Can we build more resilience into our Nuclear Medicine services?

What a difference a day makes. Who would have predicted that, as I wrote my last blog on the train out of Norwich that, less than 24 hours later, I would get the news that the reactors which supply Curium would be offline for a period of around 4 weeks. My first response was that I wasn’t overly worried. I’ve been a Radiopharmacist for three decades, and during that time I have seen my fair share of shortages – one in particular back in 2009 when the Chalk River reactor in Canada was out of action was much longer than this one and each time, I’d managed to keep my service going.

However, this time was different and this was in the main because of the significant gap that there now is market share between the generator suppliers. Another factor was that those GE generators which remained were not evenly spread across the country, with quite a few in areas such as Yorkshire and the Northeast, a few down in Devon and Exeter, but none at all in many other areas. If you read the letters I wrote through the shortage, you will already know that this meant no generators going into Scotland, Northern Ireland, Central London, the South Coast and South Wales at all and not a lot in great swathes of the rest of the country.

So, the lack of Curium generators, even for a short time had the potential to cause a real problem for patients in many areas of the country.

What followed was unprecedented. This was because, instead of it being a first come first served situation, where some Nuclear Medicines got supply and others had none, we worked together to put in place a plan for Mutual Aid to try and make sure everyone had access to something for their most urgent patients.

I was completely bowled over by the response of you all. Our Nuclear Medicine community really pulled together to put our patients first. I am very very grateful to everyone who shared their generator activity and postponed their non-urgent patients, even though they actually had a generator delivery. Thank you.

In the end, Curium were able to sweat the Safari reactor and managed to secure some extra supplies. The Maria reactor came back online a little earlier than planned and the HFR reactor repair was completed not long afterward. This all helped a lot. However, do not be deceived, the Mutual Aid arrangements we put in place made a huge difference. We didn’t end up seeing increased waiting times for those more urgently needed tests and surgeries and that means the plans worked.

Going forward, it’s important to consider what we can learn from this. These are my thoughts.

Clearly, the schedule of reactor maintenance and how repairs are handled need to be looked at to reduce vulnerabilities. This is outside of our control, but I know that the companies involved are looking at this and the schedule for next year is better.

In terms of the things we can control, perhaps we could work better as regions and have a more resilient procurement strategy. How this can be funded is to be discussed, but we could make sure that in each region there are some generators from each of the two suppliers. This is certainly what I did in the West Midlands after the 2009 Chalk River problem. I ran a big unit and had 2 generator deliveries a week, so although it cost a little more to use two difference suppliers, it wasn’t significant and essentially, I badged this the cost of having a resilient service. Clearly this is more difficult for smaller units who only have one delivery a week, but it could work on a regional level if we are all working together. This is something that is being looked at in Scotland, whereby one Radiopharmacy will use both suppliers, and the others could then contribute to any increased costs.

The Mutual Aid arrangements enabled us to prioritise more clinically urgent patients with all Nuclear Medicine departments postponing their non-urgent patients, regardless of whether they had a GE generator supply themselves. This was mandated through the National Patient Safety Alert put out by NHS England. I think this gives us a model to work to in the future which is better for our patients.

It could also work if we see problems with supply because of more domestic problems, such as we had last year when two large Radiopharmacies were closed at the same time. Although we cannot mandate the Mutual Aid on a regional level without the Patient Safety Alert, maybe we could agree a regional contingency plan between ourselves which all Trusts sign up to.

Another important consideration is the possibility of the UK having its own reactor for medical isotopes. You will probably have heard of the Arthur project, as we have had updates on this at our conference. A domestic supply of Molybdenum would help, although there are considerations, as the Molybdenum needs to be processed and generators made. We would also need to work with our neighbours to support the supply chain. We may live on an Island, but no-one is an Island (as they say).

Resilience is not just about how to respond to emergencies or about procurement strategies. It is about ensuring we have properly resourced services. I don’t think we do at the moment. Many of our Radiopharmacies are ageing or have other problems with their infrastructure. Our workforce in Radiopharmacy and in Nuclear Medicine is vulnerable. It is hard to recruit to our specialist areas, and lack of staff means lack of capacity. We need investment in our greatest asset – our people and this doesn’t just need money (although it does need money), it needs a plan.

