European Union (Withdrawal Agreement) Bill

Baroness Thornton Excerpts

Report: 2nd sitting (Hansard - continued) & Report stage & Report: 2nd sitting (Hansard - continued): House of Lords
Tuesday 21st January 2020 Lords Chamber

[Lord Warner (CB)]

My Lords, I have added my name to this amendment for a reason which keeps coming up in our debates: they are all about trust and whether we can trust the Government to behave in a reasonable way. A lot of the amendments that have been put down have been about trying to ensure that—if I may put it as crudely as this—the Government behave well in carrying out these negotiations. We have seen a kind of emotional blindness, if I may put it that way, in the discussions we have had on immigration systems and physical documents that people who have a right to live here can use. This seems to be another piece of work in which we have to table an amendment to try to ensure that the Government behave properly and well in these negotiations.

It is quite extraordinary. Having agreed these reciprocal healthcare arrangements with the EU countries and Switzerland so recently, I cannot understand why we should not just be able to use this amendment to ensure that there are no rapid changes. The Government almost seem to forget the huge number of people who in their daily living move for holidays between the other 27 EU countries and Switzerland, as though that does not matter. This is an important part of people’s lives. They book their holidays assuming the system will not change. Particularly after this recent piece of legislation, no one has told them there is a risk that something may change.

The Government are bringing on themselves a mood in which people will be suspicious of what they are up to. They will raise a lot of anxieties totally unnecessarily. In my experience of government, if you allow rumours to be fostered they spread around quite quickly. What we are trying to do with this amendment is to remove the temptation. The Government would be wise to listen, unless the Minister can give a level of assurance that will remove any suspicion that somehow, because of the way they behave, the Government are up to something.

[Baroness Thornton (Lab)]

I thank the noble Baronesses, Lady Jolly and Lady Brinton, for introducing this. As they said, we are basically picking up where we left off in Committee. I was not satisfied with the answer the Minister gave about reciprocal healthcare. As noble Lords have now said, nobody really understands why, when we already have legislation that we considered and passed last March, that does not form part of the negotiation that will take place. I read the letter that the Minister sent to the noble Baroness, Lady Brinton, and it is very confusing.

I will take a more cynical view of this. A year ago, when we had in front of us the Healthcare (International Arrangements) Bill, it had in it five or six Henry VIII powers. It gave the Secretary of State the power to make a deal about healthcare with anybody in the world they might choose, without any recourse to this Parliament or any accountability. This House wisely changed that into the Bill we passed, now the Act, which does what the Government had said they would do. They said they would not add to the policy arrangements in any area. They would take up the European Union policy and translate it into a way that worked post Brexit. That Bill we had before us a year ago did not do that; it extended the powers incredibly.

I fear that we are seeing a repeat of what the Government tried to do a year ago, so I really need to know from the Minister what powers the Government may take—not what will happen between now and December, but what will happen in a year. What will it look like? Will there be any reciprocal healthcare arrangements? Will there be 27 agreements, which is what the Minister was talking to us about a year ago when we were discussing international healthcare and looking at crashing out of the European Union? What has happened to those 27 agreements? Where have they gone?

As my previous noble friend Lord Warner said—he is still my friend—it is only a matter of time until people become very anxious about this, because not only are people working all the way across Europe, but they are going on holiday all the way across Europe. At the moment, the Department of Health and Social Care’s website is really opaque. It does not give us any clarity at all about what might happen.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, it is always a pleasure to speak to the really important issue of reciprocal healthcare, which touches on a lot of UK and EU citizens’ lives. This House has rightly tested this issue robustly and it is right that we consider it today.

The withdrawal agreement Bill guarantees that reciprocal healthcare arrangements, including for pensioners, workers, students, tourists and other temporary EEA or Swiss visitors, will not be affected during the implementation period. During this time, there will be no change to reciprocal healthcare schemes, such as S1 and EHIC, nor to the S2 route which enables planned treatment. Importantly, I can provide assurance that the European Union (Withdrawal Agreement) Bill also guarantees lifelong, reciprocal healthcare entitlements for people so long as they remain within the scope of the citizens’ rights agreements. This includes UK nationals who will have moved to the EU before 31 December 2020, as well as EU citizens who will have become resident in the UK before this time. I hope that that explanation is clearer than my letter.

Last year, as has been mentioned, this House spent a considerable amount of time holding informed and important debates scrutinising the provisions of the then Healthcare (European Economic Area and Switzerland Arrangements) Bill. With the permission of the noble Baroness, Lady Brinton, I will call it HESA. We agreed that this was a key piece of legislation, providing the UK with options to implement any future reciprocal healthcare arrangements, subject to negotiation with the EEA states or with Switzerland after the UK leaves the EU. I understand the desire to know the outcome of these negotiations but, as they are obviously in the future, I am not able to give exact details, other than to say we want to ensure the best possible outcomes.

