Cancer care hit by ‘perfect storm’ of NHS shortages

Patients are at risk as thousands of radiology scans are being held up by a shortage of chemicals used to track conditions such as prostate and bone cancers due to a slowdown of imports, lack of funds and closure of critical labs.

Hospital trusts across the country in areas including Oxford, Bath and London all issued alerts this year over shortages of radioactive material, which led to scans being delayed or cancelled.

In one instance, hundreds of urgent radiology cancer scans were delayed when two major UK laboratories – one in Wales and one on the south coast of England – closed for three months.

A combination of these closures due to lack of staff and funding, as well as faltering imports from the EU has led to a “perfect storm” of supply shortages, health chiefs have warned.

Jilly Croasdale, president of the British Nuclear Medicine Society (BNMS), and Dr Katharine Halliday, president of the Royal College of Radiologists, both raised concerns.

Radioactive chemicals are commonly used to detect diseases such as prostate and bone cancer and to check to see if they have spread. NHS data shows more than 317,000 of these types of nuclear medicine tests were carried out by the NHS in 2023-24.

The average time between a request and a test being carried out hit 25 days in June this year, a slight dip from January last year – when waits hit 28 days. Before 2023, the average time for a test did not exceed 22 days.

But in some hospitals this year, such as The Royal Orthopaedic Hospital, University Hospital Southampton and Harrogate District Hospital, the average time taken to test a patient exceeded 50 days. One trust, Alder Hey Children’s Hospital, hit 108 days.

Ms Croasdale, who is also head of radiopharmacy and associate director of healthcare science for Sandwell and West Birmingham Hospitals NHS Trust, said the delays meant people were left waiting weeks to find out if their cancer had spread.

Speaking to The Independent , she blamed a recent shortage on the closure of two of the biggest labs working on these materials for up to three months.

She said: “The problem is, for each day you don’t have a supply, you’ve got your list booked for however many weeks ahead. So then got to try and find time to rebook patients … the delays can be weeks because of the difficulty with rescheduling and the fact the shortage went on for so long in that instance.”

According to Ms Croasdale, the shortages mean patients needing urgent scans can face weeks-long delays. Although patients will be clinically prioritised, she said a delay of even a month could mean a patient’s cancer has spread.

“If they’re urgent, it will be rebooked as soon as you can get a supply … although those patients are not critically ill and in hospital, they do need to get the answer to that question.

“If you have, say, a four-week delay, that can be enough time for something that wasn’t spreading to spread, it’s a critical piece of information in terms of how we treat them,” she said.

The BNMS president also flagged a problem with a material needed for prostate cancer PET scans, called prostate-specific membrane antigen (PSMA). This is due to a lack of capacity in labs to create the material, as well as NHS national contracts in England prioritising other types of scans.

“Supply of [PSMA] is extremely patchy...[with] multiple cancellations across the country,” according to the BNMS chief.

In May, it was reported that PSMA supply problems at Oxford University Hospitals NHS Foundation Trust saw delays in scans to check whether patients’ prostate cancer had spread.

In a separate board report this month, Royal United Hospitals Bath warned that bone scans for prostate cancer patients were being delayed due to a national supply problem with PSMA.

Internal reports covering hospitals in London, obtained by The Independent , warned of a “fragile supply of radionuclides”, which is a radioactive material used in tests, in January.

In a letter to members of the BNMS, Ms Croasdale said some areas face a “perfect storm” as labs needed to create the nuclear materials are having to be closed by regulators because they’re not up to standards.

She wrote: “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.”

Ms Croasdale said in some areas of the country there had been no supplies at all of a substance called Technetium-99m radiopharmaceuticals, radioactive materials needed for scans of body organs, for weeks and months.

Her warning was backed by the president of the Royal College of Radiologists, Dr Katharine Halliday, who said: “We share the concerns raised by the BNMS regarding the ongoing shortage of .... radiopharmaceuticals and fully support efforts to address the root causes of this crisis, including improving radiopharmacy infrastructure and increasing workforce capacity.

“Collaborative action is critical to ensuring reliable access to these essential resources, and we stand ready to work alongside BNMS, NHS England, and other key stakeholders to resolve this issue and safeguard patient care moving forward.”

Chiara De Biase, director of health services, equity and improvement at Prostate Cancer UK, said: “Although not all men with prostate cancer will be affected by these supply difficulties, we know this has had an impact on waiting times for some men affected by recurrent prostate cancer.

“As a result of the shortage, these men have been unable to get the scans they need so their cancer can be imaged, and the correct treatment course progressed. These reports have come in from multiple sites across the UK, with men being left to wait while their treatment is delayed. We sincerely hope these difficulties are resolved as soon as possible.”

The UK faced similar shortages in 2019 and following Brexit. There are no facilities in the country to produce the right kind of radioactive starter material, leaving the NHS vulnerable to global supply issues.

The BNMS and Royal College of Radiologists have also cited workforce shortages.

A Department of Health and Social Care spokesperson said: “The NHS is broken. Too many patients are not getting the treatment they deserve, and we are determined to change that.

“Our mission to save the NHS includes doubling the number of MRI and CT scanners, and we will also address the chronic workforce shortages the health service has faced for years.

“This government inherited a range of ongoing global supply problems, and we are working closely with industry, the NHS, manufacturers and other partners to resolve current issues as quickly as possible.”