Medical Nuclear Radioisotopes
Baroness Bloomfield of Hinton Waldrist Excerpts(3 weeks, 1 day ago)
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Baroness Bloomfield of Hinton Waldrist
To ask His Majesty’s Government what steps they are taking to enable the domestic manufacture of medical nuclear radioisotopes.
Baroness Bloomfield of Hinton Waldrist (Con)
My Lords, it is always a privilege to be allocated a slot in the ballot for Questions for Short Debate. While I am disappointed with the small number of speakers, I feel sure that had more noble Lords been aware of the challenges facing the supply of these clever little chemical elements, this debate might have generated a bit more interest. My contribution seeks to address this issue of both national and personal significance. I declare my interest as a trustee of the Royal Marsden Cancer Charity.
Radioisotopes have transformed science, medicine and industry. Their ability to emit radiation makes them both powerful and, when handled safely, invaluable to modern society. In medicine, they are the backbone of modern diagnostics, innovative therapies and clinical trials. They are vital for the early detection and treatment of cancer, heart disease and many neurological disorders. Every year, more than 700,000 NHS procedures rely on medical isotopes and yet, despite their critical importance to world-class patient care, we face an acute and growing crisis in their supply. Currently, around 60% of our medical radioisotopes are imported. For the isotopes that we use in therapeutic treatment, almost 100% comes from overseas. The UK produces radioisotopes domestically only for PET-CT scans, and even that capacity is very limited.
Recent disruptions, triggered by overseas reactor shutdowns and global manufacturing shortfalls, have already led to the delay and cancellation of critical diagnostic tests. Delays can cost lives. Molybdenum-99, a critical isotope for cancer testing, was acutely limited in late 2024, forcing health leaders to ration supplies and to prioritise only the most urgent cases. Between January and May this year, dozens of cancer patients in the Nottinghamshire and east Midlands trusts experienced delays in PET-CT scans due to radioisotope shortages.
This fragility of supply has a very human cost. The root causes are clear: our dependence on ageing foreign reactors, transport hurdles and Brexit-related trade barriers all converge to create a precarious, expensive pipeline for these life-saving elements. The majority of them are produced by an ageing global network: 64% of current production capacity, in 11 reactors, is expected to be decommissioned by 2030. Shutdowns, such as that of the Belgian BR2 reactor, are more likely to occur as global demand increases, reactors age and more research reactors come offline.
The situation is unsustainable but, luckily, neither inevitable nor unfixable. However, it requires the Government and the scientific community to explore and pursue long-term solutions—not an easy ask in times of serious budget constraints—where cross-departmental co-operation is key. I note that it is the noble Baroness, Lady Merron, responding as Minister for Health, but it could as appropriately have been a Minister from the Department for Science, Innovation and Technology, the Department for Business and Trade or indeed the Department for Energy Security and Net Zero.
Any long-term solution must have at its core a vision for a secure, sovereign supply chain anchored in world-leading research, agile infrastructure and a skilled workforce. As well as direct benefits, research reactors have been demonstrated to create technological clusters that attract investment as industry benefits from proximity, which reduces the loss of radioactivity due to decay, and highly skilled expertise is built up in a local workforce. But the supply chain challenges for molecular radiotherapy stem from the fact that the radioactive component—the radionuclides—are short lived, so must be made continuously and cannot be stockpiled.
Where could we build a reactor where there is already a suitable nuclear site, owned by the Nuclear Decommissioning Authority, with a highly skilled local workforce in the relevant nuclear and medical sciences, a welcoming population well educated in the advantages of living in close proximity to a nuclear site, and an airfield almost adjacent to export the radionuclides with short half-lives—more likely to be counted in hours, not days—to the UK and beyond? Extensive research by the Snowdonia Enterprise Zone, backed by the Welsh Government, assessed long-term economic uses for the Trawsfynydd site in south Gwynedd. Given the site’s heritage, it concluded that it is most suited for nuclear development. Following detailed assessments of a number of different options, two projects were confirmed as having the greatest potential to deliver socioeconomic benefits, namely SMRs and a medical research reactor to produce radioisotopes for cancer diagnostics treatment and research.