Following that scrutiny and the assent of Parliament…

European Union (Withdrawal Agreement) Bill

Baroness Thornton Excerpts

Committee: 2nd sitting (Hansard continued) & Committee stage & Committee: 2nd sitting (Hansard continued): House of Lords
Wednesday 15th January 2020 Lords Chamber

The purpose of my intervention is quite simple: to ask the Government what they would do if they left the European Medicines Agency at the same time as they left the European Union, which is quite unnecessary. As far as I know, there is no basis for expelling a member. I do not think that there is any political interest in trying to expel the United Kingdom, anyway. So we would have to take the initiative and resign, if we wished to resign. Equally, we could do nothing and remain part of the European Medicines Agency, with all the advantages that my two colleagues have set out this evening.

[Baroness Thornton (Lab)]

My Lords, let me say how much I welcome the amendment moved by the noble Baroness, Lady Brinton.

When I had the temerity to raise this issue and all the others raised by the noble Baroness on Monday at Second Reading, I sought information and assurance on a range of healthcare matters. I think we can say that I got the bum’s rush from the Minister when he answered my questions. In fact, he did not answer them at all. I hope we might fare better this evening.

The medical research sector has been clear that continued close co-operation should be a priority in the negotiations. Indeed, the Government have recognised the international nature of the life sciences sector. They are committed to aligning as closely as possible with the European Union clinical trial regulation when it comes into effect, safeguarding vital UK-EU clinical trials. Indeed, the political declaration also refers to continued co-operation with the European Medicines Agency, which would help ensure that patients in the UK have swift access to the newest medicine. However, the political declaration has no legal standing, so the noble Baroness, Lady Brinton, is quite right to repeat in the Committee the concerns expressed by the European Union Committee. As it stands at the moment, we cannot see that the European Medicines Agency will continue to benefit patients in the UK.

For some treatments, those of rare diseases, a single authorisation at EU level is vital in providing for cost-effective licensing and distribution of medicines for small populations. If the UK is outside the EU market and companies are required to pay again for separate MHRA licensing, as well as an appraisal by NICE and equivalent bodies in the devolved nations, there must be real concern that some treatments for rare diseases may become not financially viable to launch in the UK, therefore risking patient access entirely.

I know that the Minister absolutely understands all this, so it is very important that she reassures the Committee that these issues will not just be taken into account but will be part of the negotiations and will be successful.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I welcome the opportunity to discuss this important issue, and I thank all noble Lords for their, as always, thoughtful and expert contributions. During the Government’s preparations for EU exit, this House has discussed on a number of occasions the great value of the UK’s life sciences industry and the importance of ensuring that it remains—as the noble Lord, Lord Warner, rightly said—one of the most productive health and life sciences sectors in the world. As noble Lords will know, this sector alone contributes over £74 billion a year to the UK economy and employs close to 250,000 people. I contest the argument that it has recently been damaged. A report just today shows our leading position in cell and gene therapies, in which ongoing UK trials represent 12% of global trials and have increased by over 45% in the last year alone. That is in the context of Brexit.

The Committee is right that this is a crucial sector to the delivery of healthcare treatments to patients across the UK and will continue to be so in future. We must get this right. I assure noble Lords that the quality and safety of patient care is paramount in the department’s and our partners’ EU exit plans. This has been visible in our extensive efforts and preparations to ensure that the supply of medicines and medical products into the UK remains uninterrupted following the UK’s departure from the EU. This led to the department’s multilayered approach to put in place in the case of a no-deal exit from the EU. It was a substantial approach, which included work to procure additional freight capacity and to ensure buffer stocks and stockpiling; working closely with industry to improve trader readiness; and collectively helping to ensure visibility in the supply chain and, therefore, much more robustly ensuring continuity of supply processes.

While no-deal planning has been stood down, there is no question but that this work will stand us in good stead going forward, given the strategic importance of the supply of medicines and medical products in all scenarios—as the noble Lord, Lord Warner, pointed out. In fact, we are finding that the learning from this work is already helping us to better manage routine shortages, which are becoming increasingly common globally.

During our preparations for EU exit, we have at all times worked closely with our delivery partners. We are committed to doing so in future. Their support, expertise and hard work have been invaluable and will remain so as we enter the next stage of negotiations.

Turning to the amendment moved by the noble Baroness, I hope noble Lords will understand that we cannot accept this proposed new clause. The amendment was originally proposed in the other place and was not accepted there. I do not want to impute motive, but following debate, the sponsor in the other place chose not to move his version of the amendment to a vote there.

I wish to reassure the Committee on some of the questions raised, because it remains our objective to work closely with our EU friends, as we do at present, to ensure that patients continue to have access to safe and effective medicines and reap the rewards of our new relationship with the EU. Our overarching aim for medicines and medical devices regulations at the end of the implementation period is underpinned by the following commitments, which I have given before: patients should not be disadvantaged, which speaks to questions raised around rare diseases in particular; innovators should be able to get products to the UK market as quickly as possible; and the UK should continue to play a leading role in promoting the health of the public. We are in a better position than some of the countries—

European Union (Withdrawal Agreement) Bill

Baroness Thornton Excerpts

2nd reading & 2nd reading (Hansard): House of Lords & 2nd reading (Hansard)
Monday 13th January 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, rather like my noble friend Lady Jones, I rise with a heavy heart to make a speech which to some may sound familiar because it is. It is about the effect this Bill will have on health and medicine in the transition period and after 2021.

