshop, following a request at
SRAG’s November meeting. Although the data
on the paper may have changed since its
creation, the issues remain valid. It was agreed
the establishments seemed current.
 The data is based on the original SoCR
document (since the new SoCR document is to
be read only in conjunction with the original
document).
 Retiral age is set as 60 years.
 Edinburgh cancer centre’s establishment
comparisons look relatively low.
 Some NHS Boards are freezing vacancies.
 Margaret Spalding asked if SRAG could apply
pressures where possible, since there are a
number of graduates in the education system but
the there are limited posts available. Graduates
may have to move south of the border for
recruitment (vacancies tend to be at senior
grades, therefore, not applicable to graduates).
 It would be useful if there were two recruitment
opportunities, rather than one, each year.
 An R-PORT lead should be
identified to Liz Preston (via
Sarah Grierson) for each
centre.
All
Centres/
SJG
June 10
 Lesley-Jean Rugg to update
the paper with summer
graduation figures for
September’s extraordinary
meeting.
 Liz Preston to circulate paper
SRAG 10/06 to her Regional
Cancer Group, to draw this
area and comparative data to
their attention.
L-JR
Sept 10
LP
June 10
Margaret Spalding to produce a
paper for the extraordinary
SRAG meeting to give an
overview of the situation with
graduates in 2010 and to
include
- the numbers who received
employment in Scotland
- the numbers who moved to
other UK countries for work
MS
Sept 10
11
SRAG 10/12
Short Life
Working Group
on Physics
Staffing for
Radiography,
Radiotherapy and
Nuclear Medicine
in Scotland
8 BRACHYTHERAP
Y
Update to
NoSCAN Gynae
BT Progress
Report
National Review
of Brachytherapy
 Graeme Robertson and Jennifer Armstrong
attended a short life working group, looking at
radiation protection and screening, as well as
recruitment management.
 Another meeting is planned for June – which
NES will also attend - and data should be
available on the existing establishments and
vacancies.
 The conclusions are awaited.
 In the letter to Richard Carey, Chair of NoSPG,
SRAG requested quarterly reports on how the
project is progressing. Peter Gent had written a
letter to the Cancer Strategies team and although
not available today, Neil McLachlan, MCN
Manager (CRC, Gynaecology, Haematology &
Upper GI Cancer) for NoSCAN, attended SRAG
to talk to this paper (SRAG 10/07).
 Neil McLachlan reported that although gynae
brachytherapy is progressing in the north,
installation of PDR is taking longer than had been
anticipated, however, it is expected to be in place
and operational by the end of the year.
 Neil McLachlan asserted that a contingency plan
for the north as a result of George Plataniotis’
(NHS Grampian) departure is not required.
- the numbers who remained
in Scotland, without a job in
the field
- the reasons why
submissions seem high.
 The SRAG physics
representatives are to liaise
to write a paper, providing
information for the
September extraordinary
meeting (along similar lines
as SRAG 10/06).
GR/TK/GC
/SS/SC
Sept 10
SJG/PN
Sept 10
Peter Gent or his deputy
(Gillian Christie) is to provide a
further written report for
SRAG’s August meeting.
PG
Aug 10
Peter Gent to confirm if a
contingency plan is required
following the notice given by
Aberdeen’s brachytherapist.
PG
June 10
 Jennifer Armstrong provided a verbal update,
12
SRAG 10/12
advising the National Review Group, chaired by
Gareth Davies, met in March 2010.
 The terms of reference and membership had
been agreed and the group is in the process of
drawing up a draft framework for the final report.
 Contingency planning will be addressed as part
of the National Review.
 SRAG will be kept informed of progress.
 Following this meeting, a request was made to
NHS QIS’ Scottish Health Technology
Assessment Group for an evaluation note on
brachytherapy (refer to SAG 10/09), which will
help inform the review. The results are due in
June 10.
9 COMPLEX
 SRAG 10/08 comprised a letter that was written
TECHNOLOGIES
to the cancer centres by SG (signatory Sara
Erridge, when she was fulfilling her role as Acting
In Vivo Dosimetry
Chair of SRAG). The letter outlines the position
which has been proposed to be adopted for
Scotland as an interim only.
 The proposed position confirms that IVD should
be used in a random selection of radical patients
receiving photon 3D CRT– a minimum of 10% of
patients within each tumour site undergoing
radical treatment (a minimum of 10 patients per
annum) assessed each year and to include all
patients for the first three months following the
introduction of any new development (or a
minimum of the first 10.
 This position was proposed pending a review of
clinical and cost effectiveness by the Scottish
Health Technologies Group of both IVD and exit
dosimetry.
SRAG to receive its next
update at the August meeting.
SJG
Aug 10
13
SRAG 10/12
 It was stressed to the group that this proposed
position provides a minimum requirement and
acknowledges that some centres are already
exceeding the recommendations
 SGHD is following this letter up with the two
centres not currently delivering IVD.