All of this is much bigger than one blog. But if after reading this, you decide to look into having a regional contingency plan, then we will have taken the first steps to better resilience and have a think about that plan – let me know if you have any ideas which could help. Until next time.

Ms Jilly Croasdale

BNMS President

What do you want from your BNMS membership? 

Since becoming BNMS President, I have been giving a lot of thought to what it means to be a BNMS member. Our society belongs to all of us, and it is my sincere hope that my being President has really emphasised that for each of you, whatever your role. All our voices should be heard and every one of us is important. As you all know, I love the BNMS and have been a member for ages, but I have been thinking a lot recently about how we make it even better for everyone. There are three main areas I’d like to highlight for us to think about:
1. Representation
BNMS is a charity run by a central Council. We have three hard working salaried members of staff, who I’m sure you will agree, are a huge asset to us (and irreplaceable in my opinion). The rest of Council is then made up of a number of Trustees and co-opted members, with ratios which roughly reflect the number of members working in the different areas. By the way, I’d like to say here that I’m not keen on the term ‘craft group’ – what does that even mean? I just think we’re all members of the various different groups. So here goes: we have three medical practitioners, at least two clinical scientists, at least one radiopharmacist, at least two RTNG representatives, including one nurse, and one trainee, with the latter currently being reviewed to make sure they represent all trainees, not just medical trainees as is currently the case. 
We are all volunteers who do it because we care passionately about Nuclear Medicine generally and what BNMS represents specifically. There are a number of subgroups reporting into Council: we have a group for Radiographers, Technologists and Nurses (the RTNG Group), there is the BNMS Radiopharmaceutical Sciences Group, which is headed by a member of the UK Radiopharmacy Group committee who is able to appraise Council of matters relating to Radiopharmacy. We also have a Royal College of Radiologists radionuclide adviser, a British Nuclear Cardiology Society representative and a patient representative. More recently, we have established our Research and Molecular Radiotherapy Consortium Groups which report into the main Council. 
There is no specific doctors, radiologists or physicians, or clinical scientists Group, but this was discussed with the Council when I first took over and it was felt there was sufficient representation of and networking by those members who fall into these categories already within Council. 
So question 1: Are you happy with your representation within the BNMS Council and do you think it is effective? If not, how could it be improved? 
2. Communication and Engagement
Communication with members who fall into each of the different groups varies – there are meetings and newsletters, for example, but it would be helpful to know if you have ideas on how this could be improved upon without putting too much on people who are volunteering their time. 
Something I really want us to look at together is how we have better 2-way communication. I think the BNMS Council does pretty well with communicating outwards – the newsletter and website are pretty good - but I am concerned that Council could be perceived as ‘central government’ where I’d perhaps like to see a bit more ‘local council’. 
I hadn’t realised before I took over as President that BNMS do have regional representatives. I recently met with them, and they are all very approachable and helpful. However, many of them are quite senior with a lot on their plate. I do also suspect a degree of arm twisting may have taken place. However it happened, they are clearly doing it to help the BNMS, but most don’t have the capacity to do much more than pass communication on to local members. It was very useful to talk to them as I do feel this could potentially be another way of having better involvement with our members. 
Maybe rather than looking at local connections of the various different groups, we look at supporting local or regional Nuclear Medicine networks. This might seem ambitious, but there are already links and networks out there, albeit quite variable depending on where you are. So maybe that is something we could build on. Maybe if you would like to be more involved with BNMS, this would be a good place to start? So, if you’d like to get involved at a more regional level, then let me know. It’s just an idea at the moment which needs to be worked out, so I’d really appreciate your thoughts, ideas and most of all, help. 
So question 2: How do you think we can improve our communication, both outwards from Council and 2-way?
3. Member Benefits
This is something else I feel strongly about. What are we all getting out of being a BNMS member? The cheaper conference rates are a definite bonus, and we do get increased membership around conference season. But often our organisation pays for this, so what more can we do to benefit people individually? 
Members all get their NMC, which is great. We are looking at options for this going digital to be more environmentally friendly, but it is complex, and people will have different preferences for this. But however it is delivered, this is a benefit. But often there is someone in the department who has a spare NMC lying around, so is this enough? I’m not sure. 
The BNMS lobbies on our behalf on many things. We engaged extensively to try and minimise the impact Brexit could have had on our services. We develop useful guidance on an ongoing basis and give other specific advice as needed, for example, during Covid. We are currently working with IPEM to encourage Government to look at Technologist registration to recognise the important work being done by Technologists across the country, and the potential risks that go with it. 
That seems like quite a lot to me, but yet, could there be more? I think so. 
So more recently, we introduced a members event the evening before the start of our annual Spring conference. This was something we did for the first time this year in Belfast, and it went really well. We had a great talk by Professor Joe O’Sullivan in a really nice place called The Dark Horse Restaurant, followed by a buffet and a drink for everyone. Non members could attend, but there was a charge and they had to be accompanied by a member. I did worry that people may not want to spend their Sunday evening listening to a talk, but it was absolutely brilliant, and everyone enjoyed the chance to catch up with people before the start of the meeting proper. We are intending to do the same the evening before the start of the Glasgow conference, so please come along if you can. 
Our latest idea for member benefits came from a thought I had about putting on some free live webinars for members. These are going to take place monthly from November onwards and will cover different aspects of research. When I put the idea out there, I had no idea that what was going to come back would be so brilliant! Honestly, the people who are giving their time to share their expertise with you are all so renowned and downright clever, not to mention all lovely, you are in for an absolute treat. Once I saw the titles of the talks and who was going to be speaking, I decided this couldn’t just be a members benefit – they are too good not to share more widely. But although non-members can all join the live events, what we are doing for our members is making them available afterwards in the members area to view at your leisure (although it you want to ask questions you’ll need to join them live). However you view them, I hope you enjoy them – I know I’m going to. The titles and speakers can be seen below - I’ll be hosting them all so look forward to welcoming you.
So third and final question: Can you suggest any other member benefits? 
I hope you feel you are getting good value for your membership – I pay by monthly direct debit, and it adds up to less than the price of a takeaway, or a decent box of chocolates. Definitely worth it (and so are the chocolates!) We may not be able to do everything you suggest, but we can certainly have a think about it and let you know. 