At every stage over the past two years, I have sought reassurance from the Government over matters of reciprocal healthcare, the free movement of medical and nursing staff, the regulation and supply of medicines, clinical trials and research, the conduct and regulation of which is so important in the UK. Indeed, access to the research portal is vital to patients across the UK and Europe. I thank the BMA, Cancer Research UK, the Royal College of Nursing and the King’s Fund for their excellent briefings on these matters. If the Minister cannot give me give me a comprehensive response to my questions, I anticipate a comprehensive written response that can be made available in the Library.

There remains some uncertainty about the status of current EU reciprocal healthcare arrangements in the event of the UK leaving the European Union without a negotiated deal. Will we have that deal by December and, if we do not, what will happen? At the moment, the National Health Service website says the following about reciprocal healthcare:

“If you’re using an EHIC issued by the UK, this will still be valid until”


the UK leaves the EU—is that at the end of this month or the beginning of next year? Can the Minister please tell me?—

“or if your treatment started before exit day.”

So perhaps you need to get a wiggle on if you want to have treatment. The website also says:

“You should prepare for possible changes to your access to healthcare”


if there’s a no-deal Brexit and

“if you’re a UK national travelling to the EU, Norway, Iceland, Liechtenstein or Switzerland … The … EHIC may not be valid if there’s a no-deal Brexit. This will depend on arrangements with individual countries and might mean you need to pay for treatment in full.”

Does the Minister think that that is satisfactory and that it will serve the citizens who might be affected by it? Perhaps he can give the House an update.

Following on from that is an issue concerning Ireland and Northern Ireland. Access to healthcare services through the common travel area differs for European reciprocal arrangements. The future of the border could have a significant impact on those areas, so I would like some clarification on that too.

In terms of staffing, nursing and other staff from the European Union not only care for our NHS patients but are active members of their local communities. However, the NHS continues to haemorrhage doctors, nurses, midwives, care staff and medical staff. The free movement of nursing staff and other healthcare professionals across the globe continues to make the UK a world leader in innovations in health treatments and care delivery. What comfort can the Minister give in that regard?

What arrangements for medical supplies are envisaged by this legislation? I failed to find them, so perhaps the Minister can help me out here. The Royal Pharmaceutical Society and many other bodies have warned that pharmacists are already struggling to obtain common medicines. Perhaps he would care to update the House on exactly what will happen in the next year and what might happen if we do not complete the transition by December?

I turn to the subject of the EMA and clinical trials. A close UK-EU relationship on medical research and the licensing of new medicines works for patients and researchers across the continent, and the medical research sector has been clear that continued close co-operation should be a priority in the negotiations. However, there is concern that recent government statements ruling out alignment with EU regulations could negatively impact UK-EU co-operation on medical research and medicines licensing, and put at risk the progress made by such collaboration. The UK’s membership of the EMA is a major advantage for UK patients, as companies generally prioritise launching new products in the European pharmaceutical market as opposed to other countries. I would like clarification from the Minister on how the Government intend to deal with this matter in the event of delays.

Finally, I turn to the subject of clinical trials. The UK’s world-leading clinical research environment is built on collaboration with European partners. This collaboration benefits all medical research and is particularly crucial for rare and childhood cancers where populations are often too small to run trials in individual countries. Likewise, as the most innovative research increasingly groups patients according to the genetic profile of their cancer, for example, the pool of eligible patients for some trials becomes smaller and one country alone may not have enough patients to make the evidence from the research meaningful.

If the UK falls outside the EU’s regulatory system for clinical trials, UK-led trials will be more burdensome and will be likely to be significantly more costly. There is already evidence that doubts about whether the UK will be part of the EU’s harmonised research system are affecting collaboration. A 2019 report found that UCL and eight other Russell group universities were running about 50 big European research collaborations in 2016 but that is now down to 20. Therefore, the key question for the Minister is whether the commitment to maintain regulations for clinical research trials in the UK still stands.

Brexit: Withdrawal Agreement and Political Declaration

Baroness Thornton Excerpts

Thursday 10th January 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I make no apology for the fact that I will continue to press the Minister, and the Government, about the effects of the political agreement on our health services.

I start by thanking the Minister for addressing some of the questions that I raised in my speech in December, particularly those concerning medical research. It saves me from repeating the whole speech, which, as good as it was, would be tedious for me and for the House. However, I will return to some of the unresolved and serious matters that the NHS, the research community, pharma and medicine face, post Brexit—and to how very serious the issues of safety and availability will become if we should be so foolish as to crash out of the EU in a couple of months. I make no apology for continuing to speak about health and social care issues. I did it during the passage of the Brexit Act. I have been doing it during the extensive and somewhat bizarre debates about the “in case we crash out” statutory instruments. We tackled those concerning the regulation of human tissues, embryology, organs and blood yesterday. I will continue to raise these serious matters today and will do so during the passage of the Trade Bill.

At every stage I have sought reassurance from the Government over matters of reciprocal healthcare, the free movement of medical and nursing staff, the regulation and supply of medicines, clinical trials and research, the conduct and regulation of which is so important in the UK. Access to the portal is vital to patients across the UK and Europe.

