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National Medical Isotope Centre: North Wales

Volume 728: debated on Wednesday 22 February 2023

Motion made, and Question proposed, That this House do now adjourn.—(Fay Jones.)

Let me start by congratulating the Minister on her recent appointment as Minister for Science, Research and Innovation in the new Department for Energy Security and Net Zero, and thanking her sincerely for her engagement prior to the debate.

This afternoon—I originally wrote the words “this evening”—I will explain why medical radioisotopes are important, why there are significant concerns about the security of supply in the UK, and, finally, how a national medical isotope centre in north Wales could provide a reliable supply of medical radioisotopes for the UK into the future.

Let us start with the basics. What are medical radioisotopes, and why are they important? Medical radioisotopes are used in a branch of medicine that employs radiation to provide diagnostics and treatment. According to the World Nuclear Association, more than 40 million procedures using radioisotopes are performed every year globally. In the UK, around 700,000 medical procedures using radioisotopes are carried out annually. The radioisotope most widely used in medicine is Tc-99, which is employed in about 80% of all such medical procedures.

Diagnostic procedures using radioisotopes are now routine, identifying cancers and illnesses such as heart disease earlier to improve outcomes for patients and save lives. The thyroid, bones, heart, liver and many other organs can be easily imaged and disorders in their function revealed by using radioisotopes. When used for diagnostics in this way, the radiation is detected by a scanner to produce an image that can be used to track disease progression, to provide predictive information about the likely success of various therapy options and to assess changes since treatment. This information helps healthcare professionals to accurately manage diseases and to make informed medical decisions on treatment options such as surgical intervention.

When used for treatment, molecular radiotherapy delivers radiation to malignant tissue, which then weakens or destroys cancerous cells. This is a rapidly evolving discipline, with research currently taking place into new drugs that could revolutionise the management of certain cancers over the coming years. Radioisotopes can also be used to sterilise single-use medical equipment such as syringes and surgical gloves, with one of the key advantages being that this approach allows already packaged products to be sterilised. In addition, because it is a cold process, radiation can be used to sterilise a range of heat-sensitive items such as powders, ointments and solutions, as well as biological preparations such as bone, nerve and skin to be used in tissue grafts.

Despite the clear importance of medical isotopes, both as a pillar of cancer care and as a diagnostic tool, this branch of medicine is being neglected. With the World Nuclear Association forecasting the use of radioisotopes increasing by up to 5% annually and the Royal College of Radiologists expecting the use of molecular radiotherapy to increase dramatically over the next decade, there are concerns that most nations and regions throughout the UK are neither prepared nor preparing for this increase in demand. It is for this reason that a review of molecular radiotherapy services in the UK, undertaken 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, recommended that each devolved Government and each of the radiotherapy operational delivery networks in England should appoint a molecular radiotherapy champion. The champion’s role would be to identify where there were gaps in the provision and what further support would be needed to deliver treatment effectively.

The UK Government have made some progress on this matter, announcing a £6 million medical radionuclide innovation programme in December last year. Can the Minister clarify whether her Department will now be responsible for this programme and whether any progress has been made on the innovation project workstream that will look at the development of technologies that could support future access to medical radionuclides? The question of which Department is responsible is significant.

The relative neglect of this branch of medicine in the UK over the last decade and more means that we now depend heavily on imports for key radioisotopes, many of which are supplied by air from South Africa and Europe. The Institute of Physics and Engineering in Medicine has expressed its concern regarding the fragility of this supply chain, with post-Brexit customs backlogs, although fortunately quickly resolved, serving to highlight just how dependent on imports we are. I would like to put on record my thanks to the IPEM for its work in drawing attention to this important matter, and particularly to Paul Barrett for his assistance.