Please send your responses and ideas to me at President@bnms.org.uk preferably by the end of October so we can review these at our next Council meeting, but you can reach me anytime with queries or suggestions at President@bnms.org.uk.
And while we’re asking questions, I’d be really grateful if someone from your department could complete the BNMS survey. I know it’s difficult to find time, but the information we get from it is really vital for understanding, and hopefully developing, our services. Until next time. Jilly
Monthly Research Webinars:
• 12th November Prof Gary Cook Professor of Molecular Imaging King's College London Navigating the Regulatory Requirements to Imaging Research
• 10th December Dr Maggie Cooper PET Chemistry Operations manager for the Positron Emitting Radiopharmaceutical Laboratory (PERL) at King's College London The challenges of producing RP for research trials
• 14th January Prof Jane Sosabowski Professor of Radionuclide Imaging and Therapy, Barts Cancer Institute Implementation of new radionuclides in clinical trials in the UK
• 11th February Dr Ian Newington Assistant Director, Innovations,  NIHR Coordinating Centre NIHR Funding for Clinical Trials and Studies in MRT
• 11th March Dr Juliana Maynard PET Director and Head of Translational Imaging Working Strategically across research councils to ensure collaboration at a national level
• 8th April Dr Jennifer Young Postdoctoral Researcher at King's College London The journey of radiopharmaceuticals from clinical trials to NHS commissioning.
• 13th May Prof Jon Wadsley Consultant Clinical Oncologist, Sheffield Teaching Hospitals Experience of leading a multi-centre MRT trial

Ms Jilly Croasdale

BNMS President

Football, leadership and Nuclear Medicine

You may or may not know this about me, but I am a massive football fan. My youngest son and I are avid Liverpool supporters and we love nothing more than the excitement of looking forward to and watching the game. We also enjoy watching international football and in particular, watching our national team play. This can often be a less than gratifying experience, however, as was evidenced recently by the Euros. 

