Covid-19: Deep Cleaning

Lord Lansley Excerpts

Wednesday 11th March 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right to emphasise the importance of personal hygiene. The Government are working hard to drive these messages home. Ultimately, it is up to the public to embrace the messages. A substantial public awareness campaign was launched 10 days ago. From the polling that we have done so far, it appears to have been extremely effective. Based on that polling, we will be launching a further campaign to ensure that everyone is aware of the hygiene protocols the noble Baroness describes.

[Lord Lansley (Con)]

My Lords, the Minister made a good point about timing. Sometimes certain measures require preparation by public authorities and the public before they can be initiated. Does he agree that we may be not too far off a point when we ask those who are elderly and have underlying health conditions not to leave home, and that many public authorities—parish councils, town councils, local government, the NHS and Age UK—might soon want to undertake preparations?

[Lord Bethell]

My noble friend is quite right that measures require preparation. This Government are determined not to be caught on the hoof. In his public statements on Monday the CMO was clear that there are three areas where the modelling suggests there might be a major difference to the delay processes that the House has heard about and understands. My noble friend is also right that the safeguarding of older and vulnerable people would be a likely candidate for that. A substantial amount of time is required though, maybe 10 to 12 weeks or more. It is important that social acceptance of that kind of measure is in place before it is initiated. We are also looking at modelling the kinds of changes which would mean that those who display any symptoms might seek to socially distance themselves or that those who have been tested think about ways of putting space between themselves and their families. These are the kinds of illustrative examples that the CMO has already discussed publicly, and the Government are preparing for those kinds of scenarios at the moment.

Wuhan Coronavirus

Lord Lansley Excerpts

Tuesday 11th February 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. We are aware that there are British nationals on board the “Diamond Princess” in Japan and that six more people have tested positive for coronavirus, none of whom is a British national. We have offered consular assistance to those British nationals—we have been in touch with the “Diamond Princess”—including one who is in hospital. We obviously pay tribute to the work being done in trying to contain the situation there. I identify myself with the thanks and tribute paid to the work of the CMOs, who are doing an extraordinary job right now to make sure that the UK is prepared.

We are one of the first countries in the world to have an effective test; it is working well. Now that the protocols have been sent to the devolved Administrations, testing centres in Glasgow, Edinburgh, Cardiff and Belfast have started testing already. Labs in Cambridge, Bristol and Manchester have started testing today and Birmingham, Newcastle and Southampton will come online shortly. I hope that reassures the House about the capability already available within the NHS.

[Lord Lansley (Con)]

My noble friend’s appreciation of what is being done in contact tracing and the urgency that has been invested in that and other aspects of containment of the disease is welcome. I share the appreciation that there is across the House for that.

I am sure my noble friend agrees that the effort put in now to try to contain the virus is not disproportionate, even if it includes the powers under the new regulation, because it buys us time. She referred to buying time for research into a potential vaccine. I have not seen any reference to other antiviral treatments that might be identified and be of use. For example, if a new flu-like virus was circulating we could use our stockpiles of Tamiflu. Have any viral treatments been explored for this particular virus?

[Baroness Blackwood of North Oxford]

As ever, my noble friend is astute on this issue. Contact tracing has been hugely effective, particularly for the 1,466 passengers and 95 staff who arrived in the UK on direct flights from Wuhan between 10 and 24 January. All those have now passed through the incubation period and none of them was a confirmed case. Of the remaining cases that we have found, a number are linked to contact tracing. We should be very proud of the effectiveness of our system.

On the question of antivirals, work and research is ongoing in regard to a particular HIV retroviral which has been used in this measure. That is being considered. There are three projects which aim to advance the vaccine candidates into clinical testing as quickly as possible. We are also looking at some correspondence from both diagnostic kit manufacturers and potential end users, and we are considering whether we can also improve the diagnostic kit.

