2013 the british government announced that £250 million had been budgeted to establish two centers for advanced radiotherapy: the christie nhs foundation trust (the christie hospital) in manchester, which opened in 2018; and university college london hospitals nhs foundation trust, which opened in 2021. these offer high-energy proton therapy, and other types of advanced radiotherapy, including intensity-modulated radiotherapy (imrt) and image-guided radiotherapy (igrt). in 2014, only low-energy proton therapy was available in the uk, at clatterbridge cancer centre nhs foundation trust in merseyside. but nhs england has paid to have suitable cases treated abroad, mostly in the us. such cases rose from 18 in 2008 to 122 in 2013, 99 of whom were children. the cost to the national health service averaged ~£100,000 per case.