Whatever you think of Southgate (and I think he is great in many ways), he clearly inspired a lot of love and loyalty from the players. They definitely seem to have grown as a team over recent years and I think most people acknowledge that they are in a much better place as he steps down than when he took the job on. 

I don’t think anyone could argue the extent of the talent on the field – we have some world class players in our squad. So why wasn’t this enough to win us some silverware? Regardless of the final result, and the style of football played under Gareth Southgate (yes, it is a bit dull to watch), it is interesting to think about the lessons that can be learned and applied to everyday life.

For example, what makes a good leader and why is it important?  Leaders are needed to help teams achieve thing and the national team has achieved a lot, albeit not the ultimate prize. Applying this to Nuclear Medicine, without good leadership, we probably would still be able to run our departments, so long as we had good managers who helped us do what needs to be done to scan and treat our patients. But would we develop and grow? Would we improve our services to get better? Or would we still be doing things the way they were done 10 years ago? The difference between management and leadership is a subject often discussed and I’m not going to go into a lot of detail about it here, other than to say that, put simply, I think management is about making sure the things that need to be done get done. Leadership, however, is about vision, growth and inspiration which ultimately leads to greater levels of satisfaction, better performance and constantly improving services. 

I remember once doing a leadership course where we were shown a video of an experiment conducted some years ago (I think it was carried out in the 70s, or at least, that is what the brown suits people were wearing would suggest!)  In this, the performance and subsequent outputs of three teams was compared.  In a nutshell, the first team was told to work to their job description, the second team was sold the vision of what they were trying to achieve and in the third team it was all about making people happy at work. It was assumed at the time that the happier team would be the highest performing (yes, definitely the 70s!) However, this was very much not the case. Feeling happy and valued was not enough. In fact, the team who understood the vision of what needed to be achieved knew their role within it and felt part of making it happen outperformed the others by a significant margin. 

When it comes to successful teams there are many elements at play.  Certainly, considering the Southgate analogy, tactics and strategy are crucial ultimately.  You can have the best people in the world on your team, but if you are asking them to do things which aren’t their strength, if you don’t train them properly or if your approach to achieving the goal is flawed, then you will limit your achievements. 

While I think it’s true to say that being happy at work is a big factor within successful teams, I think it’s actually more about relationships. I remember hearing a discussion on the radio about the approach to team building in the military, where good teamwork and performance can literally be the difference between life and death. Teams in the military are like family to each other, and this does make a difference.  Basically, you can’t lead people you don’t care about and I 100% agree. 

This brings me to whether or not you can teach someone to be a good leader or is it just that some people are born with it. You can certainly learn about leadership styles and how to put the mechanics of good leadership in place, but I don’t think you can really maximise your potential as a leader unless you build relationships and really care about the people you are leading. You can try and fake this if you can, but most people can spot a fake a mile off and they can also tell if you’re being authentic. So yes, you can learn to be a leader, but to do this you have to learn to genuinely care about the people you are leading and you need to take time to build and communicate, or support (depending on your role) the vision of what you are trying to achieve as a team together. Inspiring people to believe in the vision, knowing their strengths and playing to them and helping people take ownership of what you are trying to achieve as a team is what makes the difference. 

Achievements should be shared, something you’ve all achieved together, not just you as the leader. I remember a friend of mine saying to me, tongue in cheek, that she tells her team that their job is to make her look good. It made me laugh, and I do sometimes say this jokingly to my deputy, but actually I think that, as a leader, it’s part of my job to make my team look good. Believe me, this makes you look good too. When you hear someone running other people down, think about what impression that gives you of the person talking. Then think about how people who talk positively about their teams or workmates make you feel. I think you’ll agree - no-one ever looks bad by building other people up. 

Make a start today and you don’t necessarily have to be the manager to be a leader. Anyone can be a leader and we need all of you. Whatever your role, you can inspire other people. You can help achieve the vision and make other people feel included and part of it.  