The reality is that, without decisive action, the UK is facing a likely catastrophic breakdown in the supply chain for medical radioisotopes, which could have a severe knock-on effect on diagnostics and therapy, and therefore on patients’ lives, in the UK. The key issue of the lack of availability of radioisotopes is arising because many of the reactors that produce this material globally will be decommissioned within the next decade, many of them by 2030. It is worth noting that there was some positive news just last week from the Netherlands, with the Authority for Nuclear Safety and Radiation Protection giving approval for the construction of a new reactor to produce medical radioisotopes, which it hopes will come on stream by 2030. While welcome, this reactor will only replace the reactor that is already operational in the Netherlands; it will not add any new capacity. In addition, even if the reactor in the Netherlands comes on stream by 2030—this is important—the EU will still lose a third of its production capacity over the next seven years.

In Russia, construction has started at a plant in Obninsk, which will produce isotopes for the diagnosis and treatment of patients, with the aim of having production lines operating by 2025. ROSATOM, the Russian state nuclear energy company, has said that the plant will “ensure Russia’s sovereignty” in the production of radiopharmaceuticals. I am sure I do not need to convince anybody in the House of the merits of ensuring that we are not reliant on Russia for life-saving materials—now, in the near future, the middle future or possibly beyond.

If the UK population is to benefit from molecular radiotherapy advances and hard-won improvements in the diagnosis of symptoms and in survival rates, patients need to be able to access treatment regardless of where they live. That will require the creation of a robust supply chain, and that means being able to produce radioisotopes in the UK. While the rate of decommissioning that will take place across Europe poses a serious risk, it also gives the UK an opportunity to fill the gap that will be left in the market and, in doing so, to ensure that we have a reliable and accessible domestic supply, as well as to play a key part in strengthening the global supply chain.

In strengthening the UK’s domestic infrastructure for creating medical radioisotopes, the overarching goal should be to ensure that health services across the UK have access to these materials. Having an affordable stream of radioisotopes will also relieve the burden on health services, in terms of the costs and time involved in procuring medical isotopes. My second question to the Minister is therefore this: will the UK Government’s major conditions strategy, which is being developed by her colleagues in the Department of Health and Social Care, look at the need for radioisotopes?

Securing a domestic supply, rather than being reliant on imports, would be beneficial because one challenge with using medical radioisotopes is that they have a very short half-life, which is the time required for half of the radioactive atoms present to decay. That means that many radioisotopes have to be manufactured days or even hours before administration to a patient. That makes them vulnerable to short-term disruptions to supply, as we saw when mechanical failures at a Belgian nuclear plant last year led to cancer patients in the UK having crucial scans cancelled because of a shortage of radioisotopes. In addition, because of the large distances that medical isotopes are required to travel, more are often produced than is necessary, which increases the cost of procurement and, in turn, the financial burden on the NHS.

Securing an accessible supply of radioisotopes for the UK is at the heart of expanding the UK’s research and development capacities in this field. It would present an opportunity to drive forward research and clinical trials on cancer treatments and, in so doing, help the UK Government achieve their aim of turning the UK into a life sciences superpower. In addition, there is significant scope to capitalise on the variety and range of isotopes that a new facility could produce. For example, a radioisotopes production centre in Australia ships materials for research purposes all over the world, as well as conducting its own research.

Given the clear benefits of securing a UK supply of medical radioisotopes, it is opportune that there are calls for a generating reactor in north Wales. There are proposals for an advanced radio technology for health utility reactor, known as Project ARTHUR, which would be built in Trawsfynydd. The ARTHUR programme aims to establish a medical radioisotopes production facility to complement Bangor University’s Nuclear Futures Institute, which is already the UK’s second largest nuclear research group within UK universities. Bangor University also has a planned new medical school, so there really is an opportunity to create nuclear medicines expertise and a centre of excellence if we look to move ahead. I would like to take this opportunity to thank Professor Simon Middleburgh, the co-director of the Nuclear Futures Institute, for his work in this field, and for his assistance in preparing for this debate.

