(6 years, 8 months ago)
Lords ChamberLet me first thank noble Lords very much indeed for bringing this important topic before the House today. I reassure them that the Department of Health and Social Care is actively supporting my department in its negotiations with the EU, including forming part of the negotiation team where the topic is of direct relevance to healthcare. It is also working closely with its arm’s-length bodies, the territorial offices and others across government in preparing for EU exit under all eventualities.
I will address this group of amendments now but I note that the noble Lord, Lord Warner, who I think is not in his place at the moment, has also tabled an amendment on health to Clause 6. This will be responded to formally when we reach that group and I note his specific interest in the subject.
Amendment 11, in the name of the noble Baroness, Lady Thornton, would delay the repeal of the European Communities Act 1972 until such time as the Secretary of State has set out a strategy for ensuring the mutual recognition of medicines and devices between the EU and UK. The Government have already set out a very clear offer to the EU for the UK to continue to work in partnership in the area of medicines. It is in the interests of patients and the life sciences industry for us to find a way to continue UK-EU co-operation on medical regulation, even if our precise relationship with the EU will by necessity change. Discussions are ongoing and the outcome will form part of our future relationship with the EU. We cannot and should not delay commencement of this Act until those discussions have concluded. The UK’s medicines and medical devices regulator, the MHRA, is a strong leader that will continue to ensure that medicines and medical devices are safe and effective, regardless of the outcome of negotiations and any agreement on recognition in this area. Indeed, it is currently recognised globally as an authority in its licensing and inspections.
In response to the questions from the noble Baroness, Lady Finlay, and the noble Lords, Lord Cormack and Lord Davies, I can be extremely clear that the UK’s preferred outcome is to find a way to continue to co-operate on medicines regulation with the EMA. We have made that extremely clear to the EU. Even though our relationship with the EMA will have to change as we leave the EU, it is in our mutual interests to continue to co-operate and share scientific expertise. We believe that desire is shared by the EU.
Can I ask for some clarification from the Minister about his statement about the preferred outcome? What exactly does that mean? If we do not achieve what we want to in that preferred outcome, what exactly happens and what do we do next? What is the timescale for this? That is why the amendment is framed in the way it is.
It is obviously difficult for me to speculate on what happens if we do not achieve the outcome that we want. As I said, we strongly believe that since we contribute an awful lot of work through the MHRA—something like 40% of the EMA’s work is contributed to by UK authorities—it is in our mutual interests to continue to co-operate. If that is not possible, we will set out an alternative course of action but we believe that it is and should be.
We have a window of about two years in which to get this right. I was talking to the trade bodies for over-the-counter medicine last week and they were saying that a change to make all over-the-counter medicines UK-based would need about a five-year timescale. It is just not doable, so there is an absolute imperative to get these regulations sorted out in pretty short order.
The noble Baroness makes a powerful point. It is one of our priorities. We have a number of priorities in the negotiations but it is important that we get this one right. The MHRA already licenses nationally 90% of all medicines available in the UK but there is a small percentage regulated abroad, so we need to reach a mutual agreement on that.
Amendment 101, tabled by the noble Baroness, Lady Jolly, would prevent the Government making changes to the licensing or regulation regimes for over-the-counter medicines, to which she just referred. The Government will need to correct deficiencies arising from withdrawal in relation to the regulation regimes for over-the-counter medicines, self-care medical devices and food supplements where the UK’s exit from the EU would result in the retained EU law which governs the regimes being deficient or not operating effectively and where manufacturers of these products would have to adapt to divergent UK requirements, potentially leading to a temporary or permanent withdrawal of their product from our market.
The noble Baroness asked a number of specific questions. The Government have already made it clear that we wish to retain a close working relationship after exit. The Government have been engaging with industry and research charities through the ministerial and industry co-chaired life sciences group, and we will continue to work with that group and industry to ensure adequate notice and sufficient time to implement any changes necessary.
Whatever the outcome of negotiations, the principles which will underpin post-Brexit regulation for this sector will be that patients should not be disadvantaged, that innovators should be able to access the UK market as quickly and simply as possible, and that we will continue to play a leading role in Europe and the world in promoting public health. Over-the-counter products will continue to have an important role in relieving pressure on health professionals and promoting consumer choice to improve public health.