I’m sure you’ve all got a million things to do and may feel this isn’t something you have time for. I often look back on my NHS career and feel that we don’t seem to have as much time to be friendly anymore. I think this is a shame and to be honest, counterproductive, as a small investment in building relationships with the rest of your team really can reap rewards which are tangible. 

So, try to make some time today to start to get to know your teammates a bit better. Really talk to them and build relationships with each one – not just the outgoing ones, or the people you’re already friendly with, but the quieter people who don’t always speak up. Or maybe those you find a little more difficult to get on with. Maybe take time to really talk to those who can always be relied upon to make everyone laugh. Talk to them properly and really find out what’s below the surface – you may be surprised. 

Be part of building a happy AND successful workplace. Build your relationships but always remember to keep your eye on the prize! Until next time.

Ms Jilly Croasdale

BNMS President

Impressions of Belfast

As most of you will be aware (and if not, we didn’t shout about it loudly enough!) the BNMS held it’s Spring meeting this year in Belfast. We originally booked this venue back in 2019, with a view to holding our 2021 meeting there, but COVID struck, and life changed in many ways for us all.

Happily, we were able to reschedule, and so fast track to 2024, and here we are. I was a bit worried at the time of booking that people may not want to go to Belfast; it involves arranging a flight, for a start. And it would be disingenuous not to acknowledge its difficult history, which I did wonder may put some people off. But it certainly didn’t, and for good reason, as Belfast really is a wonderful city. It has such a friendly vibe, and in many ways does feel like a more compact Dublin. But in my opinion, Belfast is very much a great city in its own right, so although I love Dublin, my comparisons will stop there.

The conference centre is located on the banks of the River Lagan, a short walk from the city centre. There are many lovely restaurants – the people of Belfast enjoy good food – and a lot of interesting things to do. I went over on the Friday evening, and amazingly, enjoyed beautiful weather for the weekend (this doesn’t happen that often, believe me – Northern Ireland colleagues will agree.)

Some of the film locations for Game of Thrones can be found across Northern Ireland. This is, in my opinion one of the best TV series of all time - although I swear, if they’d killed off Tyrion I would have stopped watching. (Spoiler alert – no-one was safe from getting the chop!) Belfast has celebrated its connection with GoT by installing huge stained glass murals depicting different moments from the series, so I had a nice walk along the river finding them all. This was followed up by a couple of pints of Guinness in a sunny beer garden in the City Centre. And the Guinness tasted great, especially after a couple of hours walking in the hot sunshine working up a thirst!

There is also the Titanic Museum, which was very interesting. Although the Titanic maiden voyage resulted in awful tragedy, the museum didn’t just focus on that. It also looked more widely at ship building and other related industries for which Belfast was then well known. This was followed by another Guinness (the sharp eyed among you may have spotted a theme here!) in the Drawing Room of the Titanic Hotel. This is where plans were drawn up for ships built in the Belfast shipyard. Unlike the unskilled workers, these employees enjoyed good working conditions, and this room is beautiful, flooded with natural light and certainly a nice place to while away an hour, contemplating everything we had seen in the museum.

On Sunday evening we launched a new BNMS initiative for our members. If you read last month’s blog, you’ll know that the BNMS does a lot of great work, but I did feel that, as well as cheaper conference registration and a copy of the NMC, it would be nice to give something a bit more personal and tangible to those of us who are BNMS members. To this end, we hosted a welcome event on the Sunday evening which was free for members. Non-members were still able to come, but they had to be accompanied by a member, and there was a £10 charge for them. The event took place in a venue in the Belfast cathedral quarter called The Dark Horse, and we provided food and a drink for everyone. As well as that, we had a couple of talks organised. I did wonder what people would think of listening to a ‘talk’ on a Sunday evening, but it was so much more than that. Joe O’Sulllivan is an academic clinical oncologist and Clinical Director of the Northern Ireland Cancer Centre, and has a clear passion for prostate cancer treatment. Joe is a brilliant, charismatic speaker and gave us an absolutely fantastic overview of the work being done in Belfast and elsewhere on Radium therapy. Honestly, I think we were all mesmerised – we were all literally hanging off his every word. The evening was a great success, so is definitely something we will be repeating next year.

