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.
My Lords, I am pleased to take part in this short debate. All the important issues were covered by the noble Baroness, Lady Bloomfield, in her brilliant, comprehensive speech—but not by me, as they say, so I will repeat them.
The noble Baroness is right that it is time urgently to address this issue. The point has already been made that we increasingly need these radioisotopes as medical advances occur, particularly in molecular radiotherapy, which the noble Baroness did not mention. Molecular radiotherapy is used as internal therapy for diseased organs, as opposed to external radiation, which is what we are all familiar with.
We all know that one in two people are going to get cancer. The monitoring of cancers—for example, prostate cancers—requires a particular kind of radioisotope tracer to identify whether there are any metastases. This is now in short supply because we rely on a supply chain that comes from overseas.
Basically, there are two nuclear imaging modalities: SPECT, single-photon emission computed tomography, and PET, positron emission tomography. SPECT imaging relies primarily on reactor-produced isotopes, and we have to completely import them because we do not have a reactor. PET relies on cyclotron-produced images. While we have that facility, we do not have it extensively, so we often have to rely on overseas supply chains.
I will put it in the context of a patient. The overall problem is that they are waiting for a diagnosis, but cannot have it made because the supply chain for radioisotopes is in short supply or has been held up, and their appointment is cancelled. They wait another few weeks before that appointment is made again, during which time the patient’s cancer grows. Alternatively, they are relying on finding out how the cancer is progressing following diagnosis, particularly to see whether the cancer is responding if treatment is being given, and imaging facilities are needed, but the tracer or isotope is not available.
My Lords, I congratulate the noble Baroness, Lady Bloomfield, on securing this valuable debate. I think we should judge its value not by the number of people here but rather by the quality of the contributions. This is an important issue and, as the noble Lord, Lord Patel, said, the noble Baroness introduced this in a very comprehensive way, which was extremely welcome.
The Government are committed to delivering critical services that depend on the reliable supply of medical radioisotopes, to which both noble Lords referred. I agree with the noble Baroness and her reflections on the positive health outcomes, also supported by the noble Lord, Lord Patel. These isotopes support positive health outcomes, both for diagnostics and for therapeutics. I was looking at the figures: in England alone, some 700,000 procedures are carried out using radioisotopes every single year. This figure is expected to increase, not least because of their value in the process.
There are three main uses for medical radioisotopes; each relies on different manufacture to get the desired result. PET-CT scans, primarily used for cancer and cardiovascular diagnostics, use isotopes from a comprehensive network of UK-based cyclotrons. SPECT scanners are mainly used to confirm the cancer stage, to identify blood clots and to assess organ functions. These scanners use isotopes manufactured abroad in reactors; the noble Lord, Lord Patel, drew our attention to this. This is also the case for radioisotopes that are used for therapeutics.
As the noble Lord pointed out when he expressed concerns about delays to treatment and the impact on patients—the point was well made—the UK does not currently manufacture medical radioisotopes in reactors. Instead, we have in place a supply chain with isotope sources from multiple countries to aid resilience. I will come on to the point that the noble Baroness made about when that supply chain is disrupted. This gives us access to a global network of expertise and high-quality medical radioisotopes.
I know that intervening on the Minister is unusual in a short debate, but we are not exactly short of time. I think the Minister said that if we had a reactor, it would be a useful addition. It would not be a useful addition; it is a necessity. She did not define any solid plans—unless I missed them—where the Government have a clear intention to establish a nuclear reactor for producing radioisotopes. There is a promise that we will have good contractual agreements with the supply chain lines that the Minister mentioned—I cannot make the Minister’s speech, but I am asking the question—but those cannot be guaranteed because there are only six reactors in the world and they are more than 50 years old. Maybe the Minister could comment on that.
I understand the noble Lord’s point. The point I am trying to make is that a supply chain is important. I was indeed careful in my choice of words, not least because, as I mentioned elsewhere in my speech, the Government have not made a formal assessment of, in this case, the ARTHUR project. So I am limited in how far I can go on the most obvious presentation before us today, but I understand the point made by the noble Lord.
I thank the noble Lord, Lord Patel, and the noble Baroness, Lady Bloomfield, for raising this important matter, which is important for the whole of the Government.
1:24 pm
Sitting suspended.
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.
