Doctors warn red tape is creating postcode lottery for new cancer treatments in England

Senior cancer doctors have warned that excessive NHS bureaucracy is creating a postcode lottery in England that prevents some patients from accessing the latest cancer treatments.

The Royal College of Radiologists (RCR) said funding applications and commissioning processes can be “cumbersome” and leave smaller units without access to techniques routinely used in larger centres, including Stereotactic Ablative Body Radiotherapy (SABR). The college and the Society of Radiographers have asked the government to make SABR and other advanced therapies, such as some immunotherapies and molecular radiotherapy, more readily available.

The RCR said SABR — a technique that delivers a precise, high dose of radiation to very small tumours in organs such as the lung, liver, lymph nodes and brain — still requires individual cancer units to apply to NHS England for funding in some cases. "That is inequitable and unjust and not compatible with the National Health Service," said Dr Nicky Thorp, a practising cancer doctor and vice president for clinical oncology at the RCR. "We would like red tape to be cut and the commissioners to listen to clinicians who really understand the impact on patient care."

NHS England said every hospital trust that delivers radiotherapy is able to offer SABR and that it is committed to a more "streamlined approach" to expanding its use. The Department of Health described cancer care as an urgent priority and said an upcoming national cancer strategy, expected later this year, will aim to give patients "the most cutting-edge care." A department spokesman said the plan for change is already making an impact, with 148,000 more people having cancer diagnosed or ruled out within 28 days from July 2024 to June 2025 compared with a year earlier.

Clinicians argue the changes are urgent because advances in radiotherapy, immunotherapy and molecular radiotherapy are already driving improved survival for many common cancers. Molecular radiotherapy uses radioactive drugs to target cancer cells and some immunotherapies harness the immune system to attack tumours. But those advances require rapid adoption, training and investment, the RCR said, and current commissioning arrangements can slow that process.

Patient stories underline the potential impact of access differences. Ray Bowen, 76, from Middlesbrough, had one kidney removed in 2019 and was told in 2022 that surgery was not possible after cancer returned to his remaining kidney. He received SABR and said three years on he is recovering. "It's a magic treatment and without doubt it needs to be more available," he said.

Cancer charities have also raised concerns about delays in diagnosis that can affect outcomes. Cancer Research UK (CRUK) said only half of people diagnosed with cancer after an urgent referral are receiving their diagnosis within the 28-day target. For some cancers, including bone, bladder, kidney and head and neck cancers, only about a third of patients received a diagnosis within the target timeframe. Between 2021 and 2024, CRUK said the situation for people being diagnosed with cancer has worsened.

"It's promising that more people are having cancer ruled out on time, helping to put their minds at ease," said Michelle Mitchell, chief executive of Cancer Research UK. "However it's unacceptable that only half of people who have cancer are being diagnosed within the target timeframe." Jon Shelton, head of cancer intelligence at CRUK, added that follow-up tests to confirm the presence of cancer and to identify its type, particularly for complex cases, are taking too long and need to be carried out "as quickly as possible."

NHS England said it is seeing and treating more cancer patients than ever before and is rolling out initiatives such as home tests and mobile scanning trucks to help diagnose disease earlier. The health service pointed to the increased number of people diagnosed or ruled out within the 28-day period in the year to June 2025 as evidence of progress.

The debate comes as the government prepares to publish its long-awaited cancer strategy for England, now expected later this autumn. Ministers have said the strategy will seek to put the NHS "back at the forefront of global cancer care," addressing both faster diagnosis and broader access to new treatments. Clinicians and patient groups have urged the plan to set out clear mechanisms for removing funding barriers and ensuring equitable access across the country.

Until those changes are agreed, professional bodies warn that patients in some areas may continue to miss out on treatments already available elsewhere, potentially affecting outcomes and widening regional inequalities in cancer care.