The proposals for ARTHUR centre on a small non-power reactor based on the open-pool Australian lightwater technology. The reactor’s primary remit will be health intervention, as it will, as I said, have no energy output. The proposals are for a not-for-profit initiative, with health services in Wales, England, Scotland and Northern Ireland all set to benefit. The reactor will be able not only to supply diagnostic and therapeutic medicines for the UK, but to provide enough to export internationally. ARTHUR also has the potential to do other things, such as enable neutron capture therapies, which are experimental therapies for treating brain tumours, and for non-health-related neutron physics research.

In order to ensure that the production of isotopes can begin before the worst impacts of the global shortages affect patients, construction must start in 2024, so that this can come online by 2030. The Welsh Government support the project and are willing to fund a proportion of the cost, but they have made it clear that financial support is required from Westminster to bring the project to fruition. That is inevitable, given the limited financial levers available to the Welsh Government in terms of capital investment, and this would be a piece of cross-nation critical infrastructure.

In a recently finalised strategic outline business case, it was indicated that by selling radioisotopes in the UK alone—this is not including overseas exports or the research opportunities—the facility would be able to cover the capital expenditure in between 11 and 16 years, depending on interest rates. The added benefit of having the site at Trawsfynydd in my constituency is that the Welsh Government have established a development company, Cwmni Egino, whose primary remit is to bring forward potential new projects and further maximise the opportunities of the Trawsfynydd site. It is principally concentrating on bringing forward plans for a small modular reactor, but it is worth noting that there is enough room at the 15 hectare publicly owned site for continued decommissioning of the former power station, an SMR development, and Project ARTHUR. Indeed, there would be both space for a range of developments at this nuclear-licensed site and synergies between them.

Project ARTHUR has the potential to be a major Welsh and UK strategic initiative for the next 50 years or more. It is likely to operate in a way that saves countless lives, allows people to have healthier and happier family lives, and improves economic outcomes, as people will be able to work for longer and more effectively. Once up and running, it will be one of the few facilities in the world focused primarily on medical radionuclide production. It also presents an opportunity for the north Wales economy; it would bring in highly skilled jobs in the industry, create surrounding infrastructure, and build local supply chains. The jobs created, both directly and in the associated supply chain, will be long term and sustainable, and will include roles such as research scientists, engineers, drivers, operators, and production, technical and office staff. By attracting good jobs to the area, the facility will help to sustain local communities. That is incredibly important for the rural and Welsh-speaking counties in north-west Wales.

In order to realise this vision, a key stumbling block that must be addressed is the apparent lack of ownership of this issue in Westminster. Responsibility has been passed backwards and forwards between the Department of Health and Social Care and the Department for Business, Energy and Industrial Strategy. We hope that the recent reorganisation in Whitehall and the creation of the Minister’s new Department will present an opportunity for strong leadership on this matter. Will she provide clarity on whether the new Minister for nuclear will lead on this work? Who will lead on it?

I wish to touch on one final part of the puzzle that must be addressed if we are to ensure that the UK can fully maximise the benefits of medical radioisotopes: training. There is a skills gap, and a shortage of nuclear chemists and radiochemists, in the UK. New courses need to be developed and supported if we are to train the next generation of nuclear medicine physicians, oncologists and clinical scientists and deliver high-quality care using medical radioisotopes. I would appreciate it if the Minister could update the House on whether any discussions have been had on introducing regulatory reform to change the qualified person training process, so that it aligns with European standards. I have been told by those working in the sector that that would expand the opportunity for nuclear chemists and radiochemists to be involved in clinical trials and become fully qualified. At present, there are concerns that there is a shortage of qualified persons, which is hampering the number of people able to train and qualify.

Improving training is also important because the lack of trained staff means that there is a discrepancy in the provision of molecular radiotherapy services across the UK, with some patients unable to access services where they live; we have the old postcode lottery. In order to address training and the fundamental question of security of supply, I urge the UK Government to work with the devolved Governments to develop a strategy for the equitable delivery of molecular radiotherapy services—a strategy that places patients at the heart of the delivery of these services and ensures that the relevant patient advocacy groups are involved in determining the shape of molecular radiotherapy treatment.

