- Email: [email protected]
Therapeutic radiography at the crossroads
Radiography (2010) 16, 3e4
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/radi
GUEST EDITORIAL
Therapeutic radiography at the crossroads As a radiographer who is also an education manager, I inhabit two very different worlds; the professional world of radiotherapy with its attendant task of supporting the development and delivery of world class cancer services,1 and the Human Resource (HR)-led world of workforce planning and development, where subsidiarity and localitybased commissioning are guiding principles. Looking at the present state of therapeutic radiography from these two, quite different, perspectives provides cold comfort for those who are committed to its on-going development as a profession. In the former, therapeutic radiography has been catapulted to prominence. Major technological strides, such as Intensity Modulated Radiotherapy (IMRT), have revived its fortunes. It is involved in the management of 40% of those patients who are cured of cancer2 and there is tremendous pressure for IMRT to be made available as quickly as possible to those patients for whom it is of proven benefit. The professional body’s proactive stance to professional development since the 1990s3e6 ensured that when the Cancer Reform Strategy7 was published and National Radiotherapy Advisory Group (NRAG) began its work, therapeutic radiographers were ‘at the table’ and integral to the work of service development. But what evidence is there that the profession’s stance, formalised in 2002 in the Education and Professional Development Strategy,5 fleshed out in a position paper that describes a range of extended roles for radiographers6 and culminating in recent guidance supporting the development of local radiography staffing models for radiotherapy services,8 has been internalised by the profession and those responsible for commissioning cancer services? Disappointingly, the profession appears unable or unwilling to accept the leadership of its professional body and grasp the opportunity of full professionalisation that is on offer.9 The reasons for this are unclear; there is no doubt that clinical oncology services are under great pressure and, in that situation, it is difficult to lead and manage change. The focus on the need for more therapeutic radiographers to avert a crisis reinforces this and it could be argued that the profession is over-confident in itself as the
deliverer of radiotherapy treatments and does not see the need for change. Partly as a result of this, service commissioners are failing to engage with the level of workforce planning needed to provide the quality services for cancer patients that have been promised. Subsidiarity is enshrined in Darzi’s (2008) Next Stage Review10 and the starting point is the local health economy. The care pathways identified by Darzi have been reviewed by commissioning Primary Care Trusts (PCTs) who have been required by Strategic Health Authorities (SHAs) to develop workforce plans based on realistic local data sets. These plans embrace the concept of a flexible competent workforce able to deliver safe, effective, person-centred services in a timely way. Responsibility for gathering and interpreting this local intelligence is mainly an HR function and, in the region where I work, staff are professional HR workers; generally not with a health professional background. Local Education Partnership Groups work alongside Strategic Workforce Development Groups in the local PCT to deliver this challenging agenda. Their specific role is to advise about non-medical education commissioning across the board and they have a diverse, representative membership. From the many meetings that I have attended since the groups were set up in 2007, it seems that to date, whilst the principles of flexibility and new ways of working are on all of our lips, commissioning remains very profession-focussed. We still speak of ‘How many nurses?’ rather than what kind of service and who is best placed to deliver it. In relation to cancer services, specifically radiotherapy, I have observed a frightening ignorance of the role of therapeutic radiographers and am asked frequently to explain the difference between us and diagnostic colleagues. At the present time, it seems that local ignorance of therapeutic radiographer roles is one of the factors impacting on the wider profession and indirectly confirming its view of itself in the key role of radiotherapy delivery. Short term concerns about numbers, recruitment and attrition are colluding with the profession’s desire to maintain the status quo. Convenient this may be but local service commissioners may one day practice what they
1078-8174/$ - see front matter ª 2009 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2009.10.009
4 preach and insist on reprofiling the cancer workforce in ways that are detrimental to therapeutic radiographers. Safety, effectiveness and person-centred care can all be maintained and even enhanced without registered therapeutic radiographers being present at every treatment set up. Why do we remain so wedded to our technician role? The technical skills of radiotherapy planning and delivery are indeed the craft that distinguishes us from others. However, much radiotherapy is boring and routine, not challenging or complex. Radiotherapy graduates need to have these craft skills but many will not remain in cancer services unless there is more to it than that. Graduates are being prepared to manage complexity and to take on challenging roles, such as the practitioner models outlined in Radiotherapy Moving Forward.8 Arguably they are over educated for treating people with breast cancer day in and day out. Unfortunately in my view, the traditional distinction between professions and others is blurring as the term degrades and is replaced by the looser ‘professionalism’,11 the adoption of which would enable the whole community of radiotherapy practice to commit itself to ethical practice. This may be a valuable aspiration in itself; however, such a model does not privilege the high levels of knowledge and autonomy that are integral to genuine professional practice and sought after by our brightest and best graduates. Therapeutic radiography is at a crossroads and there is a choice to be made; either to forge ahead with professional career development or to remain as high-class technicians. There is still a long way to go to achieve world class cancer services,1 or even to be as good as many European countries. Radiographers need to wake up and realise that playing a full part in achieving the best depends on letting go of old practices and embracing the new.