The proposed ARTHUR—advanced radioisotope technology for health utility reactor—initiative envisages a dedicated medical reactor capable of producing a steady flow of radioisotopes for NHS use and research, and for export. The recommended reactor design for the ARTHUR project would use proven technology and is modelled on the ANSTO OPAL reactor, the world’s leading example for secure and efficient medical isotope production. The plan is supported by leading academic voices. Professor Simon Middleburgh of Bangor University’s Nuclear Futures Institute has stated that
“such a facility is not simply a Welsh inspiration—it is a UK wide imperative. Without it we remain at the mercy of foreign reactors, rising costs and global shocks”.
In 2022 the Government took a step in the right direction by announcing a £6 million medical radionuclide innovation programme. The commissioned report, issued by TÜV SÜD, warned of a supply vulnerable to technological failures, infrastructure delays and geopolitical upheaval, underscoring the conclusion that our current system is not future-proof. The recent review of molecular radiotherapy services produced by the Royal College of Radiologists, the Royal College of Physicians, the Institute of Physics and Engineering in Medicine and the British Nuclear Medicine Society made one key recommendation: that every devolved Government and every radiotherapy operational delivery network in England appoint a molecular radiotherapy champion, someone with the mandate and vision to drive the change we need. By investing in infrastructure using the existing workforce, as well as training the workforce of tomorrow, we can become self-reliant and once again lead the world in nuclear medicine innovation.
One in two UK citizens will be diagnosed with cancer in their lifetime. Many will see their quality of life and the efficacy of their treatments enhanced as a result of nuclear medicine. Every hospital in the UK uses it to help patients on a daily basis—700,000 patients a year and counting. We must act now. Let us not wait for another global shortage, another shutdown or another delayed shipment to force us into crisis mode. Let us choose instead to build a secure, resilient, sovereign supply of medical isotopes for the UK and, of course, I hope that will be in Wales.
NHS: Independent Investigation
Baroness Bloomfield of Hinton Waldrist Excerpts(1 year, 2 months ago)
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Baroness Merron (Lab)
I agree with the noble Baroness that that is unacceptable. There are just too many children and young people who are not receiving the care that they deserve. We know that waits for services are far too long and our determination is to change that—not least, as I am sure the noble Baroness has seen, given that children are at the heart of our opportunity and health missions, and rightly so. To ensure that every child has a happy and healthy start to life, among other measures we will train more health visitors and digitise the red book of children’s health records, so that parents and children can access the right support. We will be restricting vapes and junk food from being advertised to children, which will assist in the prevention of ill health, and we will ban the sale of high caffeine and energy drinks to under-16s. There will also be specialist mental health support in every school and walk-in mental health hubs in every community. I hope all of those will make a difference.
Baroness Bloomfield of Hinton Waldrist (Con)
My Lords, I draw attention to my entry in the register of interests as a trustee of the Royal Marsden Cancer Charity. The report of the noble Lord, Lord Darzi, discusses oncology services and life science research, both of which are at risk given NHS England’s planned closure of the paediatric oncology unit at the Royal Marsden in Sutton, cited alongside the Institute of Cancer Research as offering bench-to-bedside research and care. Does the Minister agree that such a closure would be devastating to the provision of paediatric cancer services, to research and to drug trials, and that it would undermine the recommendations of the report, which highlights the need to improve cancer survival rates and bolster our life sciences capability?
Baroness Merron (Lab)
I thank the noble Baroness for raising this important question, as she has done before with me. I know she is aware that I cannot comment on the individual case. What I can say is that research, diagnosis and treatment in all these areas, as we have heard from the noble Lord, Lord Darzi, are absolutely crucial to ensure that cancer patients are not being failed. We need to improve cancer survival rates, and we need to ensure that patients wait for no longer than they should. We have to research cancer, diagnose it on time and treat it faster.
NHS: Breast Screening Programme
Baroness Bloomfield of Hinton Waldrist Excerpts(1 year, 3 months ago)
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Baroness Bloomfield of Hinton Waldrist (Con)
I also begin by paying tribute to the noble Baroness, Lady Morgan, for her excellent work with Breakthrough Breast Cancer and more recently with Breast Cancer Now. Can the Minister reassure me that the Government will look again at the ceasing of breast cancer screening after the age of 70, when the incidence of disease occurring in that age group is still high, and would be higher were it not for the success of earlier breast cancer screening? This cohort of women should not be ignored.
Baroness Merron (Lab)
If a woman in the age group to which the noble Baroness refers has concerns, she may request follow-up and investigation. But it is the case that we follow the scientific advice, which is that going beyond that age as a matter of course will not give the rewards that we would hope. I can certainly reassure any woman in that age group that she will be seen should she have concerns, and she should present herself as soon as possible.