The response of the noble Lord, Lord Callanan, in his opening remarks yesterday, was welcome, after a fashion. However, I want to raise two issues. What the noble Lord said was in many ways too aspirational and not concrete enough. It was about wanting to explore new relationships, not to continue the ones that work already and are beginning to fall apart. Secondly, it was about the future. The noble Lord said:

“We have been clear that we want to explore association with EU research and innovation programmes”.—[Official Report, 9/1/19; col. 2224.]


While research programmes are protected to 2020, this completely ignores the fact that most research programmes take years to design, negotiate and fund. Brexit is already having a chilling effect on future research. What do the Government intend to do about this? How can they ensure that our universities and research organisations are not severely disadvantaged by being excluded from the funding and regulatory regimes of which they need to be part?

I shall return to the issue of the portal, which the noble Lord failed to address in his opening remarks; I hope he will do so at the end of this debate.

Agreement must be reached in the negotiations on UK participation in the single assessment procedure and access to the portal and database, which underpin the cross-national clinical trials regulation and come into operation in the next year. No access to the portal will severely reduce the ease of UK-EU trials set up and hurt our thriving life sciences environment. Clinical trials take years to plan and run. As things stand, UK researchers will enter the implementation period unsure what regulatory conditions they will face when they exit it. What is the Minister doing to resolve this issue with the necessary urgency? Is he aware of the cost of failing to do so? The deal as it is expressed does not achieve access to the portal. The political declaration makes no reference to how UK-EU clinical trials will operate after Brexit and this is of significant concern. As every day passes, uncertainty continues to increase in the research community over what the regulatory framework will be after 29 March and whether UK institutions will continue to be able to lead on UK-EU trials.

A further aspect is the mobility of researchers. The publication of the immigration White Paper in December has not clarified how changes to the rules will affect medical research; perhaps the Minister would care to do so. The current Migration Advisory Committee recommendation is for a salary threshold of £30,000 per annum, a figure that would penalise many research technicians—skilled workers who form the backbone of the research workforce but are often not highly paid. EEA nationals will now be subject to the immigration health surcharge and immigration skills charge. Students from the EEA will be required to have a visa to study, as current non-EEA students do.

On UK-EU mobility, it is good that the importance of the international movement of researchers is recognised in the political declaration, but there is not enough detail on the extent to which this will continue, either for researchers moving across borders to live and work, or for short-term travel for shared projects such as clinical trials. Could the Minister clarify that?

It is absolutely essential for our world-leading medical research environment, and for the breakthroughs that benefit patients, that we continue to attract, recruit and retain global scientific talent at all levels. At present, neither the political declaration nor the immigration White Paper offer this certainty. Yesterday, the Minister made no mention of medicines, which is an issue I will continue to raise because of the supply of medicines in the short term.

Finally, I raise the issue of the European reference networks following Brexit. The ERNs are virtual networks of medical specialists across Europe. They facilitate discussions on complex or rare diseases and conditions that require highly specialised treatment. As such, they are an essential resource for the 30 million rare disease patients in Europe. I agree with the Specialised Healthcare Alliance that continued UK involvement in European reference networks is vital to driving forward improvements in rare disease care in both the UK and the European Union. However, at present, the ERNs are open only to EU member states and EEA members, which means that there is a clear risk that the UK will no longer be able to participate. Can the Minister ensure that the Government work with the European Commission to ensure that the UK is able to contribute to ERNs following Brexit, in the interests of patients with rare diseases? I hope the Minister will be able to answer these questions at the end of this debate.

European Union (Withdrawal) Bill

Baroness Thornton Excerpts

Report: 1st sitting: House of Lords
Wednesday 18th April 2018 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I thank the Minister for her very full response to the amendment moved by my noble friend Lord Patel. She has given a powerful reassurance that the important elements of the European clinical trials regulation that can be applied independently of the European Union to improve the situation for the conduct of clinical research in our country will be brought into force. That is vital, as the Minister said, for ensuring that those who plan clinical research can do so with absolute certainty over a period of time prior to implementation. I, for one, am most grateful to her for this reassurance.

[Baroness Thornton (Lab)]

My Lords, I join everyone in thanking the Minister—the noble Baroness, Lady Goldie—and indeed the other Ministers who have been involved in the discussions. I thank them for the meetings we have had. I am sorry that I was not at the meeting the other day, but I thank her for sharing with me what she was going to say today. I am very happy that the Government have recognised the importance of this matter. Who would not be honoured to be on an amendment with the noble Lord, Lord Patel, and the noble and learned Lords, Lord Judge and Lord Mackay of Clashfern, and if they say that they are content, who am I to say that I am not? What will be necessary from now on is for the Government and all of us to reassure the medical professions and the researchers that this is exactly what will happen, so that they can plan with confidence clinical trials for the future.

[Lord Patel]

My Lords, briefly, I thank everybody who has spoken but particularly the Minister for the way in which she presented the solution. I say by the way to the noble Baroness, Lady Thornton, that we used the brains of the two noble and learned Lords for medical knowledge, not their legal knowledge. I thank them, as this will reassure the research communities, pharma and even the EU institutions of our commitment to collaborate with EU nations on clinical trials. I thank the whole ministerial team and I beg leave to withdraw my amendment.