Health
Technology
Assessments
10 VERT
11 PATIENTS’
ISSUES
SRAG 10/09 outlines the HTA requests, following
consultation with SRAG and the National
Brachytherapy Review Group. NHS QIS Scottish
Health Technology Assessment Group has agreed
to conduct these and their assessments should be
concluded by June 2010.
Outcomes from the DH
 The SoCOR (draft) report on VERT has been
evaluation report to be
circulated to NRIG but has been embargoed till
considered by SRAG.
21 May, to allow NRIG to comment on it (since
they commissioned it). Once it becomes available
after 21 May, Sarah Grierson can circulate for
‘virtual’ discussion by SRAG.
 The Cabinet Secretary is keen to be kept
informed of SRAG’s discussions and
recommendations on VERT and so we need to
carefully consider the report and its implications
for Scotland. It may even require a small group
of people to consider this in more detail before a
recommendation can be made to the Cabinet
Secretary.
A children’s day is being run by Maggies Centres,
to that children who have parents with cancer can
meet other children in similar situations. Very
positive feedback has been received from these
events.
A similar event has taken place in NHS Tayside,
which has run open evenings in the past, aimed at
ALL
TBD
14
SRAG 10/12
reducing the ‘mystique’ of cancer treatments –
patients can visit the centre, meet professionals
and see the treatment rooms.
Ian Lees (SRAG patient representative) expressed
an interest in attending such events and
representatives from the Dundee confirmed they
would be willing to facilitate his attendance at any
events they hold in the future. It was notes that
some funding for events could be provided by
patient groups (to cover catering costs etc)
although it was agreed staffing costs for out of
hours events also have to be considered.
12 RT RESEARCH IN Secretary’s Note:
This agenda item was taken at the start of the
SCOTLAND
meeting.
 Sara Erridge had provided a summary of the
current situation for research in Scotland in paper
SRAG 10/10. The questions posed in the paper
are how to develop a Scottish strategy and how
to get some funding for this.
 CSO is currently providing funding of £6million
per annum which includes radiotherapy research.
Alan McNair advised the group that since
autonomy has been given to the NHS Boards on
the way they spend SG investment, the clinical
community need to collaborate nationally and
discuss any radiotherapy research issues with
the research & development directors.
 David Dodds reported that Glasgow is soon to
appoint a research professor.
 Margaret Spalding noted that NHS Boards should
engage with the higher education institutes for
15
SRAG 10/12
support.
 Sara Erridge as the Deputy SRAG Chair to attend SE to attend the NHS
Research Scotland meeting on
the NHS Research Scotland meeting on 9th July.
9th July and feedback to the
group (August 2010).
Secretary’s Note:
Alan McNair left the meeting following the agenda
item.
13 RT Incidents in
New York
SE
Aug 10
Sara Erridge provided this NY Times article (SRAG
10/11) regarding incidents in RT treatment in USA.
Alan Rodger read out the following comments
provided by Arthur Johnston:
The most surprising feature of this article for me was
the number of incident reports:
'Even though many accident details are confidential
under state law, the records described 621 mistakes
from 2001 to 2008. While most were minor, causing no
immediate injury, they nonetheless illuminate
underlying problems.
The Times found that on 133 occasions, devices used to
shape or modulate radiation beams — contributing
factors in the injuries to Mr. Jerome-Parks and Ms. JnCharles — were left out, wrongly positioned or
otherwise misused.
'On 284 occasions, radiation missed all or part of its
intended target or treated the wrong body part entirely.'
It might be useful if someone could shed some light on
why these numbers (for NY State) are apparently so
much higher than anything we'd expect in the UK.
Arthur
16
SRAG 10/12
14
AOCB
The consensus from the group was that Scotland
would not be in a similar position to USA as USA
has smaller, commercial centres, many of which
may only commission physics to install equipment
(i.e. and not have physicists on the establishment
on a permanent basis).
 Alan Rodger raised the point that centres
need to provide SGHD early warning of any
issues, including those that may have that
are likely to impact on waiting times, so that
SRAG and SG are kept informed in the
case of any media queries.
 A Royal College of Radiologists event is
being held on 22nd September on
stereotactic body radiation. In addition,
members were advised of a lung specific
stereotactic radiotherapy event in Leeds on
the 11th of June.
 All centres will proactively
contact SGHD with any
issues in cancer centres,
including waiting times.
 Laura Steele to circulate the
Royal College of
Radiographers event details
with the action notes.
Secretary’s Note:
Event details can be found
at:
https://www.rcr.ac.uk/members
area/multievents/displayEvent.a
sp?Type=Full&Code=COASM
2010
ALL
ad hoc
LS
June 10
DATES OF NEXT MEETINGS
 The meeting on Thursday 10th August has now been cancelled.
 Thursday 4th November, Scottish Health Services Centre (video conferencing available)
Cancer Strategies
June 2010
17