ODN reports

The Operational Delivery Network (ODN) reports are produced every 6 months by the National Disease Registration Service.  It is a summary of activity reports and metrics available on CancerStats2. Further details on each of the reports can be found on CancerStats2. ODNs are a delivery network for radiotherapy services. They were established by the Adult External Beam Radiotherapy Services Service Specification in 2019.  Each Network is tasked with providing radiotherapy system leadership and the delivery of NHS England’s vision and ambitions for the modernisation of radiotherapy service

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)
• 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 

Patient acknowledgement 

This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data is collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of NHS England.

The dashboards referenced here can be found on CancerStats2 (CS2) at the below links (all open in a new page):

• Events Dashboard
• RTDS Quality Dashboard
• RTDS Dose and Fractionation Dashboard

The CS2 platform requires an N3 / HSCN secure network connection and users will need to sign up to an agreement restricting what can be done with this data due to the sensitive nature of it. If people need help setting up their connection / logging in or have any questions about data reported on the CS2 platform, please contact the team at  [email protected]

The CS2 platform hosts a variety of RTDS dashboards, including the radiotherapy quality metrics dashboard, the dose and fractionation dashboard and regularly updated operational data. In addition to RTDS data, the platform features dashboards reporting for cancer incidence and mortality, molecular and genetics and systemic anti-cancer therapy. CancerStats2 platform enables key stakeholders to generate reports using NDRS data on a self-service basis.

Find out more more about the CancerStats2 reporting platform. 

The report includes summaries of the Specialised Services Quality Dashboards (SSQDs) metrics, referred to in this report as 'Quality dashboard'.  The purpose of collecting SSQD data is to monitor the quality of these specialised services, helping providers and commissioning teams identify areas for improvement to ensure better patient outcomes and fair, safe care. CS2 provides the metrics by Trust of delivery, whereas this report focuses on the ODN regions, aggregating the trusts within it.  The definitions for the quality metrics are as follows:

RAD12A: Percentage of radical episodes (excluding non-melanoma skin cancer) where the difference between decision to treat date and treatment start date is greater than 31 days.

Description:   The number of radical episodes (excluding non-melanoma skin cancer episodes) where the difference between the decision to treat date and the treatment start date is over 31 days, by the number of all radical episodes starting treatment in the reporting period.

Exceptions and assumptions:   ICD10 codes C00-D48 excluding C44.   Earliest clinically appropriate date is used where episode is missing the decision to treat date. If both dates are available, the most recent (greatest) date from either the decision to treat date and earliest clinically appropriate date is used. External beam radiotherapy only.

RAD12B: Percentage of palliative episodes (excluding non-melanoma skin cancer) where the difference between the decision to treat date and treatment start date is greater than 31 days.

Description:  The number of palliative episodes (excluding non-melanoma skin cancer episodes) where the difference between the decision to treat and the treatment start date is greater than 31 days, by the number of all palliative episodes starting treatment in the reporting period.

Exceptions and assumptions:  ICD10 codes C00-D48 excluding C44.  Earliest clinically appropriate date is used where episode is missing the decision to treat date. If both dates are available, the most recent (greatest) date from either the decision to treat date and earliest clinically appropriate date is used. External beam radiotherapy only.

RAD13A: Percentage of radical lung episodes  

Description:  The number of radical lung episodes, by the number of all lung episodes starting treatment in the reporting period.

Exceptions and assumptions:  Includes all lung treatments, including SABR treatment.  ICD10 codes C33-C34 only are included. External beam radiotherapy only.

RAD13B: Percentage of radical lung SABR episodes  

Description:   The number of radical lung SABR episodes, divided by the number of all radical lung episodes starting treatment in the reporting period.

Exceptions and assumptions:   Includes only SABR treatments. ICD10 codes C33-C34 only are included. External beam radiotherapy only.

RAD13C: Percentage of radical head and neck episodes.  

Description:   The number of radical head and neck episodes, divided by the number of all head and neck episodes starting treatment in the reporting period.  