European Union (Withdrawal) Bill

Baroness Thornton Excerpts

Monday 19th March 2018 Lords Chamber

[Lord Russell of Liverpool (CB)]

My Lords, I want to say one or two words, not least because I thought it might be appropriate to have at least one male voice speaking in this debate about violence against women and girls. I declare my trusteeship of Coram, which contains the Coram Children’s Legal Centre. The centre often gives advice and tries to help the victims of domestic abuse—particularly children, including girls and boys.

As ever, these are probing amendments and we do not expect the Minister to come up with a list of magic solutions. However, we are concerned with two key areas. One is to seek reassurance that the levels and types of co-operation currently in place will, to the best of the Government’s ability, continue to be as effective—and even more effective in the future. The second is to seek reassurance that the sources of funding, some of which are plugging important gaps that we have been unable to fill domestically in the recent past, will not be unwittingly left behind.

Nobody suggests for a moment that Her Majesty’s Government do not care about these things. When I googled what the Prime Minister said about violence against women and girls, I saw that one of her first speeches when she became Home Secretary in 2010 was at a Women’s Aid conference, when she said:

“As both Home Secretary and minister for women and equalities I believe I have a unique opportunity to bring about real change to the lives and the status of women in this country and my ambition is nothing less than ending violence against women and girls”.


I am sure the Minister would agree with that.

We are not looking for chapter, book and verse. The Government have put a huge amount of effort into this. I returned to Google and looked at the Home Office website on violence against women and girls. It has no fewer than seven pages full of a whole variety of initiatives and policy statements that the coalition Government and now the current Government have undertaken and made, so it is not for lack of activity or lack of trying. We are concerned to try to ensure that that momentum continues. We are really trying to make three points. I think we know the answer to the first, which is whether the Government are aware of our concerns. Secondly, are they actively reviewing the content and looking at how to try to sort some of these out? Thirdly, to the best of their ability, can they remedy any of the unintended consequences?

Lastly, I put on the record an apology to the House. Two weeks ago, I fell an unwitting victim to what I believe the President of another country calls fake news. After googling some contributions by the noble Lord, Lord Callanan, I inadvertently attributed to him a mildly scurrilous article that appeared to be in his name in the Sun newspaper—a well-known and respectable organ. However, it turned out not to be the case. I have apologised to him in person, and I am now apologising to the House. My comments at cols. 924 and 925 of Hansard on Monday 5 March were not entirely correct.

[Baroness Thornton (Lab)]

That was a very nicely put apology.

It is important to remind ourselves that European policy currently ensures that victims escaping violence are able to access basic provisions and that restraining orders put on abusive partners apply across the whole EU. Those fleeing domestic violence across borders within the EU have the European protection order—as mentioned by several noble Lords—which is recognised across the EU. There is no guarantee we can see at the moment that this will continue to include the UK. As for women with insecure immigration status, a female migrant worker escaping violence in the UK would need to rely on the social security system, putting them in a weak position. We have to ensure these vulnerable women are protected and safeguarded. If we do not, they almost certainly will not be.

These two amendments are about issues that we have generally addressed in the House, which is that we do not want to see any gaps. We do not want to see Brexit happening and gaps in the provision of protection—in this case, for women and girls facing violence. My noble friend Lady Kennedy explained very ably what assurances we need from the Minister. They are about policy, funding and implementation. I think that every single person who has spoken in this debate has in some way or other mentioned policy, implementation, continuity and assurance. The noble and learned Baroness, Lady Butler-Sloss, is completely right that the EU protection order and the EU arrest warrant are absolutely vital in this context.

I thank the Fawcett Society and Her Future, which includes 25 organisations that are intimately and actively involved in the protection of women and girls. They are very concerned about the fact that some of them will fall off a cliff if European funding is removed. They are very concerned about the implications that that will have for women and girls across Europe. From these Benches, I echo that we very much support these amendments and that we are seeking the assurance that many—I think all—noble Lords have raised today.

[Baroness Goldie (Con)]

My Lords, I thank the noble Lord, Lord Russell, for his very gracious apology, and I am sure that if my noble friend Lord Callanan were present he would wish to acknowledge it in person.

The noble Baroness, Lady Kennedy, has raised an issue of great importance, and I thank her for tabling this amendment. It touches on issues that invite concern and lead people, not just across this House but universally, to seek reassurance. It may assist the House if I explain that the Government are taking forward a range of work to tackle violence against women and girls and if I set out the Government’s position on current and future international co-operation on these issues. I appreciate that, as far as the noble Baroness is concerned, I am probably teaching a very young grandmother how to suck eggs, and I apologise for that in advance. However, I hope that in giving this further explanation I will reassure her that, while her amendments are undoubtedly well-intended, at this stage they are unnecessary.

