Christmas Challenges and Some Cheer (at last)

As we approach Christmas, it is generally seen as a time of celebration for many. And I sincerely hope this will be the case for you.

However, it would be disingenuous not to acknowledge that many in our Nuclear Medicine community have had a very tough time over the last few months which has inevitably had a negative impact on some of our patients.

Most of you will be aware that there has been a significant and widespread shortage of Technetium-99m radiopharmaceuticals since October, and unlike other shortages, this has not been related to reactor problems or difficulties getting any materials into the country. It has been as a result of a perfect storm of a number of Radiopharmacy closures, for various reasons. And to complicate things even more, some of them were acting as a contingency supplier themselves before closing.

The upshot of this has not just been delayed or limited supplies. For some Nuclear Medicine departments, it has meant NO supplies. And not just for the occasional day. For some, it has been for several days, running over the weeks and months since the beginning of October.

There was a similar problem a few years ago in 2019, but to a lesser extent because it involved just one large Radiopharmacy. And that was bad enough. After that the BNMS and the UK Radiopharmacy Group highlighted the clear problems we have nationally in the UK with spare capacity to supply and the lack of good contingencies in place for our patients. Whilst some Radiopharmacies around the country have provided some contingency supplies, this has been limited by a number of factors. For example:

• Staffing capacity within individual Radiopharmacy units to supply – Radiopharmacies have a regulatory responsibility to work within defined capacity limits

• Isotope capacity within the limitations of local Permit

• Impact of increased workload on individual radiation exposure

• Availability of trained and approved drivers

The problems experienced in 2019 led to the 2021 national review in England of Radiopharmacy services, which was based on similar principles to a review which had previously been conducted on Pharmacy aseptic services. Unfortunately, there hasn’t been much progress for a number of reasons. Many of the things which need to change or improve need time - for example, improving ageing infrastructures, increasing availability of a suitably trained workforce.

And then we ended up in the position we have seen this year, and I don’t feel it is an exaggeration to say it has come to crisis point for many of us, and it is now very clear that these things, and others, need to be addressed as a matter of urgency.

So to move towards more positive news. We are now finally starting to see light at the end of the tunnel for many of us. One of the large units is starting to resume services from the 27th December onwards, so many of us can look forward to a happier and more plentiful (from a Technetium-99m supply point of view) New Year. This is not the case for all, but for the units who remain affected by other closures, hopefully this will release some capacity for ongoing supplies to them.

Recent months have made it clear that there is a significant risk to patients when the Radiopharmacy itself cannot operate. And because of this, BNMS and the UKRG will continue to work hard behind the scenes with our partners at NHS England and within the devolved nations to try to improve things for our patients and for our community.

So I would like to end this month’s blog by saying thank you to all of you who have kept your services running through such a difficult time. To those of you who have reassured worried patients. Who have had to deliver bad news to surgeons about not being able to support their lists. Who have borne the brunt of disappointed patients when having to deliver the news their scan has had to be delayed.

I’d also like to thank those Radiopharmacy colleagues who have stepped in to try to support services where they can. You’ve been amazing. And to the Radiopharmacy staff at the affected centre who have worked hard to re-open their unit, I know it’s been a tough few months, but I know you’re looking forward to being able to do what you do best – providing a reliable and effective Radiopharmacy service.

I’d like to finish by quoting American writer and artist, Agnes M Pharo, who gave us this definition of Christmas: ‘What is Christmas? It is tenderness for the past, courage for the present and hope for the future. It is a wish that every cup may overflow with blessings rich and eternal and that every path may lead to peace.’ Whether you celebrate Christmas or not, that sounds like a pretty decent aspiration.

Or alternatively, this quote by Maya Angelou, American memoirist, poet and civil rights activist: ‘I’ve learned that you can tell a lot about a person by the way he/she handles these three things: a rainy day, lost luggage, and tangled Christmas tree lights’. And maybe we should add to that ‘Technetium-99m shortages’!

I do hope you manage to have a break to enjoy some time with your friends and family. And please join me in wishing us all a very happy, healthy and successful 2024 (Let’s aim high and hope for the best, as Agnes says!)

Ms Jilly Croasdale

BNMS President