In the event that it is not possible to reach a deal that secures ongoing, close collaboration between the UK and Europe, we will set up a regulatory system in the UK that protects the best interests of patients and supports industry to grow and flourish. I hope that my comments will provide the noble Baronesses, Lady Thornton and Lady Jolly, with the reassurance they need not to press their amendments.
Amendments 9 and 205 were tabled by a number of noble Lords, including the noble Baroness, Lady Jolly, and the noble Earl, Lord Clancarty. The Government recognise how important reciprocal healthcare is to the 190,000 UK pensioners who currently benefit from it, to UK tourists who use the European Health Insurance Card scheme and to EU nationals visiting and living in the UK. This point was powerfully made by the noble Lord, Lord Davies. We want to protect reciprocal healthcare arrangements and have made important progress towards this in this first phase of negotiations. It is the intention of the UK and the EU that the final withdrawal agreement will protect reciprocal healthcare rights for UK citizens resident in the EU on exit day and vice versa on a reciprocal basis.
The Minister said that important progress has been made. Will he tell the Committee what that progress is?
The important progress was announced in the agreement reached in December in the first phase of the negotiations. Reciprocal healthcare benefits were guaranteed for existing UK residents in the EU and for existing EU residents here. The next phase is what happens in the future.
The points I raised related not to the important matter of residents, whether continental residents living here or British residents living on the continent, but to travellers—people who may want to travel for a short period for tourism, family reasons or what have you. Has any progress been made on that front? If not, are the Government proposing to make any progress and, if so, what progress?
That will be for the next phase of the negotiations. We have guaranteed the right of existing residents from the EU in the UK and for UK residents in the EU. The next phase of the negotiations is for people who will travel there in future.
Is the Minister saying that the Government intend to retain the EHIC reciprocal agreement or is he talking about something else?
We would like to retain an arrangement similar to the EHIC if possible. We cannot give any guarantee about what might happen in the next phase of the negotiations.
We welcome the progress made, but we are clear that we want a wider agreement on reciprocal healthcare. I am sure that noble Lords will appreciate that this is not something we can simply legislate for in the withdrawal Bill, but must be negotiated with the EU, which is what we have been doing. We are very clear that we want to protect reciprocal healthcare arrangements.
On 8 December, the UK and EU Commission reached an agreement which delivered on the Prime Minister’s number one priority: to safeguard the rights of people who have built their lives in the UK and EU.
I asked the Minister for information about billing across borders to date, because that information must have been available to the Government before they started negotiating over the travel arrangements.
I will need to write to the noble Baroness with the exact amount of billing, as I do not have those figures in front of me at the moment.
I turn to Amendment 353, tabled by the noble Lord, Lord Stephen. The Government already keep NHS performance and health outcomes constantly under review, including through the NHS outcomes framework, which measures a number of health indicators intended to form an overarching picture of the current state of health and care services in England. We are committed to positive and productive engagement with the devolved Administrations going forward as we seek a deal that works for the entire United Kingdom.
The Secretary of State for Health and Social Care also publishes an annual assessment on the performance of NHS England, including how it has met its mandate from the Government, as well as an annual report on the overall performance of the health service.
As the Minister has confirmed that there is in fact ongoing, detailed monitoring of these matters, can he confirm that we are losing National Health Service staff returning to the European Union and are having greater difficulty in recruiting from Europe to fill the vacant spaces?
I am not sure that is the case. Obviously there are people returning to the EU all the time, and different people coming to the UK to take up job offers. We can get into detailed figures, but I do not think there is any large-scale exodus of health service staff.
For the reasons I have set out, this amendment is both unnecessary and risks creating unwelcome new burdens at a time when that is least appropriate. I hope I have been able to provide noble Lords with sufficient reassurance.
My noble friend is batting on a difficult wicket. We understand that. He has my total personal sympathy for the plight in which he finds himself, but what he has said this afternoon just ain’t good enough. It is important that he takes on board what has been said during this debate, particularly by the noble Baroness, Lady Finlay of Llandaff, and that when we come to this on Report, he has some substantial and detailed specific progress to report to your Lordships’ House.