Exceptions and assumptions:  ICD10 codes C00-C14 and C30-C32 only are included. External beam radiotherapy only.

RAD13D: Percentage of radical cervical episodes.  

Description:  The number of radical cervical episodes, divided by the number of all cervical episodes starting treatment in the reporting period.  

Exceptions and assumptions:  ICD10 code C53 only is included. External beam radiotherapy only.

RAD14: Percentage of radical IMRT episodes.  

Description:   The number of radical IMRT episodes (including any SABR episodes), divided by the number of all radical episodes starting treatment in the reporting period.

Exceptions and assumptions:  Numerator radical IMRT episodes: Excludes ICD10 codes C50, D05 and C44.  Denominator all radical episodes: Excludes ICD10 code C44 only. External beam radiotherapy only.

RAD15A: Percentage of radical lung episodes treated using image guidance.  

Description:   The number of radical lung IMRT episodes (including any SABR episodes), divided by the number of all radical lung episodes starting treatment in the reporting period.

Exceptions and assumptions:   ICD10 code C33 - C34 only are included. External beam radiotherapy only. Radical episodes only.

RAD15B: Percentage of radical prostate episodes treated using image guidance.  

Description:  The number of radical prostate IMRT episodes (including any SABR episodes), divided by the number of all radical prostate episodes starting treatment in the reporting period.  

Exceptions and assumptions:  ICD10 code C61 only is included. External beam radiotherapy only. Radical episodes only.

RAD15C: Percentage of radical head and neck episodes treated using image guidance.  

Description:   The number of radical head and neck IMRT episodes (including any SABR episodes), divided by the number of all radical head and neck episodes starting treatment in the reporting period.  

Exceptions and assumptions:   ICD10 codes C00-C14, C30-C32 only are included. External beam radiotherapy only. Radical episodes only. 

RAD16: Average number of days between date of referral to a radiotherapy department to the treatment start date for Category 1 episodes.

Description:   Sum of the number of days waited from decision to treat date to the treatment start date, divided by the number of episodes starting treatment in the reporting period.

Exceptions and assumptions:   Earliest clinically appropriate date is used where episode is missing decision to treat date. If both dates are available, the most recent (greatest) date from either the decision to treat date and earliest clinically appropriate date is used.   Radical episodes only. External beam radiotherapy only. Category 1 episodes only, including: Site (ICD10 codes) Head and Neck (C00-C06, C09-C14); Cervix, Vagina and Vulva (C51-C53); Anus (C21); Lung (C30-C36, C39); Oesophagus (C15)

RAD17: Percentage of breast episodes treated with less than or equal to 15 prescribed fractions.  

Description:   The number of breast episodes where the first prescription in the episode has 15 or less prescribed fractions, divided by the number of all breast episodes starting treatment in the reporting period.  

Exceptions and assumptions:   Excludes any episodes that are non-anatomically specific to the primary treatment region or metastasis.  ICD10 codes C50 or D05 only are included. External beam radiotherapy only. Excludes electron beam treatment. Excludes palliative treatment.

RAD18: Percentage of metastatic bone episodes treated in a single attendance.  

Description:  The number of metastatic bone episodes treated in a single attendance, divided by the number of all metastatic bone episodes starting treatment in the reporting period.  

Exceptions and assumptions:  OPCS codes Z63-Z66, Z68-Z80 or Z84-Z87 only are included.  Spinal cord compression with the expected OPCS codes of Z06 and Z07 are excluded. External beam radiotherapy only. Metastatic treatment region only included.

RAD19: Percentage of prostate episodes treated in 5, 19 or 20 attendances.

Description:  Number of prostate episodes treated in 5, 19 or 20 attendances, divided by the number of prostate episodes treated in 5, 19, 20 or more attendances in the reporting period.  

Exceptions and assumptions:  ICD10 code C61 only included. External beam radiotherapy only. Excludes prophylactic and non-anatomically specific to the primary.   