Ending violence against women and girls, and protecting and supporting victims, remain a key priority for this Government. The UK continues to be a global leader in its efforts to tackle violence against women and girls, and it is our reforms to domestic law that in turn help to support a stronger international framework; that is something that it is very important to acknowledge. Our cross-government violence against women and girls strategy outlines our ambition that no victim of abuse should be turned away from the support that she needs, and is underpinned by increased funding of £100 million through to 2020. We have put in place a range of measures to tackle violence against women and girls, including the criminalisation of forced marriage, two new stalking laws, the national rollout of domestic violence protection orders and the domestic violence disclosure scheme, and a new offence of domestic abuse covering controlling and coercive behaviour, which I think many will acknowledge is a very welcome extension of the law. We have also introduced new guidance on domestic homicide reviews and a new domestic abuse statistical tool and dataset that brings together comprehensive data on domestic abuse at a local level.

We are proud of the progress that we have led, but we know that there is more to do. The prevalence of these crimes continues to be unacceptable, with violence or the threat of it, sadly and appallingly, a daily reality for millions of women and girls in the UK and internationally. That is why we will continue to build on this work, driving forward our agenda to further address these injustices. We have committed to publishing a landmark draft domestic abuse Bill and are supporting the introduction of a new civil stalking protection Bill to protect victims at the earliest possible stage. The domestic abuse Bill will protect and support victims, recognise the lifelong impact that domestic abuse can have on children, make sure that agencies effectively respond to domestic abuse and extend our extraterritorial jurisdiction over violence against women and girls-related offences in England and Wales.

We have clear mechanisms for reporting on our progress. I know that the noble Baroness, Lady Kennedy, said that she hoped I was not going to give the stock response that had been given in the other place—but I am the mere obedient servant of my masters, so I have to say that I am not permitted or authorised to stray beyond what the Government have already indicated is their position. However, I will point out that we are already required to lay annual reports in Parliament on this issue in the context of the Council of Europe Convention on Preventing and Combating Violence Against Women and Domestic Violence—the Istanbul convention to which the noble Baroness referred.

It was the coalition Government who signed the Istanbul convention in 2012 to demonstrate their strong commitment to tackling violence against women and girls, and this Government have made absolutely clear our commitment to ratifying it. The convention sets forth obligations on parties to take a co-ordinated, coherent and cross-border approach to tackling violence against women and girls, and it is the first pan-European and legally binding instrument to provide a comprehensive set of standards. The convention highlights the need for more effective international and regional co-operation and, while there is no one-size-fits-all model in our approach, I suggest that the measures within the convention will ensure that more robust action is taken through legally binding and harmonised standards.

[Baroness Thornton]

Does the Minister mean to say that the safeguards contained in the European protection order will be continued? Is that what will happen?

--- Later in debate ---

[Baroness Deech (CB)]

Will the existing Hague convention on maintenance cover the situation? From what I have learned there are dozens, if not hundreds, of other states with which we have reciprocal arrangements for enforcing child maintenance. Some say that once we leave Europe, and leave the Brussels conventions, it will be simpler. We will simply have one international regime. There are those who say that it is actually better than the Brussels regime. All we need to do is sign up as an individual member—not as an EU member—of the Hague maintenance convention with its advantages stretching all around the world. I would like to be reassured that that will be just as good as the situation that we have at the moment.

I also support other Members in pointing out how very bad child maintenance law is at the moment in this country. It is very difficult to enforce in England, let alone elsewhere, but this is not the time to go into the great failings of that particular area of the law. We need to know whether the Hague convention will do, and whether we will sign up with the necessary three months’ notice before we exit from the Brussels conventions.

[Baroness Thornton]

I say to the noble Baroness, Lady Deech, that her neighbour, the noble and learned Baroness, Lady Butler-Sloss, was shaking her head during her remarks about the Hague convention and its applicability in this case. We are again talking about reciprocity and gaps. This is a theme that noble Lords will recognise has run throughout this Bill. My noble friend Lady Sherlock spoke about it at Second Reading and at an earlier stage in Committee, painting some very vivid and moving pictures about all of these issues to do with divorce, maintenance and safeguarding children. This is yet another step along that road.

These are issues that affect ordinary people who happen to marry people from another country and have children with them. These are everyday issues—not the gigantic ones to do with human rights that we have come to recognise as part of this discussion—and will affect people because they will not be able to afford to go to law without the reciprocity that exists at the moment. The Minister needs to assure the House that the reciprocity that we have now is going to continue.

[Baroness Goldie]

My Lords, I again thank the noble Baroness, Lady Kennedy, for raising a very important issue, the whole area of child maintenance. We recognise that it has a significant impact for many families in the UK and in the other EU member states. The reciprocal enforcement of maintenance decisions has a long history. Establishing procedures to enable decisions made in one country to be enforced in another helps to ensure that children receive appropriate financial support after the parents have separated and when one parent is living in another country. The noble and learned Baroness, Lady Butler-Sloss, interestingly observed that even with the structures, there are still challenges. We all have to be cognisant of that.

European Union (Withdrawal) Bill

Baroness Thornton Excerpts

Committee: 6th sitting (Hansard): House of Lords
Monday 12th March 2018 Lords Chamber

[Lord Spicer (Con)]

My Lords, I have a tentative question. If it is true that we do not trust our own legal environment with medical research in which, as has been said, we have great expertise, why should we trust ourselves with anything else? Across the whole of the Bill, responsibility is being transferred to this country. Why should we not be able to do that for medical research as much as for anything else?