I thank my noble friend for his comments. A lot of these matters are still to be negotiated in the next phase. We made substantial progress in the first phase, and we will endeavour to ensure that we make good progress to achieve a good working relationship with the EMA and to guarantee the rights of travellers through a system similar to the European health insurance card for those travelling in future. I hope to be able to provide more information on Report.
Following on from the comments of the noble Lord, Lord Cormack, could the Minister provide us with data in writing on the numbers of EU staff who have applied for jobs in healthcare in the last 12 months and the numbers of EU staff who have left? We need to have the data rather than bald statements about what is happening based on anecdotes, because it may well be that the Minister is hearing a quite different set of anecdotes from the ones the rest of us are hearing.
Will the Minister also confirm, or not, my interpretation of his comments on the outcome if there is no agreement? Here I return in part to Amendment 11, but to others as well. If there is no agreement with these regulations, will the Government then simply adopt European regulations de facto? I cannot see any other way for our pharmaceutical and biotech industries to continue to function. We need them for our economy, quite apart from needing them to ensure that there is a supply of medical and biotech advances for our patients. It is particularly important because biotech is an emerging field in which to date, within Europe, the UK has been the leader. I should declare an interest here because my son is a senior lecturer in bioengineering and cardiology, so he is involved in some of this ground-breaking work.
It would be helpful for us to know that and whether, in the context of there being no deal, the Government are already establishing dialogue between different Ministers in the devolved Administrations. As the noble Lord, Lord Wigley, has pointed out, there are very real implications for Wales, particularly west Wales—I declare my interest as someone who lives and works there—because we know there are large gaps there. We have to know how the Government intend to behave in the event of there being no deal at all.
The noble Baroness has made some valuable points. On the question of data on EU staff applying to jobs in the UK, if that information is available then we will certainly share it with her.
She asked what happens if there is no agreement. As I said, the MHRA already issues national licences for some 90% of medicines on the UK market. If we are no longer co-operating with the EMA on the regulation of new novel medicines, the UK will ensure that our own procedures do not lead to any delay in patient access to new medicines and are no more burdensome to industry.
The noble Baroness’s point about working with the devolved Administrations is a good one and we will ensure that that happens.
My Lords, I thank the noble Baroness, Lady Finlay, who as always is much more qualified than me and indeed most of the House, for her support. I respectfully suggest that the Minister needs to actually talk to some of these bodies about how complicated, difficult and costly it will be if we do not reach an agreement. That needs to be taken into account.
I thank noble Lords for their support across the House for this suite of amendments. The amendment from the noble Baroness, Lady Jolly, is important and—like my own, I hope—very practical. This is about what medicines people buy over the counter, what health supplements they have access to and whether those will change post Brexit.
The noble Earl, Lord Clancarty, tabled Amendment 205, and I thank him for his support for my amendment. He and I want the same thing: we want this scheme, which protects people’s right to healthcare, to continue, and as the noble Lord, Lord Cormack, said, its current form would be the easiest form for it to do so. It is often the case that the noble Lord, Lord Cormack, makes the observation that you wish you had—in this case, about disease knowing no boundaries. He is absolutely right.
My noble friend Lady Blackstone made an eloquent point about cutting-edge research and the importance that that has for children and the rare diseases that they experience.
I do not deny that the amendment from the noble Lord, Lord Stephen, is important. It will be very important that we know what the impact of Brexit has been, not just a year later but ongoing. However, the argument that we are having on the earlier part of this suite of amendments is about what happens in the negotiations and what happens if they fail. It is about the action that we take now.
The noble Lord, Lord Wigley, is quite correct about the uncertainty that has been created for NHS staff in terms of their retention and recruitment. In fact I asked a Question of the Health Minister about precisely that not so long ago. Those figures have been collected by organisations such as the Royal Colleges so we know that the number of nurses coming from Europe in the last year has fallen by, from memory, around 80%. That is a huge drop in the number of nurses prepared to come and work in this country from Europe.
I say to the Minister that we understand—I agree with the noble Lord, Lord Cormack—that this is a difficult time and the Government are in the middle of negotiations. However, it is a long time since the referendum and we are a short time away from falling off the edge of the Brexit cliff, and issues of licensing of medicines and access of citizens to healthcare can none of them brook a two or three-year negotiation after Brexit because of the suffering that would cause and the impact it would have. That is what the amendments concern.
