Radiotherapy is a key component of cancer treatment, relying on high levels of technical and scientific competence to safely and accurately deliver radiation directly to tumours. Since 2008, the radiotherapy department at Hull University Teaching Hospitals (HUTH) NHS Trust has been based in the Queen’s Centre at Castle Hill Hospital. Serving a catchment area of over 1.2million people from the whole of East Yorkshire and parts of North Yorkshire and Lincolnshire, the radiology department delivers over 40,000 treatments to around 3,500 patients every year.
HUTH has a long history of being at the leading edge of radiotherapy innovations and treatments. HUTH’s predecessor, the Princess Royal Hospital in Kingston Upon Hull, was one of the first hospitals in the UK to use a cobalt treatment unit in the targeted treatment of cancer in the 1960s. These were replaced by linear accelerators in the 1980s for precise targeting and verification of tumour position, enabling more accurate treatment delivery and minimising damage to the surrounding healthy tissue and organs. In 2019, HUTH became the first centre in the North of England to commission the use of a Varian Halcyon linear accelerator, providing quieter and quicker treatments to improve the patient experience.
Keeping up the MPACE
Medical physics and clinical engineering is a vital element of nearly every patient care pathway, significantly contributing to both the management of risk and the delivery of diagnostic and therapeutic procedures.
The radiotherapy department at HUTH comprises 57 therapeutic radiographers along with 18 nursing, booking and clinical support worker roles. Radiotherapy physics supports radiotherapy teams by providing scientific and technical quality assurance on every treatment plan before it is delivered to the patient. This crucial activity optimises treatment plans by analysing the level and accuracy of radiation delivery, problem-solving unique patient issues such as complex multi-site or unusual tumour locations, as well as implementing the latest techniques and equipment.
Leading the way in radiotherapy quality assurance, in 2017 HUTH participated in a UKAS pilot accreditation programme for the assessment of medical physics and clinical engineering services (MPACE) against the BS70000:2017 standard. Towards the end of 2019, HUTH became the first radiotherapy service to become UKAS-accredited to this standard.This represented an important step in the department’s quality assurance process as Richard Whitlam, Radiotherapy and Radiotherapy Physics Quality Manager explained:
“For several years, the medical physics department at HUTH has held ISO 9001:2015 quality management certification. Whilst ISO 9001 is a good general test that your quality systems are functional, it doesn’t include an evaluation of technical competence and isn’t focused on patient care. In addition to incorporating similar QMS, governance and risk management principles as ISO 9001, BS70000 under the MPACE scheme better reflects the highly specialised and scientific aspects of our service and provides a clear framework to ensure that any risks are managed and mitigated appropriately.”
Furthermore: “MPACE provided the ideal opportunity to increase assurance levels in both the competence of our staff and the quality of care our services provide. Additionally, the impartial and independent nature of UKAS accreditation avoids any implications we might be marking our own homework. Gaining UKAS accreditation to BS 70000 means we can easily demonstrate to commissioners, colleagues and patients that our technically competent staff and processes deliver a high-quality service that is fit for purpose, continually improving and focused on putting patient care first.”
Further commenting the advantages of accreditation over certification, Clare Hutton, Radiotherapy Manager said: “Accreditation standards are very service specific and seek to provide assurance relating not just to process performance but to technical competence and, therefore, independent evidence of ‘fitness for purpose’ for a given area.”
Reaping the rewards
Outlining some of the benefits of going through the accreditation process, Richard said: “A UKAS pre-assessment during the pilot programme confirmed our belief that accreditation to MPACE was going to positively challenge us in ways that ISO 9001 certification had not; particularly around demonstrating the competency of all staff groups (including those who deliver work on our behalf) on a task-related basis, rather than a professional knowledge basis. In addition to continuously improving services and strengthening accountability, this provides a better overview of the skill mix, integration and capacity across the department.”
Expanding on Richard’s observations, Nick Harding, Lead Physicist for Treatment Planning said: “Whilst being both thorough and robust, the accreditation assessment process itself did not necessitate any big step change in terms of our policies and processes, as it largely involved providing evidence of what we were already doing. Every UKAS assessment requires new evidence of ongoing compliance with each requirement of the standard, which drives and encourages consistent improvement. Regular competency reviews mean you’re continuously assessing what you’re doing, ensuring you’re maintaining CPD and performing at the highest level. The third-party assurance of our competence you get from UKAS accreditation means we know we’re doing a good job and, more importantly, have the evidence to prove it.”
In addition to contributing to the refinement and streamlining of processes, going through the accreditation process has seen a subtle change in departmental culture, as Peter explained: “Accreditation is empowering and sets aspirational standards that permeate throughout the department, so is something the team got behind very quickly. Since starting the accreditation process there has been a noticeable change in the internal narrative. All staff groups are showing buy-in to a demonstrating quality mindset by talking about ‘seeking assurance’ and asking, ‘Where’s the evidence?’ for all areas of our work, not just the accredited aspects.”
