• Royal College of Radiologists has not seen “any finite logistical detail” of increased air freight capacity needed to deliver short-life medical isotopes
  • If Brexit delays imports, trusts will have to prioritise which patients receive cancer care
  • Latest government report on issue did not confirm a final exit deal was in place to ensure continuity of supply

NHS trusts will have “no choice but to prioritise” which patients receive cancer treatment if a no-deal Brexit delays the import of radioactive isotopes, the Royal College of Radiologists has warned.

With just 28 working days to go before the UK may leave the EU without a deal, the RCR told HSJ it has not yet seen “any finite logistical detail” of the increased air freight capacity needed to guarantee delivery of short-life isotopes.

The college said it has also not seen the “detail of the customs paperwork” that would allow the materials, which cannot be stockpiled as they decay too quickly, to gain fast-track entry into the UK.

The college said it is meeting with the Department of Health and Social Care again this month to ask “officials for more concrete information on these issues”.

Medical isotopes are used in nuclear medicine either to treat cancer by killing diseased cells, or to diagnose diseases by injecting a radioactive tracer into the body that allows scanner images to be taken of tissue and organs.

In the case of a no-deal Brexit, expected delays at UK ports would make delivery of these materials by land or sea unviable because of their short shelf-life.

Nicola Strickland, president of the RCR, said: “The [college] has been assured that government is working closely with suppliers in an attempt to mitigate disruption in the event of no-deal, but we are also waiting on more definitive logistical detail on what no-deal supply could look like for hospitals.

“If a no-deal Brexit does delay or change the arrival of particular radioisotopes to individual cancer centres, then imaging and oncology teams will have no choice but to carefully plan and prioritise the use of each type of radioisotope in scans and cancer treatment, based on patient need and the availability of suitable alternatives.”

Dr Strickland added the college is aware patients and clinicians are “worried and speculating about disrupted or rationed treatment because of the ongoing uncertainty over what form Brexit will take”.

Last week, the government published its latest report into its progress on the UK’s exit from the European Atomic Energy Community Treaty.

The Euratom treaty regulates civilian nuclear activity and supports the “secure and safe supply and use of medical radioisotopes”. Without a new agreement, the UK would operate outside of Euratom and have to source radioisotopes from outside the framework.

The paper said there had been “significant progress between the UK and Euratom to ensure continuity of supply”, but did not confirm a final deal was in place.

It added: “The government recognises there is concern that the UK’s withdrawal from the EU has the potential to affect the timely supply of these medical radioisotopes.”

Trusts have also raised concerns about patient care if medical isotope supplies are disrupted.

The Dudley Group Foundation Trust’s February board paper said: “Delays at borders, due to customs controls, would be problematic for isotopes with short half lives. Issues with nuclear med-therapy could delay treatment of patients on cancer pathways.”

However, one source at a specialist trust told HSJ that although alternative diagnostic treatments are likely to be needed, they did not expect this to delay diagnosis or slow down patient’s access to treatment.

A 2017 British Medical Association report into Brexit and Euratom said breaks in supply in 2009 and 2013, caused reactors going temporarily offline, resulted in “delayed diagnosis and treatment”.

A DHSC spokeswoman said: “We recognise the vital importance of medical radioisotopes and action is being taken so supplies are safeguarded in the event of a no deal. We have asked suppliers to have plans in place to air freight these medicines so patients can continue their treatment uninterrupted – these medicines will be prioritised on the Government’s alternative shipping routes.”