Children’s Cancer Services
Baroness Bloomfield of Hinton Waldrist Excerpts(1 year, 8 months ago)
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Baroness Bloomfield of Hinton Waldrist
To ask His Majesty’s Government whether a fully funded delivery plan has been agreed in relation to NHS England’s proposal to relocate children’s cancer services away from The Royal Marsden NHS Foundation Trust to other providers across London.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
NHS England has decided that Evelina London should be the future location of the principal treatment centre, following extensive engagement with a wide range of stakeholders across the south London/south-east region. A delivery plan has been assessed as affordable by NHS England, with capital funding in place, and remains subject to robust financial scrutiny. Ministers are considering next steps.
Baroness Bloomfield of Hinton Waldrist (Con)
I thank my noble friend the Minister for his Answer and draw attention to my entry in the register of interests. This is an extraordinary act of self-harm. NHS England, in a decision delegated to the London region, announced that it will be closing the world-leading paediatric cancer services of the Royal Marsden Hospital in Sutton and transferring these to the Evelina Hospital in central London. The Royal Marsden is the largest centre for clinical trials for new drugs for children with cancer in Europe. Its unique co-location with the ICR and the team developing new adult cancer drugs and researching how these can be used to help support childhood cancers means risking the loss of many of these trials and breakthroughs by breaking this bond. Will my noble friend undertake to ask the Secretary of State to call in this decision, as legislation allows her to?
Lord Markham (Con)
First, I thank my noble friend for the tireless work she does on behalf of the Royal Marsden, and convey the views of probably all noble Lords on the fantastic work the Royal Marsden does. The current situation, as I think noble Lords know, is that the NHS has reached a decision. The Secretary of State does have the power to call in exceptional cases, and as a result of that, Minister Stephenson is undertaking a fact-finding mission. I have set up a meeting with him to discuss this, and my noble friend is very welcome to join me at that meeting.
Anaesthesia Associates and Physician Associates Order 2024
Baroness Bloomfield of Hinton Waldrist Excerpts(1 year, 9 months ago)
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Lord Bethell (Con)
My Lords, I hope that my noble friend the Minister will not mind if I say that I am very grateful to the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, for the regret amendments and this debate today. Secondary legislation comes through the House and too often we overlook it. Every now and again we need to put a spotlight on some of the important measures that go through.
I regret two things. I deeply regret the way in which the professions of associate physician and associate anaesthetist have been denigrated in the press, in the lobbying material that has been sent around, and, frankly, in aspects of this debate. I agree with my noble friend Lady Harding and the noble Lord, Lord Hunt, that the feelings and sentiment of these hard-working contributors to our healthcare system have been overlooked. I was sent a very robust briefing by the BMA. I replied: “Is there nothing positive you can say about these hard-working healthcare professionals?” The reply came back—the noble Baroness, Lady Finlay, was copied in on it—that there was not: there was nothing positive it could say about them. I greatly regret that tone, and wish it had not happened.
I am not a clinician and I do not have anything to rival some of the comments made by the clinicians. However, I point out that our hard-working healthcare professionals are incredibly stretched. Take GPs, for instance: 350 million appointments were conducted in primary care last year, 160 million of which were by GPs themselves. That was 50 million more than in 2019, so 44 more appointments per practice. That trend is going up. Britain is getting less healthy, and there is a large amount of immigration. The number of full-time equivalent GPs—although the number of GPs has gone up, a lot of them are working fewer hours—has decreased from 28,000 in September 2015 to 27,000 in October 2023. The complexity of many people turning up to these appointments is very high.
We have to find people from somewhere to do some of these appointments, and there are going to be people who have a lot to contribute who do not necessarily go through the 10 years of qualification to become a GP. We should be embracing them. That is what is happening in every other professional walk of life—it is happening with the astronauts who fly to the moon, the people who fly our planes, and the lawyers who run our courts. The modernisation of workforces is happening everywhere; we should embrace that. My noble friend the Minister alluded to 12,000 AAs and PAs by 2036; that would be just 8% of the number of doctors. That is not a revolution or a threat that the doctors of Britain should be worried about.