On to the conference itself. Opening the meeting was fairly terrifying, and of course, a little bit of the old Imposter Syndrome reared its head, but I pushed it firmly back down. It’s always a bit scary at the beginning, but as the meeting went on, confidence grew, and so many of you were so kind! When you’re speaking to a large group of people it’s easy to feel like everyone is going to be a critic, but my experience of our BNMS family is that everyone is, in fact, a cheerleader. Thank you all so much for your support.

Following on from the conference opening address, this year we decided to present the highlights lectures at the start of the meeting. The idea was that this would help you navigate the programme. We had separate Clinical, Scientific and RTN highlight presentations. It was a new thing for us, and it will be interesting to hear the feedback on it. From my own point of view, I thought it was more useful, although we can probably refine it a bit further. I also feel the people putting together the highlights lectures put such a lot of work into it, it was nice for them to present to a full room, rather than at the end, when some people have had to leave.

I then realised I had to speak at the President’s Reception. It should have been fairly obvious I’d need to speak, but it hadn’t registered! Mild panic ensued – I’d used all my best material in the morning opening speech! But it went OK, and we proceeded to enjoy a lovely couple of hours in the exhibition hall networking, meeting up with old friends and hopefully making new ones. I include our Industry partners in this – the exhibition was great, and several people commented on this. Furthermore, the food throughout the three days was really very good. If you’ve ever been involved in organising events, you’ll know the food is difficult to get right, but the feedback at the meeting was overwhelmingly positive and speaking of food, I really do have to mention the Conference Dinner at this point. It was held at Belfast City Hall and what an amazing venue. I had the privilege of presenting the President’s Medal to Dr. John Buscombe, who needs no introduction. I’ve known John for about 25 years, having worked with him at the Royal Free so many years ago, so it was really special to be able to recognise all he has done over the years for Nuclear Medicine and for the Society. He’s been a brilliant advocate for British Nuclear Medicine across the world. I also presented the Roll of Honour to Dr. Beverly Ellis. This is a recently established award for outstanding contribution to Nuclear Medicine and Radiopharmacy, and Bev has definitely done that, working diligently behind the scenes to provide support and guidance to Radiopharmacy and Nuclear Medicine. A big shout out has to go the inimitable Dr. Glen Flux, recipient of the Norman Veall Medal who has done so much for Radionuclide therapy and associated dosimetry in the UK and the worthy winner of the RTN award was Prof. Peter Hogg, who has been a great ambassador for Nuclear Medicine in the wider world of Radiology and advanced practice. All four of them are utterly brilliant. I know that being recognised by their peers meant a lot to all of them, so it is definitely one of the perks of being President that you are able to be part of that. I must also mention the honorary membership award, which was presented by Sue Hatchard to Steve Anderson, previously of Bright Technologies. This was pretty special for a couple of reasons. Firstly, as many of you will remember, as Charlotte’s predecessor, Sue was an integral part of the BNMS for many years, and I would argue has achieved legendary status for many of us. And secondly, because this is the first time such an award has been made to someone from Industry. Over the last few years, the relationship between the BNMS and Industry has definitely become a partnership, and it was nice to recognise that – and I know from speaking to Industry colleagues the day after the dinner that recognition of Steve’s contribution to the BNMS felt like a recognition of them all.

