Private Notice Question (Lords) on Brexit: Imports of Radioisotopes - Mar 7

To ask Her Majesty’s Government what assessment they have made of the impact of a ‘no deal’ Brexit on the import of radioisotopes which are vital to the diagnosis and the treatment of cancer patients.

My Lords, I beg leave to ask a Question of which I have given private notice.

My Lords, the Government have been working very closely with the Royal College of Radiologists and the pharmaceutical industry to ensure that the NHS has robust contingency plans in place so that patients can continue to have access to medicines, including medical radioisotopes, whatever the EU exit outcome. Yesterday, the Royal College of Radiologists published sensible and pragmatic guidance to specialist NHS clinicians, which the Government support, to ensure that all necessary operational planning has taken place before 29 March.

My Lords, the Royal College of Radiologists, the British Nuclear Medicine Society and the UK Radiotherapy Board have all stated categorically that Brexit, particularly a no-deal Brexit, will mean delays in the supply of imported radioisotopes, which are so vital to the diagnosis and treatment of cancer patients. I too have read the guidance the Minister referred to, but does she agree that all these authorities are not convinced anti-Brexiteers trying to sensationalise the position? They are experienced and skilled in prolonging and saving the lives of cancer patients and they are clear that a no-deal Brexit will put already vulnerable patients at risk, while an extension of Article 50 will improve matters considerably. Does she further agree that while these authorities are making this point, if there were no other reason than that, the risk to people who may be diagnosed or may already have cancer is reason enough to take no deal off the table now?

I thank the noble Baroness for this. It is a very important question that she has raised. The Government’s first priority is to ensure continuity of care and patient safety, no matter the outcome of EU exit. That is why we have been putting important medical supply and contingency plans in place for the unlikely event of a no deal, even though that is not the Government’s plan. 

The guidelines issued by the Royal College of Radiologists were in response to the plans from two major suppliers, representing at least 80% of the market, which have arranged contracts for air freight capacity to commence this month for the supply of radioisotopes. It is important to note that many isotopes already use air freight, and their deliveries will see no change in their arrival arrangements. Of course, the supply in these routes is relevant because radioisotopic materials have a short half-life, and therefore these changes, although minor, will have an impact on clinical pathways. 

It is absolutely right for the Royal College of Radiologists to put some guidelines in place, and we have been working closely with it, the Department of Health and NHS England to offer clinics practical advice in allowing adjustment in their clinical processes. We do not expect any patient harm to arise from this, and the changes in clinical pathways and practice are expected to be minor and short-lived. We do not expect any delays or increased waiting times to arise from this; this is straightforward, practical advice to support clinics in adapting to changes in delivery times. 

I hope that is a reassuring Answer for the noble Baroness, and that it has clarified what was, I think, some sensationalist media reporting of the advice.

My Lords, it is not this House that needs reassurance but doctors and consultants, who are feeling the need to reduce their treatment lists next month because they simply do not trust the Prime Minister to avoid a no-deal Brexit. The reason for that is because she adamantly refuses to take it off the table, despite the fact that, as a negotiating tool, it is about as much use as a chocolate fireguard. The other side knows that she cannot use it; when will she take off the blinkers?

I thank the noble Baroness for her question. This advice has come not from the Prime Minister, but from the Royal College of Radiologists. On the basis of that advice, we know that many services will be unaffected. For other services, the NHS is already working closely with suppliers to minimise the impact of changes to medical radioisotope delivery times, which are expected to be a matter of hours and easily managed by clinics. But it is appropriate that they should be given sensible and practical advice to ensure that patients are protected and that patient safety is maintained to the highest possible standards.

My Lords, in many ways this Question is the just-in-time question of healthcare. We know that our manufacturing industries, particularly the automotive industries, will be affected by Brexit because of the just-in-time nature of their work. This is the just-in-time of cancer care. If you do not have the isotopes the tests do not get done, because the delivery is timed for the morning of an appointment when patients are due to arrive at the hospital—if there is nothing to give them, they then have to go home and wait for another slot. 

My question to the Minister, who has done her best to reassure us on this, is: what calculation have the Government made of the risks? Certainly, the organisations which have waved a flag about this are not trying to panic anyone; they have legitimate concerns that they may have to delay treatment and tests because of Brexit. What calculations have the Government made of the risks there would be to people’s lives from delays that may happen as a result of this lack of just-in-time?

I think I answered that in my response to the noble Baroness. We have assessed that we do not expect any patient harm to arise from this, and the changes to clinical pathways and practices are expected to be minor and short-lived. It is one of the reasons why we started working with industry early in the process to ensure that air freight capacity was put in place. It is also why we have been working with the Royal College of Radiologists, NHS England and the department to ensure that the guidance was put in place, so that clinics could be prepared to adapt to these changes in delivery times.

My Lords, the EU Home Affairs Sub-Committee looked at this matter and debated it in a take-note debate in July last year. At the time, I flagged up the importance of developing a new generation of alpha- and beta-emitting isotopes for cancer treatment in helping to mitigate the problems of importation. The then Minister, my noble friend Lord O’Shaughnessy, reassured the House that quite a lot of work was indeed going on with regard to proton beam treatment, that the Christie Hospital would be starting that very soon—that was last year—and that another unit was on the go. So there are alternative provisions for cancer treatment with proton beam therapy. None the less, there is an issue about what would happen in a no-deal Brexit as regards the gap between what we currently receive and what we are able to provide. Can the Minister say anything about when we can expect these new systems to come on stream? It is a challenging question, so she may wish to write to me on that.

I thank my noble friend for that helpful question. I assure him that both the Christie and UCL proton beam programmes are well under way, and we can be proud of our world-leading programmes in cancer proton beam therapy. I cannot give him an exact progress update on that, so I shall write to him on it. However, he is absolutely right that we must make sure that we progress those programmes, as well as ensuring that our supply of imported radioisotopes remains protected during the Brexit period.

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It is the turn of the Cross Benches.

My Lords, to what extent does the Minister consider that patients will be put at much greater risk in a no-deal scenario if a large number of oncologists up and down the country take the view that they cannot rely on the supply of medical isotopes and therefore start a programme of delaying access to an assessment and treatment by them? Does she consider that the Government cannot give these assurances because they do not know what the behaviour will be of individual clinicians who require the isotopes to treat their patients?

One of the reasons why we worked so closely with the Royal College of Radiologists to provide the guidance, as well as working closely with NHS England to communicate to the NHS, is to ensure that reassurance has been sent out through the system with regard to the arrangements which have been made for medical supplies so that those concerns can be allayed and to ensure that clinical pathways are not disrupted. For that reason we do not expect any patient harm to arise from this, and changes to clinical pathways and practice are expected to be minor and short lived.