Radiotherapy populations for England, Wales and the UK
Reporting period: 01 April 2021 - 31 March 2022
About the NDRS
The National Disease Registration Service (NDRS) is part of NHS England (NHSE). Its purpose is to collect, curate, quality-assure and analyse on patients with cancer, congenital anomalies, and rare diseases. It provides robust surveillance to monitor and detect changes in health and disease in the population. NDRS is a vital resource that helps researchers, healthcare professionals and policy makers make decisions about NHS services and the treatments people receive.
The NDRS includes:
- the National Cancer Registration and Analysis Service (NCRAS)
and
- the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS)
Healthcare professionals, researchers and policy makers use data to better understand population health and disease. The data is provided by patients and collected by the NHS as part of their care and support. The NDRS uses the data to help:
- understand cancer, rare diseases, and congenital anomalies
- improve diagnosis
- plan NHS services
- improve treatment
- evaluate policy
- improve genetic counselling
For queries relating to this document, please contact rtds.helpdesk@nhs.net
Introduction
Radiotherapy is a major treatment modality in the care of patients diagnosed with cancer. Treatment can be delivered with curative intent or with a view to disease control or palliation of symptoms associated with advanced disease.
The national radiotherapy dataset (RTDS) is collected from radiotherapy providers in England and includes information about treatment delivery for all patients treated within the NHS. Radiotherapy is delivered by 51 NHS providers across England, each receiving referrals from surrounding primary, secondary and third sector care providers. Planning of radiotherapy services relies upon an understanding of the expected number of patients requiring treatment in a provider’s catchment area. As such, defining the number of people within these catchment areas and their geographical location is crucial to inform service planning. Here we aim to provide this information, based upon existing data captured by the National Disease Registration Service in combination with geographical population data provided by the Office for National Statistics (ONS).
Methods
To derive England and Wales radiotherapy center populations, all radiotherapy episodes were linked to a patients postcode. Each radiotherapy episode captures the radiotherapy center it was delivered at. Using the national postcode directory (ONS) file, these postcodes were then linked to identify the Middle Super Output Area (MSOA, a geographical region including 5,000-15,000 people) in which each patient resides. As all radiotherapy episodes in each MSOA have their delivery NHS radiotherapy provider captured, the percentage of radiotherapy activity in each MSOA delivered by each NHS Trust was calculated. Using the 2021 MSOA mid-year populations we then assigned the appropriate proportion of each MSOA population to each provider organisation.
Example: 35% of radiotherapy activity for patients living in E1234500 was delivered at Trust A, therefore 35% of the population for E1234500 will be assigned to Trust A.
MSOA population figures are not available for the Channel Islands, Isle of Man, Northern Ireland and Scotland. To account for radiotherapy activity delivered in English and Welsh radiotherapy centers to non-England and Wales patients a formula was created that divided the total 2021 population for England and Wales by the total number of radiotherapy episodes delivered to residents of England and Wales in 2021/2022.
Example: 59,660,524 England and Wales residents / episodes = 417 people per episode.
For each episode delivered to a patient from the Channel Islands, Isle of Man, Northern Ireland and Scotland, the number of episodes delivered to these individuals was multiplied by the above adjustment figure.
Example: 23 episodes are received by Scottish residents in Trust A in England = 23 episodes * 417 = 9,591 additional people added to Trust A. This approach assumes the treatment rate in Scotland is the same as that seen in England and Wales - see Appendix.
During this exercise a number of patient postcodes did not map to the postcode directory, at closer inspection these were identified as the following:
- No fixed abode, invalid, not known, null (N=141/ 0.10%)
- Overseas patients (N=193 / 0.13%)
No adjustment to the population size was possible for these cases and as such they were excluded from the radiotherapy episode activity and population calculation.
Any MSOA that had no radiotherapy activity assigned i.e. no patients known to reside in that MSOA were treated with radiotherapy during the time period of interest, that MSOA population was not accounted for in the populations calculation. In 2021/2022 all MSOAs were accounted for - see Appendix 1.
The total catchment populations are reported in three ways:
- UK populations – these report catchment populations for all NHS radiotherapy centers in England and Wales and include the allocation of both English and Welsh MSOA populations based on the radiotherapy activity delivered. UK populations also include the described adjustment to account of radiotherapy activity delivered to patients who live in Scotland, Northern Ireland, Isle of Man and the Channel Islands.
The UK population estimates are the total of the Welsh or English estimates and the adjustment. As an example, the population for Barts Health NHS Trust is 1,438,866 in the England populations table and 1,440,117 in the UK populations table. This is because the UK estimate includes the adjustment of 1,251 people, as reported in Appendix 1.
The overall UK population is estimated to be 59,895,708 people. This is derived from a population in England of 56,554,891, Wales of 3,105,633 and adjustment of 235,188.
England populations – these report catchment populations for all NHS radiotherapy centers in England and include the allocation of both English and Welsh MSOA populations based on the radiotherapy activity delivered. The MSOA populations for England are a subset of the UK populations where the trust was located in England.
Wales populations – these report catchment populations for all NHS radiotherapy centers in Wales and include the allocation of both Welsh and English MSOA populations based on the radiotherapy activity delivered. The MSOA populations for Wales are a subset of the UK populations where the trust was located in Wales.
Derived radiotherapy center populations
England populations
Table 1: Populations derived for radiotherapy centers in England where the patient resides in England or Wales
Wales populations
Table 2: Populations derived for radiotherapy centers in Wales where the patient resides in Wales or England
UK populations
Table 3: Populations derived for the UK
England & Wales provider catchment areas
The below map displays radiotherapy provider catchment areas grouped by radiotherapy network. This information is designed to provide a visual representation of radiotherapy populations and does not contain the level of accuracy possible with the above tabular data for the following reasons:
- For MSOAs where radiotherapy activity was delivered by multiple NHS Trusts, the MSOA is allocated to the NHS Trust which delivered the highest percentage of activity.
- In cases where the highest radiotherapy activity for an MSOA is delivered equally by more than one NHS Trust, for example radiotherapy activity for MSOA E02004540 is split 33% each between Barts, Middlesex and Barking, then a single Trust is arbitrarily selected.
Areas which are shaded darker are where 75% or more of radiotherapy activity for that population is delivered by the indicated provider.
Use the list in the bottom left to filter which networks are shown on the map and to hide/show ICS boundaries.
Map 1: Provider catchment areas for England and Wales