I hope that, between now and the next stage of the Bill, we will make some progress on both those issues. If we do not, we shall return to them. I beg leave to withdraw the amendment.
My Lords, I agree with every word that the noble Lord, Lord Kerr, has just uttered. The noble Lord, Lord Patten, said that we were not expecting miracles from the Minister. I think even the Minister’s most ardent admirers do not credit him with miraculous powers, and he is not going to able to produce any rabbits out of a hat for us this evening. But it is not miracles we need here: all we need is a continuation of the status quo. This is one of those areas we come back to time and again—we had it in the long debate on Euratom last week: all we need to do is to avoid massive, self-inflicted damage.
There is no need to create whole new programmes and ways of working. We have Horizon 2020 and Erasmus; the latter has been going on for the best part of 30 years and is a highly successful programme. When you are doing something well, the usual trick is just to keep on doing it. There are so many things that do not work that the idea that Parliament and Government should be spending their time dismantling things that do is clearly crazy. What we want to hear from the Minister is simply that he is open-minded to continuing with the present arrangements. The sooner the Government are prepared to say that, the better.
The most telling contribution to this debate came from the noble Baroness, Lady Brown of Cambridge. In the higher education world, there is—I shall choose my words slightly diplomatically—a pronounced air of self-congratulation on how excellent everything is in this country and how brilliantly we do it, and if only the rest of world copied us then they would be a great deal better off. In many areas that is true, but in one we have a very poor international record: the propensity of our students to study abroad. According to the Erasmus figures, twice as many European students come to Britain as Brits go abroad. The noble Baroness was right to say there is a big problem with students from poorer backgrounds studying abroad. When I was preparing figures for this debate, I found that it looks as if Singapore, a country less than one-tenth the size of the UK, has about as many students studying abroad as we have in our entirety.
The fact is that we do not have nearly enough of our students studying abroad. When I visited Singapore as Minister for Schools, they were aiming—by about now, so maybe they have achieved it—at requiring all students at the National University of Singapore, regardless of their course, to spend at least six months, one semester, studying abroad. Can your Lordships imagine if we had anything like that commitment here? It might be a good thing if in due course we did. The great irony is that one of the great slogans to emerge from this Brexit policy as it has developed is “Global Britain”—but how can there ever be a global Britain unless far more of our students go and see the rest of the globe and spend time studying there? The first requirement for that is that we should not make the situation worse than it currently is.
The noble Lord, Lord Kerr, was right that what we seek from the Minister is not a miracle; we are clearly not going to get that from the present Minister. We simply expect a commitment to continue with the current programmes, and it is absolutely within the scope of the Government to say unilaterally that the negotiating position of Her Majesty’s Government now, in 2018, is that these programmes will continue with full British participation after 2020. If the Minister does not say that, he is staring at near-certain defeat on this issue on Report.
My Lords, I thank noble Lords for another excellent debate. I thank the noble Lord, Lord Hunt, and the noble Baroness, Lady Garden, for their Amendments 10 and 163, which respectively seek clarification on the Government’s future membership of the Erasmus and Horizon 2020 programmes. I am particularly grateful to my noble friends Lord Deben and Lord Patten for their helpful attempts to rewrite my notes for me before I started.
At the December European Council last year, the Prime Minister confirmed that UK students will continue to be able to participate in the Erasmus student exchange programme for at least another three years, until the end of the current budget period. She welcomed the opportunity to provide clarity to young people and the education sector, and she reaffirmed our commitment to the deep and special relationship that we want to build with the EU.
In response to my noble friend Lord Cormack, I say that the Government have made it clear many times that we value the Erasmus+ programme and international exchanges more generally. Cultural exchange helps to build important business, political and diplomatic bridges around the world, not to mention lifelong friendships.
I am grateful for that, but if that is the case then why do we not carry on beyond the three years?
If my noble friend will have some patience, I will come to that in a second. Supporting young people to study, work, volunteer, teach and train abroad, and supporting their schools, youth and sports organisations to build transnational partnerships, helps us to create a new generation of globally mobile, culturally agile people who can succeed in an increasingly global marketplace.