In closing, this issue is about patients having equitable access to innovative treatments, minimising health inequalities and ensuring that the promised improvements in survival rates can be delivered to all those who could gain from them. I hope that the Minister will agree to work with me and with Welsh Government Ministers to harness the capability, skills and expertise in north Wales, and to bring Project ARTHUR to fruition.

I thank the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) for the connection that we had before this debate. On the point about the portfolios in the new Department, it may well be that some questions remain unanswered, but she has my guarantee that I will get them to the right Minister for a response.

I thank the right hon. Lady for securing this debate on a national medical isotope centre in north Wales. This is such an important matter to discuss. I agree that there is more that the UK can do to maintain secure access to the radionuclides that we need. Radionuclides, also known as radioisotopes, are vital to UK healthcare. Common uses include the diagnosis of cancer and heart and lung disease, as she mentioned. They are vital in the treatment of some cancers. The already important role of radionuclides in our healthcare system is set to grow. New radiopharmaceuticals are under development, including for cancer therapy, and there is an ever-increasing demand for diagnostics. The Government recognise the importance of finding a sustainable solution to radionuclide production to safeguard the provision and development of radiopharmaceuticals for UK patients.

Most radionuclides are produced in research reactors outside the UK. This leaves the UK reliant on ageing infrastructure overseas. A number of these reactors are due to come offline this decade, and their replacement projects have been delayed. Without a confirmed route to replace production, the supply chain will risk becoming even more fragile.

In 2022, the unplanned maintenance of a research reactor in Belgium caused global shortages of several critical medical radionuclides, including weeks of shortages in the UK. Those shortages were managed through a combination of Government, NHS and industry responses. The Department of Health and Social Care, working closely with the British Nuclear Medicine Society and other specialist clinicians, issued guidance to the NHS. This guidance outlined how to manage patient services effectively to prioritise the usage of pharmaceuticals that require radionuclides produced in reactors.

Thanks to a significant amount of work by DHSC officials and a strong relationship with UK suppliers, the UK was able to source adequate material to ensure that the impact on patients was minimal. Access to a global resilient network of research reactors is critical for these products, which cannot, as we know, be stockpiled. That international co-operation ensured a continued, albeit limited, supply of those products during the shortage period.

A European Commission report, published in 2021, supports the idea that the supply chain may become more fragile. It notes that the shutdown of European research reactors, as well as the general ageing of infrastructure and the lack of immediate replacements, are unsolved issues that require concerted European action.

The Government recognise the need to strengthen our access to medical radionuclides in the UK to mitigate the impact of shortages and to continue delivering nuclear medicine services for UK patients. As the lead Department for nuclear innovation, the Department for Energy Security and Net Zero is playing a central role. By reviewing our access to medical radionuclides and developing technologies, we aim to improve security of supply. We have been clear that nuclear technology has a role to play in the UK, and our ambitions have centred around providing secure, reliable, low-carbon energy to millions of UK homes.

However, we must continue to use our capability as a nuclear nation to support the provision of nuclear medicine services and to drive healthcare innovation. In recognition of the opportunity for the UK to do more to secure its access to medical radionuclides, my Department launched the £6 million medical radionuclide innovation programme in December last year. The programme will focus on encouraging innovation in technologies and techniques that could support access to radionuclides and increase our national resilience against global shortages.

The call for projects to receive funding will be competitive, but the programme has been designed to be technologically agnostic and a research reactor such as the proposed medical isotope centre is one of the technology options it could support. The programme will also provide a comprehensive understanding of global supply and UK demand for medical radionuclides up to 2050. Any gaps in supply will be analysed to understand the impact on UK patients. That work will provide the evidence base that the Government need to take informed decisions on future radionuclide supply.