[Baroness Thornton (Lab)]

This benefits all patient populations, and is particularly important for paediatric and rare cancers—diseases which, precisely because they are uncommon, are among the hardest to research and treat. You therefore need a larger pool than the 66 million people who live in this country: Europe has a combined population of 510 million to draw on. That is nothing to do with trust; it is to do with how clinical trials need to be carried out. You need a larger pool of patients to test these drugs.

I was pleased to add my name to the amendment in the name of the noble Lord, Lord Patel. I raised this issue in my speech at Second Reading and will mention only one additional matter, which is to do with rare paediatric illness; tumour types which affect relatively few people; and rare cancers which translate to over 20% of all cancer diagnoses across the world. If the UK is to make progress on therapies for paediatric and rare cancer, it is vital that we can work closely with EU nations on clinical trials. Cross-border collaboration is crucial to paediatric and rare cancer clinical trials. Some 75% of clinical trials in the EU involve cross-national collaboration, rising to 86% for rare disease trials. As noble Lords have remarked, that is because of the patient population across Europe. We will be doing a huge disservice to our children, and to the cancers which threaten a few of them, if we fall out of this system. It is as simple as that.

The BEACON clinical trial system is an example of how cross-national collaboration is fighting back against rare paediatric cancers. Neuroblastoma is a form of cancer that affects around 100 children, mostly under the age of five, every year in the UK. More than half the children with aggressive forms of the cancer will see it return and, for these children, there are few treatment options left. In 2013, Cancer Research UK scientists and paediatric cancer specialists launched the BEACON-neuroblastoma trial to find the best chemotherapy treatment for children and young adults with recurring neuroblastoma. To do this, it is bringing together clinicians and scientists from 10 European countries and two international consortia, with funding from Cancer Research UK and European partners. It is a fantastic example of successful European collaboration. The rarity of this neuroblastoma and the low number of patients means that trials could not have happened in a single European country. It is vital that this type of cancer trial—

[Baroness Kramer (LD)]

Given the noble Baroness’s expertise on this issue, I wish to ask her a question. As I understand it, medicine is becoming more and more personalised and customised. Therefore, by definition, the pool for a far wider suite of diseases is becoming smaller and smaller because of that much narrower customisation and personalisation. Therefore, the situation with rare diseases today is about to become the norm across a very wide range of diseases. Does the noble Baroness read it that way?

[Baroness Thornton]

I absolutely agree with the noble Baroness. In fact, several noble Lords who are much more expert on this have already mentioned that aspect. The noble Baroness is absolutely right. I do not think I need to say anything more. I think this amendment is the remedy. I hope that the Government will respond positively to it. The case is unanswerable.

[Baroness Ludford (LD)]

My Lords, when she replies, will the Minister comment on the remarks of her noble and learned friend Lord Keen of Elie on 28 February, when we discussed this issue in the context of directives whose implementation date was beyond exit day? The noble and learned Lord addressed this issue, partly because the noble Baroness, Lady Hayter, mentioned regulations. In his reply, he said something rather interesting: namely:

“There are examples of regulations … where we accept that the regulation has come into domestic law but its actual operation is deferred, perhaps until 2020”.


I think that date was given just as an example. The noble and learned Lord continued:

“That regulation … will form part of our domestic law at the exit date, even though the operative provisions come into force only after the exit date”.—[Official Report, 28/2/18; col. 690.]


Will the Minister clarify whether she believes that the clinical trials regulation falls into the category envisaged by the noble and learned Lord, Lord Keen of Elie? If not, why not?

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[Baroness Thornton]

Will the Government therefore consider amending the Bill to allow that to happen?

--- Later in debate ---

[Baroness Goldie]

My noble friend Lord O’Shaughnessy, who is advising me, says that once there is a new regime in Europe, all non-member states will have to make a decision about whether or not to be compliant with that. We hope that in our Brexit negotiations we have made clear—the Prime Minister has emphasised this—the huge importance we attach to these issues. They are massively important and we want to get a positive outcome in the negotiations, but it would be premature at this stage to incorporate into this Bill the anticipated enactment of the new regulation because it might be inert law.

[Baroness Thornton]

I have already written to the Minister asking for a meeting to discuss this issue and have copied the letter to many noble Lords. It is important that we have the meeting before the next stage of the Bill.

[Baroness Goldie]

I am happy, as are my colleagues, to engage in and attend meetings and to listen to the views expressed.

I was going to make an observation about the amendment of the noble Lord, Lord Patel. The noble Lord, Lord Kakkar, made an important point about how we deal with whatever law we will have if this new regulation has not become law when we leave. It is important that we have the flexibility in the Bill to deal with such matters but, under the amendment of the noble Lord, Lord Patel—I am sure it is not intentional—there could inadvertently be a delay in dealing with them as we leave because his amendment stipulates that Clause 7 powers could not make regulations until a report had been laid before both Houses assessing the costs and benefits of adopting the new EU regulation. We do not know when that is coming through. We think it might be March 2020—we do not know—but in the meantime we could be in limbo in trying to do the very things that noble Lords want us to be able to do in respect of the existing law. For these reasons, I urge the noble Lord to withdraw his amendment.