In response to the noble Baroness, Lady Royall, I say that the UK has a strong offer to EU and international students, with four universities in the world’s top 10 and 16 in the top 100. In fact, as the noble Lord, Lord Adonis, pointed out, we received many more students under Erasmus than we sent. Erasmus is an important programme, but it represents only about half the student exchange programmes we have in the UK.
Our young people get first-hand experience of different cultures, helping them to broaden their horizons and their ambitions. Students who have spent time abroad as a part of their degree are much more likely to achieve better degree outcomes, improved starting salaries and stronger employment prospects, as noble Lords have pointed out. This is especially the case for students from disadvantaged or less represented backgrounds.
In response to the noble Earl, Lord Dundee, no decisions have yet been made about post-2020 programme participation as the scope of that programme has not been agreed. We look forward to the Commission’s proposal, which we expect to be published in May. Participation in the successor to the Erasmus+ programme, which we think is valuable, will form part of the negotiations.
The UK fully participated in the mid-term evaluation of the current programme and we reached broadly the same conclusions as the Commission: the programme works well but there is room for improvement and simplification, especially for smaller applicants. UK respondents to the mid-term evaluation made many detailed comments and criticisms, but few suggested that radical change was needed. The proposal for the next programme will be published in May, as I said, and we are currently shaping the debate and looking forward to further discussions with the Commission about that.
We see future co-operation in education programmes as an area of mutual benefit to both the EU and the UK, provided that we can agree a fair ongoing contribution.
My Lords, what reassurance can the Minister give to students who are beginning their courses in September this year or September next year? Will they be able to participate in Erasmus or does that depend on whatever decisions the Government take after May? Is that not too late for certainty?
They will be able to participate in the existing Erasmus scheme up till 2020, should they wish to do so, and, as I said, we will see what the next programme will be. We await the proposals from the Commission in May, and we will discuss our participation in that with them.
As I said, we see future co-operation in education programmes as an area of mutual benefit to both the UK and the EU, provided that we can agree a fair ongoing contribution. We are giving this matter careful consideration as we negotiate the UK’s exit and are listening to the views of the sector.
As many noble Lords are aware, we have proposed a time-limited implementation period based on the current structure of rules and regulations. Looking to the future, we recognise the value of international exchange and collaboration in education and training as part of our vision for the UK as a global nation. That is why we said in our science and innovation policy paper, published in September, that we would discuss with the EU future arrangements to facilitate the mobility of researchers, academics and students engaged in cross-border collaboration. The UK and EU agreed in December that UK entities’ right to participate in current EU programmes for their duration will be unaffected by withdrawal. This includes the Horizon 2020 framework programme for research and innovation.
A number of noble Lords—the noble Lords, Lord Hunt and Lord Wallace, the noble Baroness, Lady Royall, the noble Earl, Lord Clancarty, and my noble friend Lord Deben—have asked me about the future of the Horizon programmes. Horizon will be succeeded by the ninth framework programme, as the noble Lord, Lord Kakkar, reminded us. This programme is also still being developed by the European Commission, and we are participating in discussions on that. The UK has declared that it would like to reach an ambitious science and innovation agreement with the EU that would include future framework programmes. It is too early to speculate on whether the UK will seek to associate to framework programme nine which, as I said, is still being developed.
The Government are deeply conscious of the importance of the Horizon 2020 and the future framework programmes to research in the UK, in which we have an international reputation. We are working hard to secure a research and innovation agreement with the EU that will take effect after Brexit.
The Minister says it is too early to decide whether we will co-operate. Can he tell us in what circumstances we will decide that it is not in the national interest for the UK to participate in the next Horizon programme?
I very much expect that it will be in our interest to participate in it. As I said, we are taking part in discussions. We have not yet seen the detail of how it will be financed, but, given a fair ongoing contribution, I suspect that we will want to participate. But they are a matter of negotiation. It is fine for us to say that, yes, we would like to take part; we need the EU side, the other side to the negotiation, to say that, yes, they would like us to take part as well. It is a negotiation. We can give a commitment that we would like to; we cannot give a commitment that we will be accepted.