If these regulations do not go through—the noble Baroness, Lady Bennett, has said that they will—then it would be difficult to enforce standards, there would be years of delay to regulate the professions, there would be a reduction in the number of healthcare professionals to support our healthcare system, and training programmes would be on hold. I support the passage of this legislation, so that we can modernise the workforce, increase primary care capacity, improve the lot of our hard-pressed GPs and make it easier for a wide range of talents to make a difference to the British healthcare system.
Baroness Bloomfield of Hinton Waldrist (Con)
My Lords, I will speak very briefly in favour of these regulations. I am absolutely in favour of any way in which we can leverage the ability of our doctors to concentrate on what they want to do, and what they have been highly and expensively trained to do, which is to take responsibility for seeing, diagnosing and treating patients who are ill and in need of medical help. I am also in favour of trying to reduce the exorbitant cost of locum GPs, which bleed resources from the National Health Service—resources which could be much better spent elsewhere. Some of the Government’s initiatives, such as allowing pharmacists greater and more extensive advisory and prescribing powers, are also very welcome.
I have no philosophical objection to the concept of physicians or anaesthetists being supported by assistants, whether they are senior nursing staff or others, but I share the concern that the very term “associate” implies a greater degree of qualification than is actually the case. Two years’ training post a science degree does not a doctor make. Of course they should be regulated by an organisation which enjoys public confidence, so long as that in itself does not imply a greater medical qualification.
It is easier to prevent overreach in a hospital environment, where supervision in anaesthesia should be routine, but it is much harder in general practice. The reason I rise now is because my husband was seen by a physician associate when his throat failed to heal weeks after he burned it with a hot cup of coffee. After the young man had taken a photograph and disappeared up the corridor with his phone, allegedly to see a GP, he reappeared with an ominous pamphlet entitled “Suspected throat cancer” and suggested an urgent appointment at the John Radcliffe Hospital. I am pretty sure he was not trained to be the bearer of such bad news. So undoubtedly physician associates need to be regulated, though I acknowledge it was better this way round than ignoring something and saying that there was no issue to be dealt with when there might have been.
We have 14 GPs in our local practice, in a small town in Oxfordshire: 11 work three days per week, none of them works full-time and one of them works one day per week. Perhaps we should also address the loss of 40 working days per week from any similar team, as well as putting in place things that make doctors’ working lives more rewarding and meaningful. If physician associates are part of that then I am fully supportive, so long as they are properly regulated. The Faculty of Physician Associates code of conduct, produced with the GMC, says that physician associates will always work under the supervision of a designated senior medical practitioner and that they must work within the limits of their experience. Let us make sure that these regulations will help make that happen.
Lord Scriven (LD)
My Lords, I have listened to the debate very carefully. My professional experience as a former health service manager over many years is that we have had this debate about people taking on different roles in health and always the same arguments come. Whether it be physiotherapists taking on roles, nurses becoming nurse practitioners or pharmacists coming into this, the same argument always happens: that somehow this dilutes patient care and safety. The answer is that it does not if it is properly regulated, there is proper training and there is proper monitoring of what happens to patients.
I understand that there is some anxiety, but I have to say to the BMA, in particular, that its language in the briefings it has given has driven the bullying and ostracisation of colleagues in hospitals who are valued members of a clinical team. That is the word: “team”. It needs to be led by a senior doctor, normally the consultant, without ostracising people within that team. I gently say to the noble Baroness, Lady—I have forgotten.
Primary and Community Care: Improving Patient Outcomes
Baroness Bloomfield of Hinton Waldrist Excerpts(3 years, 3 months ago)
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Lord Baker of Dorking (Con)
Before the noble Baroness sits down, I thank her for a very interesting, well-informed speech. She identified the pressures placed upon GPs, which are not going to be relieved easily. Would she welcome what happens in a country such as France, where many—
Baroness Bloomfield of Hinton Waldrist (Con)
I am very sorry, but the noble Lord is not on the speakers’ list.
Baroness Bloomfield of Hinton Waldrist (Con)
No, not in a time-limited debate with a provided speaking time.
Blood Safety and Quality (Amendment) (EU Exit) Regulations 2020
Baroness Bloomfield of Hinton Waldrist Excerpts(5 years, 1 month ago)
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Baroness Bloomfield of Hinton Waldrist
That the draft Regulations laid before the House on 8 October be approved.
Considered in Grand Committee on 2 November.
Baroness Bloomfield of Hinton Waldrist (Con)
My Lords, on behalf of my noble friend Lord Bethell, and with the leave of the House, I beg to move the four Motions standing in his name on the Order Paper en bloc.