There is a further issue: if we have our own reactor that can be used for research, we will innovate for newer radioisotopes for both diagnosis and treatment. Our scientists are good enough; in fact, they are world leading. Furthermore, most tissues in the body are specific to certain chemical agents. For instance, iodine is used for the thyroid. If we want to diagnose or treat thyroid cancer using internal therapy, we would have a tracer with iodine to target thyroid tumours. Glucose is similarly used for brain tumours, and for identifying cancers that an MRI sometimes will not see. With a particular kind of tracer, PET-CT scans will see them, and therefore diagnosis and treatment happen earlier.
I could say this in one sentence or half an hour of speech, but the message would be the same. We urgently need UK-based radioisotope reactor facilities that produce tracers using radioisotopes, and also a cyclotron facility, so that the whole UK can then rely on our own supply. It also enables our researchers to further innovate for new tracers, and therefore end up leading the world. I say to the Minister that the time is now. Can we have the plan, please? Whether it is in Wales or not—I might have been tempted to say Scotland—the ARTHUR project has already made a good business case and worked this out. The cost is not enormous, particularly in the context of the NHS budget and the benefits that the NHS will derive. I plead for the same as the noble Baroness, Lady Bloomfield.
The noble Baroness made a strong case in advocating for the Welsh project ARTHUR, a reactor specifically designed for the purpose of medical radioisotope manufacture. The Minister for Medical Technology and Innovation, Zubir Ahmed MP, recently met Liz Saville Roberts MP to discuss this matter, and I can assure the Committee that the Government are in active discussions about this project. I note the points made about the suitability of the area and the potential benefits of this project. The UK Government have not made a formal assessment of the project at this time but are supportive of any manufacturing capacity that can improve reliable access to medical radioisotopes, as has been called for. A domestic reactor would certainly be a welcome addition to the overall supply.
The noble Baroness understandably highlighted the severe shortage of a specific medical radioisotope in 2024. I agree that this was caused by a global disruption to its manufacture. The underlying issue was that several nuclear reactors used for its manufacture were undergoing critical repair work. As noble Lords can imagine, these repairs are normally planned ahead and co-ordinated to ensure that there is always enough capacity to deliver critical isotopes. However, the safe running of reactors will always determine whether they will be taken offline for repairs. In this instance, critical repair work was identified and meant that multiple reactors were closed down at the same time.
Due to a diligent response from the Department of Health and Social Care, NHS England, industry and the NHS services impacted, I am glad to say that the patient impact from this severe shortage was limited. I am grateful to all those who worked to ensure this. However, it underscores the need for multiple available sources of medical radioisotopes. A Welsh reactor—or perhaps a Scottish one, although I would rather not dwell on the argument around the devolved Governments and locations—could be an important addition to this supplier base.
Also raised were the issues with the supplies for PET-CT scanners earlier this year. I can give an assurance that, when there are specific supply issues, such as the one the noble Baroness referred to that impacted north England and the Midlands, the department works with suppliers to recover supplies and services. We are aware of the difficulties and issues that both noble Lords have raised. I hope that response is of some assistance.
We are working to support services and improve outcomes for patients. The noble Baroness said that the Government should explore long-term solutions, so let me outline some of these actions. First, we are committed to a thriving life sciences sector and the development of high-skilled jobs in that sector. The Government have made up to £520 million available through the life sciences innovative manufacturing fund; that is available for any private manufacturing proposal, including for medical radioisotopes in the UK.
Medical radioisotopes support life-saving services, including for diagnostic tests; this Government are committed to supporting the improvement of these services. Therefore, we have announced £6 billion of additional capital investment over five years across new diagnostic, elective and urgent care capacity. This includes funding to increase capacity for both testing and reporting across community diagnostic centres and hospitals.
In early 2026, which is nearly upon us, the Government will publish their national cancer plan. This will set out how we will improve diagnosis, treatment and waiting times in order to improve outcomes for cancer patients and increase survival rates. UKRI, the UK’s national funding agency for science and research, also supports the overall service delivery and has recently invested £32 million for novel total-body PET-CT scanners. All these interventions will, as I say, improve the situation for patients and improve services.
In conclusion, as the noble Lord and the noble Baroness have called for, this Government are committed to ensuring robust and reliable supplies of medical radioisotopes to deliver critical services. We are supporting the development of manufacturing and delivery capabilities in the UK, where this is appropriate, alongside working closely with international partners and suppliers. We are also committed to the economic and industrial development of the UK science sector. That is why we have made available investment funds that are open for applicants who are looking to expand or improve UK manufacture of medicine and medical technology products. This includes UK-based manufacture of medical radioisotopes or their adaption for diagnostic or therapeutic applications.
Medical Nuclear Radioisotopes · Order Paper · Order Paper