As part of the new deep and special partnership with the EU, we will recognise our shared interest in maintaining and strengthening research collaboration. The UK will seek an ambitious agreement, one that promotes science and innovation across Europe now and in future. For the avoidance of any doubt, in response to the many questions that have been asked, let me say that we support Erasmus, we support Horizon 2020, but, contrary to what many noble Lords have suggested, these are EU programmes. The UK cannot adopt a unilateral stance; there has to be bilateral agreement on them. That agreement depends, first, on understanding the shape of the Erasmus programme in May and framework programme nine, when it is clarified by the Commission, and finding a mutually acceptable financial arrangement. Subject to those conditions, we would be very happy to be able to participate in both those programmes in future.
My Lords, I am not sure whether the Minister is drawing to an end, but he has not managed so far to say anything about the movement of researchers and students. Why can he not state categorically that we will not introduce any new impediments to students or researchers offered places in our universities? That would be entirely consistent with the introduction of a work permit scheme, because neither of those two categories come to our universities without a work offer. Why can he not say that now? Mobility is crucial in this area, but he has not said a word about it.
I totally agree with the noble Lord that mobility is crucial. I am fairly certain that we would not want to introduce restrictions on mobility in these areas—we want as many students to come as possible—but, as I am sure he is aware, this will be a matter for the Home Office to decide in the immigration policy that will be discussed shortly.
Indeed so. I was hoping that the Minister would say that there is not now, and never has been, any limit on the number of genuine students who can come to the UK. I would have thought that that is bound to continue: this is a false issue.
Yes, we have been a proud recipient of and destination for thousands of international students in the past. They are welcome in this country, they contribute greatly to our education services and I am sure that we will want that to continue in future, but I cannot speculate on what a future immigration policy may look like.
If this is a non-issue, why cannot my noble friend say very simply: “There will be no additional stops or impediments on students”? Does he not understand that constantly saying how wonderful everything is but that he cannot actually tell us anything is very difficult for anyone trying to plan their future and very unfair on young people?
As I said, I am fairly certain that we will want to continue to welcome as many students and researchers as want to visit this country in future, but, as I am sure the noble Lord will understand, I cannot speculate on what a future immigration policy might be before it has been announced by the Home Office and published by the Government.
Nevertheless, let me say for the avoidance of doubt that I have heard the message from all parts of the House and I will certainly reflect on these matters before we come back to the issue on Report. I understand that there are very strong feelings from all parts of the House about these issues and we will certainly see what we can do about that.
My Lords, first, let me say that I welcome the Minister saying that he will reflect on this debate, because I think it is the first chink of light from him on any of these important debates in Committee. It has been a remarkable debate. We have heard from many noble Lords about the importance of the Erasmus programme. I agree with my noble friend Lord Adonis: the noble Baroness, Lady Brown, speaking from huge experience as a former vice-chancellor of Aston University of the impact that Erasmus has had on the students who go to Aston and the way it has widened their horizons, is for me one of the most important illustrations of why future participation by the UK in Erasmus is so important.
On research, again, my worry is that the Government are hugely complacent about the UK’s position. Consider the consequences of uncertainty over Horizon 2020, which is having an impact on universities at this very moment in terms of collaboration on future research bids. Even where European Union universities will still collaborate with UK universities—and it is by no means certain that they will continue to do so in every case—they are reluctant for UK universities to be in the lead. Added to the uncertainties about the movement of both academics and students, we are entering a hugely uncertain position for a very important sector.
I listened with care to what the Minister said. To be fair, he has said that the Government value both Erasmus and Horizon 2020 and he repeated the Prime Minister’s comments, particularly in relation to Horizon 2020. He then said that while he values these programmes, the EU is working out the next stage of both Erasmus and Horizon 2020, that the UK is part of some discussion about that but they will form part of the negotiations and that there is nothing more he can say.
I think there is something more that the Minister can say. I think it is without question that it is in our national interest that we continue wholeheartedly to take part in those programmes. Thinking about the negotiations and the UK Government’s tactics, this niggardly, churlish approach does not seem to be getting us very far. This Government would attract a hell of a lot of good will if in relation to just these two programmes they said, “Whatever, we are going to stick with it, and we will make good any deficiency in UK university research programmes if the price of sticking with it means that we will get less than we did in the past”.
The whole Committee—almost all Members—really wants these programmes to continue. We will obviously come back at Report. The Minister has kindly said he will reflect on it. I very much hope that he will do so. I beg leave to withdraw the amendment.