Recapping the experience of going through the assessment process, Clare said: “The process of an accreditation assessment is very challenging, especially when you are asked to provide evidence that your practice meets the required standard and are then asked further questions to explain why processes are designed in certain ways.” Paula Mcloone, Pre-Treatment Team Leader, added: “Being assessed is not something to be terrified of. You are doing your job just as you would any other day, but you are doing it with a few friendly, professional and questioning representatives. They are not there to catch you out, but to ensure the service you believe you are delivering matches up to the service you are delivering.”
Improving patient outcomes
Explaining the potential impact this accreditation can have on patient confidence, Peter Colley, Consultant Physicist and Head of the Radiotherapy Physics Service said:
“Accreditation provides external third-party assurance on the competency and reliability of a wide range of services provided by the department that play a critical role in diagnosing and underpinning a patient’s health. In many cases we’re a hidden service, where patients often don’t know we exist or understand what we do. However, whilst patients may not see us all, they assume we’re competent scientists and practitioners, using the right equipment to deliver effective treatments in a timely manner. Here, the department must be an advocate for the patient, and UKAS accreditation provides the ongoing external assurance that we’re doing things right.”
MPACE BA 70000:2017 standard assessment also examines how departments gather and utilise patient feedback, which has helped the radiotherapy physics team remain focused on improving patient outcomes. Nick continued: “What we do is very technical, so patient feedback helps you remember there’s someone who needs care at the centre of everything we do.”
Describing the effect of UKAS accreditation on patient assurance Paula said: “Since being granted accreditation, we have had several patients ask about and comment on this. It shows that patients do pay attention to these things and are reassured by the UKAS accreditation we have achieved and how it impacts on them as patients.”
Extending the scope of accreditation
UKAS accreditation is restricted to the specific activities and locations listed in each organisation’s scope of accreditation. However, achieving UKAS accreditation has also enabled HUTH to refine and enhance other radiotherapy physics services that currently fall outside the scope of its UKAS accreditation. Nick said: “We’ve been able to transfer some of the lessons learnt from going through the accreditation process and harmonise the principles into other services. This means that whilst we may not be accredited for every service we provide, all our services have improved as a result of us going down the accreditation route.”
Echoing those sentiments, Peter added: “The granular nature of accreditation meant that the MPACE pilot was by necessity limited to one scope, namely the external beam radiotherapy treatment of adults. However, running the entire service ‘in the spirit of UKAS’ meant we were able to get our systems and processes up to the required standard before applying to extend our scope of accreditation into other related areas.”
Early in 2022 UKAS granted HUTH an initial extension to its accreditation scope to cover pre-treatment processes, along with Computed Tomography (CT) localisation services, representing another BS70000 accreditation first. Expanding on why HUTH elected not to apply for accreditation to an imaging quality standard for this advanced x-ray technique Clare said: “Radiology quality standards are not transferable to the radiotherapy CT setting, upon investigation with the College of Radiographers we could not apply for the imaging standard process for CT localisation. So the decision was made to test the MPACE scope (initially written with medical physics services in mind) to include CT localisation.”
This was followed by the addition of brachytherapy, mould room and Surface Guided Radiotherapy (SGRT) activities in late 2025, meaning HUTH’s entire radiotherapy physics service is covered by UKAS accreditation.
Explaining the significance of these extensions, Peter said: “The mould room and SGRT accreditation extensions work together to ensure that numerous radiation therapies, including in the treatment of breast, brain, head and neck cancer, are delivered with greater precision. Similarly, CT localisation minimises damage to healthy tissue and organs in patients undergoing treatment for cancer. Conversely, brachytherapy involves the patient having direct contact with a radioactive source, making it potentially our most compliance challenging treatment. We have wanted to add these activities to our MPACE scope since the initial pilot, so are delighted that patients can now have greater confidence in the quality, safety and accuracy of the full range of our radiotherapy treatments.”
Summarising HUTH’s overall experience and opinions of accreditation, Richard concluded: “At HUTH we are justifiably proud to have gained UKAS accreditation for our whole radiotherapy physics service. MPACE provided an opportunity to gain an independent assurance of competency and the quality of our service. Although it involved a great deal of time, thought and effort, successfully completing the accreditation process was both challenging and stimulating. Initially achieving, then gradually extending the scope of our accredited MPACE activities has made us a more robust service. It demonstrates we are providing an excellent scientific service that continues to deliver a better quality of patient care. This has also put us in a stronger position, both in terms of service quality and meeting the requirements of healthcare regulators and commissioning groups. Overall, it has proved to be an extremely worthwhile endeavour, and I would strongly encourage other medical physics and clinical engineering services to consider applying to UKAS for accreditation under the MPACE scheme.”