Royal Marsden Nhs Foundation Trust

Highlighting best practice as a representative in The Parliamentary Review

The ability to listen and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. The following article from Royal Marsden Nhs Foundation Trust is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

Chief Executive Cally Palmer CBE
The Royal Marsden,
founded in 1851
More than 360,000 people in the UK are diagnosed with
cancer each year, and it is now estimated that one
in two people will develop cancer at some point in
their lives. Yet while more people will develop cancer, survival
is also improving. Currently, half of all cancer patients survive
their disease for ten years or more. Chief Executive of The Royal
Marsden NHS Foundation Trust and NHS England National
Cancer Director Cally Palmer tells
The Parliamentary Review
about working with partners to develop optimal models of care
and working with cancer centres globally to transform survival.
The Royal Marsden was founded in 1851 as the world’s first hospital dedicated
to cancer. Today, together with our academic partner, The Institute of Cancer
Research, we are one of the largest comprehensive cancer centres in Europe with
the primary aim of delivering the best cancer treatment and care through world-
leading research.
Pioneering technology
As a specialist provider, we have a responsibility to innovate and ensure that
we can act as a site of best practice for the NHS. We have a history of trialling
new technology, including pioneering intensity-modulated radiotherapy
techniques, and, in 2017, we installed the UK’s first magnetic resonance linear
»Chief Executive: Cally Palmer
»Founded in 1851
»Based in Chelsea and Sutton
»Services: Hospital dedicated to
cancer diagnosis, treatment,
research and education
»No. of employees: 4,500
»No. of patients: 55,000
»CQC: “Outstanding”,
September 2018
The Royal Marsden
NHS Foundation Trust
Highlighting best practice
The MR Linac combines two
technologies: a magnetic resonance
imaging scanner and a linear
accelerator. This is used to precisely
locate tumours, tailor the shape of
x-ray beams in real time and accurately
target doses of radiotherapy.
Being able to see and better target the
tumour during radiotherapy allows our
clinicians to deliver a higher dose of
radiation each time. This means that
patients with hard-to-treat cancers
can be treated more effectively, while
other patients may need fewer doses
in total. This pioneering equipment
could also mean a significant reduction
in treatment times and side effects
and provide a better experience
Following a period of pre-clinical
testing in September 2018, clinicians
treated the first patient in the UK and
the third in the world with this new
technology . This was undertaken
as part of the PRISM trial, which will
examine all aspects of the patient’s
experience of treatment on the
machine, including side effects and
comfort, together with the technical
feasibility for clinicalteams. The
moonshot is to diagnose, treat and
cure a patient on the same day with
highly targeted and precise delivery
The MR Linac was funded by a
£10 million grant from the Medical
Research Council, with additional
support from The Royal Marsden
Cancer Charity and the ICR. Physicists
from The Royal Marsden and the ICR
have been developing the technology
as part of an international consortium
initiated and co-ordinated by Elekta,
which makes the MR Linac, alongside
its partner, Philips.
Sharing best practice
We are the host and founder of RM
Partners, one of 19 cancer alliances
tasked with trialling and rolling
out new models of care, as well as
reducing variation to improve survival
and quality of care for patients.
Two examples of this work are the
implementation of an early diagnosis
prostate pathway and the introduction
of the first oncology biosimilars
Over the last year, RM Partners has
designed and implemented a new
rapid-access prostate imaging and
diagnosis pathway for suspected
prostate cancers, which has been
successfully launched by three partner
trusts. This has already received an
overwhelmingly positive response
from patients, as well as improving
operational performance against the
national 62-day referral-to-treatment
target. We are now working with
other partners to extend this pilot and
prepare for a wider roll-out both locally
and nationally.
The Royal Marsden, working with RM
Partners, has introduced a national
cancer medicines optimisation
programme, leading the introduction
of biosimilars in the NHS, which are
copies of biological drugs. These
achieve the same result for patients
but are up to 60 per cent cheaper
compared with the originals.
Radiographers working
on the MR Linac at The
Royal Marsden and the
ICR, the first one in the
We have a
history of trialling
new technology,
techniques, and
we installed the
UK’s first
resonance linear
Within months of the introduction of
the biosimilar rituximab, an important
drug for blood cancers including
lymphoma, 80 per cent of eligible
patients across England had been
switched to the biosimilar. If used
nationwide, this biosimilar alone could
save the NHS up to £100 million a year.
The success of this project demonstrated
the scale and impact of RM Partners to
great effect. We are working on the
introduction of future biosimilars in
oncology for NHS England.
This work will provide many opportunities
to accelerate the adoption of new
treatment protocols for cancer patients
across the whole country. We aim to
implement best practice across the whole
system in order to reduce variation
in outcomes and improve patient
treatment and care across theUK.
AI and big data
Although the concept of artificial
intelligence has existed since 1956, it
is only now that its use has become
the norm. Earlier this year, the
Prime Minister put AI and big data
in the spotlight when she called for
technology to transform how the UK
prevents, diagnoses and treats cancer.
Our experts are exploring the latest
advances in technology to help to provide
an earlier diagnosis and to improve the
quality of life for patients living with
cancer. As part of a groundbreaking
project, our team and Imperial College
London have developed machine
learning that will assist radiologists in
reporting whole-body MRI scans in
patients with myeloma. Machine learning
is a type of AI in which computers are
taught how to do things independently –
for example, to identify scans that show
evidence of cancer from healthyimages.
The challenge with using whole-body
MRI scans is that they generate a
vast amount of data – around 1,000
images for each scan, which need
to be examined individually by a
radiologist. Using AI can remove some
of these more time-consuming tasks.
By developing a system that can flag
up sites and measure the amount of
disease, clinical teams can work more
quickly on diagnosing and treating
patients, guided by extremely precise
The new study with Imperial,
MALIMAR (machine learning in
myeloma response), funded by the
National Institute for Health Research,
will train a computer algorithm to
recognise the difference between a
healthy scan and a scan of a patient
with myeloma. Researchers will then
examine the time it takes to process
and report whole-body MRI scans
normally, compared with a radiologist
using machine-learning technology.
The study also aims to find a way to
quantify the amount of disease visible
on whole-body MRI scans.
The Royal Marsden has a vital role to
play in the transformation of cancer
services to ensure patients receive
early and fast diagnosis and optimal
treatment and care. We will continue
to work with cancer centres globally to
accelerate the translation of research
and innovation into patient treatment
and care for the benefit of cancer
patients everywhere.
We are now
working on the
introduction of
biosimilars in
oncology for
NHS England
Jatinder Harchowal,
Chief Pharmacist at The
Royal Marsden, led the
RM Partners biosimilars

This article was sponsored by Royal Marsden Nhs Foundation Trust. The Parliamentary Review is wholly funded by the representatives who write for it.