Health: Eating Disorders

Lord Lansley Excerpts

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord, as ever, is quite right to delve into the detail of the 2017 survey into the mental health of children and young people in England. It found that eating disorders were identified in 0.4% of five to 19 year-olds—the spread was 0.7% of girls and 0.1% of boys—but it rose to 1.6% of girls aged seven to 19. Obviously, we want to understand what this rise in admissions means. There could be a number of reasons, which we hope are linked to earlier and better diagnosis, but of course we need to understand it better. We have a much better understanding of the data through the NHS mental health dashboard, which tracks down to CCG level what is happening with it, but we need to make sure that this work is properly funded and properly tracked in order to lead to better and more effective policies and provision of commissioned services.

[Lord Lansley (Con)]

Does my noble friend recognise that sometimes the point at which young people with severe eating disorders are able to meet the criteria for admission to an in-patient bed is so severe that some of the potential benefits from an earlier admission are lost? I ask my noble friend to return to the number of in-patient beds. We have a deficiency. What is the Government’s estimate of the extent of that deficiency, and what steps are being taken to commission additional in-patient beds?

[Baroness Blackwood of North Oxford]

We are increasing the number of commissioned in-patient beds up and down the country, but we are doing it in a way that recognises that it is better to have earlier diagnosis—prevention of the need to admit—and ensures that we do not wait until patients are at the stage where they need admission, which is the primary aim. My noble friend is absolutely right that we need to make sure that we have the right balance between those two. At the moment, we are doing a thorough assessment, and I will be happy to write to him on that issue.

NHS: Bullying

Lord Lansley Excerpts

Wednesday 5th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The CQC takes this extremely seriously. One proposal in the people plan is for the CQC’s scorecard to include a proper measure of a sustainable workforce, so that the new staff engagement metrics for the NHS oversight framework can be taken into account in the CQC’s well-led assessments during inspections, and that includes questions about bullying.

[Lord Lansley (Con)]

My Lords, I hope that my noble friend will agree that good leadership in the NHS is critical to removing a bullying culture. In that respect, might the Government support the NHS Leadership Academy to the extent that all aspiring chief executives in the NHS should themselves have gone through its Aspiring Chief Executive programme?

[Baroness Blackwood of North Oxford]

My noble friend, as ever, makes a very good point. Obviously there are a number of routes where leadership has been shown on this issue. In 2016 the Social Partnership Forum, which is chaired by Ministers but works across the system, gave a call to action, tasking employers and trade unions in all NHS organisations with working in partnership to create positive workplace cultures and to tackle bullying. In addition, recognising that no one organisation has the answer, royal colleges and others have joined together to create an alliance to tackle workplace bullying. They concluded that:

“Bullying behaviour is unacceptable. It is unprofessional and unnecessary. It affects the wellbeing of individuals and the teams within which they work”.


My noble friend’s proposal is another part of the picture. We need to come together across the system to tackle a completely unacceptable set of behaviours in the NHS—one that needs to be stamped out entirely.

Tessa Jowell Brain Cancer Mission

Lord Lansley Excerpts

Monday 13th May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for his comments and in particular for the leadership he showed in responding to Tessa’s call to arms to improve outcomes for those with brain cancer diagnoses. I can absolutely give him the commitment that the Government’s commitment to the mission will not waver, and there is a very good reason for this. The outcome we are already seeing is so significant; over the last 12 months there has been the launching with partners of the mission and the making available of funding that has resulted in 24 brain cancer research proposals—the highest number ever—with a further four under active consideration. In addition, progress has been made on moving towards new service and staffing models, with commitments in the long-term plan and the life sciences sector deal. This will deliver exactly what my noble friend is talking about: namely, better care and support for patients, targeted to the kind of diagnoses they have, which is exactly what the brain cancer mission has recognised, and exactly the specialist advice which government needs to tailor care for patients in the most appropriate way when they most need it.