European Union (Withdrawal) Bill

Baroness Thornton Excerpts

Committee: 2nd sitting (Hansard): House of Lords
Monday 26th February 2018 Lords Chamber

Moved by

[Baroness Thornton]

9: Clause 1, page 1, line 3, at end insert—
“( ) Regulations bringing into force subsection (1) may not be made until the Secretary of State has set out a strategy for seeking to ensure that any citizen of the United Kingdom or of an EU country, who requires health care in a different country of the EU or in the United Kingdom, will be treated as if they live in the country in which they require treatment, with the home country reimbursing the country where care was provided.”

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[Baroness Thornton (Lab)]

My Lords, I rise to move Amendment 9 and speak to Amendment 11 in my name on the Marshalled List. Even since Committee stage began in your Lordships’ House last Wednesday, the Brexit world has shifted again and is doing so even today. The Prime Minister has had her summit at Chequers and my own leader is posing a serious challenge to the Government. We have to wonder how many millions are following the detail of hard Brexit; soft Brexit; tariff-free access; managed divergence or even ambitious managed divergence; hard and soft borders; regulatory alignment; cake philosophy, which is something to do with cherry-picking and having your cake and eating it; the three baskets theory, which I understand is a bit like the cake philosophy, only it is three choices; transition or implementation; and, finally, a bespoke economic partnership.

The media is full of it. The Westminster bubble and the chatterati—from which I do not exclude myself—talk of little else. That is because it is important to our nation’s future and our prosperity, or otherwise. However, I will propose one amendment, and speak to another, on matters which do not at present feature in the headlines or in the huge and momentous agenda being discussed in your Lordships’ House, but which do affect millions of citizens in the UK and the EU, including every Member of this House. These amendments affect all who work and travel in Europe; who buy medicines and take for granted the supply and availability of the most up-to-date, clinically approved remedies.

Like millions of UK citizens, I have been on holiday and travelled all over the EU. Most often, my summer holidays have been in France with my children. Every year while my children were growing up we had at least one ear infection, sometimes a dose of tonsillitis and, one memorable year, an adult with Bell’s palsy. The wonderful Dr Duterte in Brantôme came to know us quite well over 25 years. My son lived in Brussels for five years and, although mostly healthy, he and we thankfully did not need to worry ourselves about his access to healthcare. An important part of a stress-free holiday with a mother with chronic obstructive pulmonary disease was knowing, with confidence, that the oxygen supply would be waiting in the house—free, like in the UK. I tell these everyday stories precisely because they are so ordinary. It is the experience of millions of us: the package holidays; the weekends; the hen parties in Barcelona; the stag dos in Amsterdam and elsewhere; the conferences in all sorts of places. We and our fellow citizens are accustomed to travelling with ease and confidence. The ease with which people can do what they are used to doing is a matter which will colour how they judge whether Brexit is succeeding and whether it has been worth while.

Amendment 9 concerns the EU reciprocal healthcare arrangements which allow citizens of EU and EEA nations, as well as Switzerland, to access health and social care services while in any other of these nations, on the same basis as a resident of that nation would at no or low cost. The schemes include the EHIC, the European healthcare insurance card, which provides access to state-provided healthcare for short-term visitors; and the SI scheme, which, for example, allows ongoing access to health services for people working abroad and social care services for individuals such as pensioners living abroad. This is important for workers, students, the retired and holidaymakers, and, as I said, it affects millions of us.

Post Brexit, the UK could lose access to these arrangements, depending on the final outcome of ongoing negotiations between the EU and the UK Government. So far, the two parties have agreed that UK pensioners already living in the EU will be able to use the SI and EHIC schemes post Brexit, but no deal has been reached on wider access to them. Losing access to these arrangements would have a significant impact in a number of areas. This is one area where some progress seems to have been made but, as with many other matters, there is some uncertainty about what will happen after Brexit. The latest joint EU-UK document on the Brexit talks in November said that citizens who live in another EU country on the day that the UK leaves will still be eligible for the same healthcare as citizens and will still be able to use the EHIC scheme when visiting another EU country. This includes citizens who work or study in another country or are retired there. However, agreement has not been reached on whether the EHIC would be available to those who travel to, or go and live in, another EU country after the UK has left the bloc. It would seem that the EU wants discussions on that to be included in the negotiations on the future relationship between the UK and the EU, which will come only after sufficient progress has been made on the divorce issues.

Our amendment seeks to prioritise the negotiation of continued access to existing EU reciprocal healthcare schemes, or the creation of comparable alternatives. We need to fully assess the impact which loss of access to the schemes might have on patients and health services. For the UK, this approach would ensure continuity of care for its citizens living abroad and ease of access for UK citizens visiting the EU or EEA and avoid increased demand on and costs for the NHS.

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[The Minister of State, Department for Exiting the European Union (Lord Callanan) (Con)]

Let 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.

[Baroness Thornton]

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.

[Lord Callanan]

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.

--- Later in debate ---

[Lord Callanan]

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.

[Baroness Thornton]

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.

Amendment 9 withdrawn.