The content of the meeting was fantastic, and huge thanks need to go to the SEC chairs and committee members, and to our wonderful BNMS staff, who make all this possible. They’ve all worked incredibly hard, and it showed. We had so many great papers and posters to choose from. Please take some time to review the abstracts in NMC. And this year, rather than having the educational talks all front loaded into a bootcamp, they were spread throughout the meeting, something I thought worked well. There were so many brilliant invited talks too, I can’t talk about them all here, but I do have to mention a few. The first was our Annual Lecture, this year given by Prof. Ian Law from Copenhagen University Hospital, who gave us a great insight into state of the art neuro PET imaging. He was another great speaker, and the allotted hour flew by. I also really enjoyed a talk given by Dr. Samantha Terry from Kings College London on Auger Electron Therapy and the updates from Dr. Jennifer Young on new work being done by Radionuclides for Health with Iodine 124 and Astatine-211. We also had a talk on considerations for trans and non-binary patients with cancer as well as one on improving the experience of gender non-conforming patients. Both were well attended, and it makes me so proud that we are an inclusive society who want to support and provide compassionate care to all our patients. There was plenty on MRT and theranostics, and some brilliant talks on Total Body PET. This is definitely going to be a big talking point going forward. But what was also really good was there were also plenty of interesting general Nuclear Medicine talks and I think the balance between everything was pretty much perfect. What exciting times we have ahead of us - I feel so fortunate to be working in Nuclear Medicine now, despite the challenges we all face around resources and staffing.

I do also have to mention one poster which struck a real cord with me personally, and this was one about how to make our services more dementia friendly. As you know, this is a subject close to my heart and there are simple things which we can do to better support people who are unfortunate enough to suffer from this awful disease. For example, not booking appointments towards the end of the day, when people living with dementia may experience heightened confusion, something called ‘sundowning’, which can start in late afternoon.

You probably know about the still very recent loss of my mum. She was my confidant, the person I told about all the highs and lows of my life and this was most definitely a high. All of you who have lost people you love dearly will know it is a journey and I did feel sad that I couldn’t call her after the conference to tell her all about it. She would have been so proud and pleased for me. But the BNMS is not just about sharing learning and experience; in Nuclear Medicine we support each other. So sharing my impressions of Belfast with all of you is what I’m doing instead. To all of you who attended it gave me a much needed lift to share the experience with you, so thank you. I hope you enjoyed the conference as much as me, and that you also found lots of things in it to further improve the already great services being provided by you across the country.

If you weren’t able to attend this time, please do think about joining us in Glasgow next year from 19th – 21st May. If you are struggling to get funding for this, and are a Radiographer, Technologist or Nurse, have a look at the Ros Breen fund – you can find information on it on our website. Ros was a Superintendent Radiographer at Southampton General Hospital who made a great contribution to the field on Nuclear Medicine Technology and this fund was set up in memory of her to support RTN colleagues to come to the conference. I’m not sure if people know about it, as we don’t get lots of applications, so have a look to see if it might help you.

The conference offers us a great opportunity to reflect on what we have learnt in the last year, and to make plans for the next. Let’s make it amazing. Until the next time.

Ms Jilly Croasdale
BNMS President

Seeing the person behind the dementia diagnosis

If you read my January blog, you will realise I am speaking from some personal experience on this. My mum was formally diagnosed with dementia last year. Everyone's journey is different, and hers was a real eye opener for me. Firstly, the way it started was quite insidious. She didn’t start by forgetting anyone’s name. She just started to randomly, every now and again, forget to take her tablets. She had a medidose system (one of those cases with different little boxes for morning and evening for each day), which my sister filled up every week and we started seeing that on the occasional day, she’d just forgotten to take them. Not very often – at first. But it got more and more frequent. We changed the medidose system for one with an alarm to remind her. It didn’t make any difference. She complained she had too many to take, and didn’t like ‘those big ones’. It seems so ridiculous now, but we actually thought at the time she was doing it on purpose to make a stand in her own way – a bit of a ‘you’re not going to control me’ sort of stance and that was the only thing for some time. Then she stopped doing her jigsaws. She almost always had a 1000 piece one on the go and she was good at it. I realise now this was because she couldn’t concentrate – later on, she would enjoy doing simpler jigsaws - but at the time, she didn’t know what to do, so just stopped. She stopped reading books, but everything else seemed normal - she still read her magazines, so it wasn’t so noticeable. Again, books took more concentration. 

But on Boxing Day 2022 when I saw her at my sisters, she seemed not quite right. I couldn’t put my finger on it, but she had a rabbit in the headlights sort of look about her. And in the months following that, it started to quickly become clearer that something was wrong. She couldn’t remember what she’d had to eat. She stopped showering without a reminder. She had to have dressings on her legs and couldn’t remember why, so would remove them quickly after the nurse had gone. She started wondering off up the street and a couple of times fell over. She tried to give her house keys to the window cleaner. She stopped watching TV. She lost track of time and stopped going to bed. 