DHSC continually monitors supply concerns, including through regular contact with UK suppliers, and is working closely with officials in the Department for Energy Security and Net Zero. Together, we recognise the need for leads in nuclear technology and healthcare to collaborate and deliver results.

Radiopharmaceuticals play an important role in the diagnosis and treatment of some cancers, as we have acknowledged, and the recovery of elective cancer services remains a Government priority. Thanks to symptom awareness campaigns and the hard work of NHS staff, there are continued high levels of urgent cancer referrals, with more than 10,000 urgent GP referrals seen for suspected cancer per working day in December 2022. DHSC is working to reduce the 62-day cancer backlog, which has fallen by 9% since peaking in May 2020.

It is promising that more cancers are being caught early. Recent data also shows that more than 100,000 patients last year were diagnosed with cancer at an earlier stage, when of course it is easier to treat. I know that researchers and staff across the service are focused on achieving the NHS long-term plan ambition to diagnose 75% of all cancers at an early stage by 2028. In addition to the immediate action to support cancer services, recognising that the majority of cancer patients will have at least one other condition, DHSC is developing a major conditions strategy that will cover disease areas including cancer.

I have outlined the important progress that the Government are already delivering across nuclear medicine and radionuclide supply. However, we acknowledge that there is always more that can be done to maintain future access to radionuclides and to deliver for UK patients. It is important to note that, when making recommendations for future policy, our advice must be driven by evidence. That is especially salient when making decisions on high-budget interventions such as the construction of a national medical isotope centre. With nuclear innovation, and especially innovation in healthcare, we must ensure that we have the strongest possible rationale for what we are asking the Government to deliver.

We aim to ensure that resources are focused effectively, giving best value and the greatest possible benefit to the taxpayer. We will do so via the medical radionuclide innovation programme and other important initiatives such as NHS England’s review of NHS trusts’ radiopharmacy services to better understand the facilities, equipment, workforce and capacity needed to effectively deliver nuclear medicine.

I am keen to stress, however, that the medical radionuclide innovation programme is not running in contradiction to proposals for large infrastructure projects, including the one under debate today. Our programme aims to determine the technologies needed to deliver the radionuclides required for nuclear medicine services across the United Kingdom. As well as supporting the development of new targeted therapies, the programme will therefore consider the suitability of a national research reactor as one of the technology options once we have concluded our assessment of the radionuclide landscape. While the delivery of healthcare and the supply of medicines are devolved matters, it remains important that the four nations can come together and support one another where possible.

Our chief scientific adviser at the Department for Energy Security and Net Zero has had regular engagement on this issue over the past two years with his counterparts in the Welsh Government and the Department of Health and Social Care. Together, they understand the need to build an evidence base to provide clarity on the best means of supporting supply resilience of radionuclides in the future—from bench to bedside. Officials in my Department and DHSC engage regularly with their counterparts in the devolved Governments and their nuclear medicine leads. It is clear that the four nations share the same commitment to delivering patient outcomes, and the issue of nuclear medicines is no different.

One of questions asked by the right hon. Member for Dwyfor Meirionnydd was whether we imported from Russia. Analysis performed by the Department of Health and Social Care indicated that there are no known medical radionuclides within the supply touchpoints impacted by the sanctions. She also asked about the champions we could have for radionuclides. That is certainly something that I would encourage, and I will pass it on to the relevant Minister to look into further.

My Department will progress the medical radionuclide innovation programme, and our decisions will be driven by the evidence as it is gathered over the coming months. We remain open-minded to the conclusions of the programme, and the role the Government might have in medical radionuclides supply in the future. We are keen to stay up to date with the proposal of a medical isotope centre in north Wales. Our policy teams will continue to meet regularly with their Welsh counterparts to discuss the project as it progresses. My Department is excited to play a part in the future of medical radionuclide supply for the United Kingdom. I thank the right hon. Member again for raising this vital topic.

Question put and agreed to.

House adjourned.