Guest Editorial
References 1. Department of Health. Radiotherapy: developing a world class service for England. Report to ministers from National Radiotherapy Advisory Group. London: DH; 2007. 2. Burnet N, Mackay R, Staffurth J, Williams M, Cooper T. IMRT e a guide for commissioners. An NRIG Technology sub-group Report; July 2009. 3. Paterson A. Role development- towards 2000: a survey of role developments in radiography. London: SCoR; 1995. 4. The Society and College of Radiographers. The practice and process of therapeutic radiography: a professional perspective. London: SCoR; 1999. 5. The Society and College of Radiographers. A strategy for the education and development of therapeutic radiographers. London: SCoR; 2002. 6. The Society and College of Radiographers. Positioning therapeutic radiographers within cancer services: delivering patient-centred care. London: SCoR; 2006. 7. Department of Health. Cancer reform strategy. London: DH; 2007. 8. The Society and College of Radiographers. Radiotherapy moving forward: delivering new radiography staffing models in response to the cancer reform strategy. SCoR, http://doclib.sor.org; June 2009. Document Library. 9. Price R, Edwards H, Heasman F, Miller L, Vosper M. The scope of radiographic practice 2008. Hatfield: The University of Hertfordshire; 2009. 10. Darzi A. High quality care for all: NHS next stage review. London: DH; 2008. 11. Whiting C. Promoting professionalism. Guest Editorial. Synergy; September 2009.
Hazel Colyer Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU, United Kingdom E-mail address: [email protected]
8 October 2009 Available online 5 November 2009
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/radi
GUEST EDITORIAL
Therapeutic radiography at the crossroads As a radiographer who is also an education manager, I inhabit two very different worlds; the professional world of radiotherapy with its attendant task of supporting the development and delivery of world class cancer services,1 and the Human Resource (HR)-led world of workforce planning and development, where subsidiarity and localitybased commissioning are guiding principles. Looking at the present state of therapeutic radiography from these two, quite different, perspectives provides cold comfort for those who are committed to its on-going development as a profession. In the former, therapeutic radiography has been catapulted to prominence. Major technological strides, such as Intensity Modulated Radiotherapy (IMRT), have revived its fortunes. It is involved in the management of 40% of those patients who are cured of cancer2 and there is tremendous pressure for IMRT to be made available as quickly as possible to those patients for whom it is of proven benefit. The professional body’s proactive stance to professional development since the 1990s3e6 ensured that when the Cancer Reform Strategy7 was published and National Radiotherapy Advisory Group (NRAG) began its work, therapeutic radiographers were ‘at the table’ and integral to the work of service development. But what evidence is there that the profession’s stance, formalised in 2002 in the Education and Professional Development Strategy,5 fleshed out in a position paper that describes a range of extended roles for radiographers6 and culminating in recent guidance supporting the development of local radiography staffing models for radiotherapy services,8 has been internalised by the profession and those responsible for commissioning cancer services? Disappointingly, the profession appears unable or unwilling to accept the leadership of its professional body and grasp the opportunity of full professionalisation that is on offer.9 The reasons for this are unclear; there is no doubt that clinical oncology services are under great pressure and, in that situation, it is difficult to lead and manage change. The focus on the need for more therapeutic radiographers to avert a crisis reinforces this and it could be argued that the profession is over-confident in itself as the
deliverer of radiotherapy treatments and does not see the need for change. Partly as a result of this, service commissioners are failing to engage with the level of workforce planning needed to provide the quality services for cancer patients that have been promised. Subsidiarity is enshrined in Darzi’s (2008) Next Stage Review10 and the starting point is the local health economy. The care pathways identified by Darzi have been reviewed by commissioning Primary Care Trusts (PCTs) who have been required by Strategic Health Authorities (SHAs) to develop workforce plans based on realistic local data sets. These plans embrace the concept of a flexible competent workforce able to deliver safe, effective, person-centred services in a timely way. Responsibility for gathering and interpreting this local intelligence is mainly an HR function and, in the region where I work, staff are professional HR workers; generally not with a health professional background. Local Education Partnership Groups work alongside Strategic Workforce Development Groups in the local PCT to deliver this challenging agenda. Their specific role is to advise about non-medical education commissioning across the board and they have a diverse, representative membership. From the many meetings that I have attended since the groups were set up in 2007, it seems that to date, whilst the principles of flexibility and new ways of working are on all of our lips, commissioning remains very profession-focussed. We still speak of ‘How many nurses?’ rather than what kind of service and who is best placed to deliver it. In relation to cancer services, specifically radiotherapy, I have observed a frightening ignorance of the role of therapeutic radiographers and am asked frequently to explain the difference between us and diagnostic colleagues. At the present time, it seems that local ignorance of therapeutic radiographer roles is one of the factors impacting on the wider profession and indirectly confirming its view of itself in the key role of radiotherapy delivery. Short term concerns about numbers, recruitment and attrition are colluding with the profession’s desire to maintain the status quo. Convenient this may be but local service commissioners may one day practice what they
1078-8174/$ - see front matter ª 2009 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2009.10.009
4 preach and insist on reprofiling the cancer workforce in ways that are detrimental to therapeutic radiographers. Safety, effectiveness and person-centred care can all be maintained and even enhanced without registered therapeutic radiographers being present at every treatment set up. Why do we remain so wedded to our technician role? The technical skills of radiotherapy planning and delivery are indeed the craft that distinguishes us from others. However, much radiotherapy is boring and routine, not challenging or complex. Radiotherapy graduates need to have these craft skills but many will not remain in cancer services unless there is more to it than that. Graduates are being prepared to manage complexity and to take on challenging roles, such as the practitioner models outlined in Radiotherapy Moving Forward.8 Arguably they are over educated for treating people with breast cancer day in and day out. Unfortunately in my view, the traditional distinction between professions and others is blurring as the term degrades and is replaced by the looser ‘professionalism’,11 the adoption of which would enable the whole community of radiotherapy practice to commit itself to ethical practice. This may be a valuable aspiration in itself; however, such a model does not privilege the high levels of knowledge and autonomy that are integral to genuine professional practice and sought after by our brightest and best graduates. Therapeutic radiography is at a crossroads and there is a choice to be made; either to forge ahead with professional career development or to remain as high-class technicians. There is still a long way to go to achieve world class cancer services,1 or even to be as good as many European countries. Radiographers need to wake up and realise that playing a full part in achieving the best depends on letting go of old practices and embracing the new.
Guest Editorial
References 1. Department of Health. Radiotherapy: developing a world class service for England. Report to ministers from National Radiotherapy Advisory Group. London: DH; 2007. 2. Burnet N, Mackay R, Staffurth J, Williams M, Cooper T. IMRT e a guide for commissioners. An NRIG Technology sub-group Report; July 2009. 3. Paterson A. Role development- towards 2000: a survey of role developments in radiography. London: SCoR; 1995. 4. The Society and College of Radiographers. The practice and process of therapeutic radiography: a professional perspective. London: SCoR; 1999. 5. The Society and College of Radiographers. A strategy for the education and development of therapeutic radiographers. London: SCoR; 2002. 6. The Society and College of Radiographers. Positioning therapeutic radiographers within cancer services: delivering patient-centred care. London: SCoR; 2006. 7. Department of Health. Cancer reform strategy. London: DH; 2007. 8. The Society and College of Radiographers. Radiotherapy moving forward: delivering new radiography staffing models in response to the cancer reform strategy. SCoR, http://doclib.sor.org; June 2009. Document Library. 9. Price R, Edwards H, Heasman F, Miller L, Vosper M. The scope of radiographic practice 2008. Hatfield: The University of Hertfordshire; 2009. 10. Darzi A. High quality care for all: NHS next stage review. London: DH; 2008. 11. Whiting C. Promoting professionalism. Guest Editorial. Synergy; September 2009.
Hazel Colyer Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU, United Kingdom E-mail address: [email protected]
8 October 2009 Available online 5 November 2009