RAD20: Departmental average number of attendances per LINAC

Description:  The total number of attendances divided by the total number of LINACs.  

Exceptions and assumptions:  LINAC attendances only. 

The events by provider (mapped up to ODN) are defined as a count of the number of events by provider where a patient was treated with radiotherapy. This count includes all patient activity associated with the provider, regardless of postcode (including overseas, null, invalid, etc.). Episode count is a count of episodes starting in that month. Prescription count is a count of prescriptions starting in that month. Attendance count is a count of appointments in that month.

• Patients - the report includes all adult patients aged 18+.   
• RTDS activity is defined as a unique count of treatment episodes. A treatment episode is defined as a continuous period of care for radiotherapy including all preparation, planning and delivery of radiotherapy.   

• Dose and fractionation schedules have been compared to the guidance provided by the Royal College of Radiologists for radiotherapy treatments occurring during Covid 19, in addition to the standard radiotherapy dose fractionation guidance produced by the RCR.      
• Fractionation Categories: 
  • Low Fractionation - less than 2Gy per fraction 
  • Standard Fractionation - 2.0Gy - 2.49GY per fraction 
  • Mild-Moderate hypofractionation - 2.5Gy - 4.99Gy 
  • Ultra-High hypofractionation - 5Gy or greater   

• Episode count is a count of episodes starting in that month. 

The Royal Marsden NHS Foundation Trust (RPY) have approximately 10% of their RTDS data missing between April 2023 and December 2023. The Royal Marsden typically account for 3-4% of all radiotherapy episodes in England.

From October 2023, Cambridge University Hospitals NHS Foundation Trust (RGT) submitted all palliative episodes as radical, this was due to errors in the Trust's mapping process. The impact of this issue is small overall, with the incorrectly mapped palliative activity constituting approximately 100 episodes per month which makes up around 3% of England's total monthly palliative activity, though this is 35% of the Trust’s monthly activity. The Trust is aware of the issue, and both the submission mappings and the RTDS data held by NDRS are being corrected.

The Christie NHS Foundation Trust (RBV) have incorrectly coded some episodes as Other intent rather than Radical or Palliative. This affects their activity from 2023 onwards and is most pronounced in May to August 2024 when 47% of their episodes are coded as Other. The Christie typically account for approximately 6.5% of all radiotherapy episodes in England.

The RTDS data liaison team are aware of these issues and working to correct them in the near future.

Providers

From January 2023, Salford Royal / Northern Care Alliance (trust code: RM3) is included with the Christie NHS Foundation Trust (trust code: RBV) data for all metrics in this report. North Cumbria Integrated Care NHS Foundation Trust (RNN) merged with The Newcastle Upon Tyne NHS Foundation Trust (RTD) from April 2023. Data reported for RNN in the period January 2023 to June 2023 will therefore not represent a full six-month period, with all data reported under RTD from this point onwards.

Decision to treat

The RTDS data item decision to treat date is used in the following metrics as a start point for time to treatment. In some instances, particularly in data for The Christie NHS Foundation Trust (RBV) and University Hospitals Coventry and Warwickshire (RKB), an incorrect decision to treat date is assigned to an episode because the patient has had a previous primary tumour. In the period January 2020 to June 2024 this affects less than 1% of tumours.

The National Disease Registration Service (NDRS) are making every effort to support each NHS Trust in achieving the highest levels of data quality in their RTDS submission. To support this aim, the following resources are available: 

Your NDRS Data Liaison Manager 

Your Data Liaison Manager can provide extensive support to improve the quality of data submitted to the National Disease Registration Service. Please contact the RTDS Helpdesk at [email protected] for further details. 

NDRS Data Hub and Website

A single point of access for all NDRS related information including cancer data collection, datasets, supporting tools, training materials and guidance documents can be found in the Cancer Data Hub section of our website. 

*Please note we are in the process of creating html versions of pdf documents and we will publish these as soon as possible.