But she always knew who we all were. She always knew who I was, who my sister was. She always remembered her hospital consultant (he was apparently a ‘bit of alright’). People who she had long-standing relationships with, she remembered, even if she hadn’t seen them for a long time. Her new GP was always a surprise to her though, as she was transferred to him more recently.  

My mum was always very compliant, and I would say she ‘did dementia’ well. I put that partly down to her personality; she was a lovely and gentle person and partly down to my amazing sister, Sally, who was so reassuring to her, always. Think what it’s like when you lose the thread of what you’re talking about. It’s on the tip of your tongue, but you can’t quire remember it. Or you walk through a door to get something and then can’t remember why you’re there. This does occasionally happen to me (I’m a woman of a ‘certain age’ - I’m sure some of you who understand what this is like). It’s frustrating. But eventually I find a way of remembering. Imagine this happens more and more to you. It would start to make you anxious and eventually frightened. A lot of the behaviour exhibited by people living with dementia stems from anxiety, so they need a lot of reassurance, rather than being reminded that what they are talking about isn’t right. So, for example, a lady living with dementia at the hospital we were at with Mammy a few weeks ago was accusing the staff of taking her things. We saw one Healthcare assistant respond harshly to demand ‘why would I take your things?’ But actually the lady just couldn’t remember where she’d put anything, didn’t really understand why she was there in this unfamiliar environment and was simply anxious. My sister suggested to her that maybe her son, who had visited that afternoon, had got them put away safe, and that she didn’t need to worry and do you know what? She calmed down. It was a reassuring suggestion she accepted. My mum was the same when she couldn’t find her purse, for example. I’d say to her, Sally has that safe, don’t worry, and she was reassured. So correcting someone living with dementia can make them anxious. Going along with it or providing a reassuring reason for things does help.  

We all see patients living with dementia in our Nuclear Medicine departments. Notice that I call them patients living with dementia, not dementia patients. I strongly feel we should not label people or let things like their dementia define them. My mum was what I would call an extraordinary ordinary woman. She was a teacher, although she never moved very far away from where she was born - as is the case for a lot of people who live in the Yorkshire mining town where I grew up. She would often bump into people when she was pottering to the shops who would say she’d taught them. She used to say how old it made her feel as these people stopped being young mothers and became older women with grey hair and grandchildren themselves. But they all remembered Mrs Hepplewhite fondly. She made a difference to them. And to me she was the best mum anyone could have wished for. She was kind, she was generous and she was funny – even when she developed dementia. She called it ‘The Forgettery’. See, funny. Another thing I loved about her was that she was totally partisan. Always completely on my side, my cheerleader. And don’t we all need one of those? She was just the best sort of person. If you had her as a friend, as so many did, your life was richer for it and you were lucky.  

She was 86 and frail, and living with dementia – but my goodness, she was brave about it. No-one else’s face will ever light up like hers did whenever she saw me. That never changed. I remember when I told her I was President of BNMS, how impressed she was. Then she asked me to write it down so she got it right when she rang round all her friends to show off her bragging rights. 

So it sounds obvious, and I’m sure most of you do this, but when a person who is living with dementia comes to our departments, we need to remember that they are a person first and foremost. They will have lived their own extraordinary ordinary life. We need to respect them, to understand and reassure them, but not be condescending (don’t let me get started again on being called ‘sweetheart’ by strangers in hospitals). We need to be kind. 

You might have already guessed from the past tense references. Mammy succumbed to Sepsis and died on the 26th February. So this is my tribute to her. I couldn’t write a blog this month on anything else – it’s too much of a life-changing event for me. I’m so sad she’s gone, but so grateful to have had her for so long. Life will never be quite the same again, but a life having had her in it will be forever enriched.  

R.I.P. Barbara Hepplewhite, an extraordinary ordinary woman. 27.6.1937 – 26.2.2024

Ms Jilly Croasdale

BNMS President