[Lord Lansley (Con)]

My Lords, the update is most welcome. I will say two things to my noble friend. First, as part of the update, would she be able to update us on outcomes, particularly one-year and five-year survival rates, which are what we most want to see moving consistently in the right direction? Secondly, my noble friend will recall that about eight years ago we in the coalition Government agreed a programme for investment in positron emission tomography—PET—scanners. One of the particular reasons we did so was that patients in this country through the NHS were not accessing a form of radiography that would be particularly relevant for those with brain cancer, because of the minimisation of collateral damage to tissue around the tumour site. What my noble friend was saying about the identification and targeting of tumours is true not just for surgery but for radiography. Can she update us also on the availability of PET scanners through the NHS?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. He is absolutely right that we want to focus on outcomes. That begins with earlier diagnosis, shorter waiting times and access to treatment. However, when it comes down to it, we want to know that we have better survival rates. Cancer is a priority for the Government so that we can improve that, and the quality of care for patients. I am pleased to report to the House that survival rates are at a record high: since 2010, rates of survival from cancers have increased year on year. However, we know that there is more to do, and we will never have any measure of complacency about this. That is why in 2018 the Prime Minister rolled out a package of measures to see three-quarters of cancers detected at an early stage by 2028—the current figure is just over half. The plan is to radically overhaul screening programmes to provide new investments in state-of-the-art technologies to transform the process of diagnosis and boost R&D. My noble friend is absolutely right that one of the areas that we must focus on is ensuring that treatment has the lowest burden of side-effects possible. The proportion of cancer survivors living with long-term disabilities as a result of treatment is high, so having more targeted treatment is absolutely a priority within our cancer strategy. I will be delighted to write to my noble friend with a specific update on where we have got to with PET scanners.

Antimicrobial Resistance

Lord Lansley Excerpts

Thursday 2nd May 2019 Lords Chamber

Moved by

[Lord Lansley]

That this House takes note of Tackling Antimicrobial Resistance 2019-2024: the UK’s five-year national action plan.

[Lord Lansley (Con)]

My Lords, it is my privilege to move that the House takes note of this government publication. I am very grateful for the opportunity to secure this debate and, in my case, to return to the issue of antimicrobial resistance. I was fortunate enough to have a debate on this subject about three years ago, and indeed other noble Lords have also initiated debates on it. It is important that we do so. Today is a powerful illustration of where we can give ground to the climate change debate. However, there is more than one issue on which it is really important that we have these opportunities for debate, not least because they give us the chance, over a slightly longer period, to realise the complexity and multifaceted character of the challenges we face and the need for us to work intensively and consistently to deal with them.

I am grateful to noble Lords for participating in the debate. It is evident from conversations I have had and communications I have received that, for every one of us here, there are two or three more who would have liked to be here and to have contributed. I hope that future opportunities will offer themselves.

It is not in the custom of this House to say so but, if it had been down to me, I would have been “taking note with approval” of the Government’s national action plan. I say that very straightforwardly. My purpose is not to criticise the national action plan but to commend the initial five-year plan and the refresh published in January. The timeliness of this debate was further illustrated by the fact that on Monday the United Nations Interagency Coordination Group on Antimicrobial Resistance reported to the Secretary-General with a document that said:

“Unless the world acts urgently, antimicrobial resistance will have disastrous impact within a generation”.


In many debates we have understood the scale of the threat that we face. Indeed, when I was in the coalition Government, we included, for the first time, AMR as one of the top-tier risks in the national risk assessment and we understood its character. I was proud of the fact that shortly after I ceased to be Secretary of State—although none the less the work had begun—we saw the publication of the first five-year action plan, which ran from 2013 to 2018.

An illustration of the nature of the problem we face is that UK data—the Minister may refer to some of it later—clearly shows that there has been a significant reduction in antibiotic prescribing for animals and there is clearly some reduction in the extent of drug-resistant infections that animals for food production are harbouring. In human health, there has been something like a 6% reduction over five years in the prescribing of antibiotics, which compares with about a 6% increase in the preceding five years. None the less, the burden of infection and antibiotic-resistant infections among the human population in the United Kingdom is not going down. It is at best stable and some specific drug-resistant pathogens are increasing.

That tells us—it is something that I think we all know—that we are dealing not with a static problem but with a dynamic threat. The problem is that bacteria are rapidly evolving and adaptable, and the number of drug-resistant pathogens will rapidly increase. They have the capacity to swap DNA, so they will be able to acquire resistance to new antibacterial agents. We are also seeing the emergence of some drug-resistant pathogens; they are resistant to a number of antibiotics. Indeed, I noted that about three and a half years ago America was particularly worried about the presence of a pan-resistant infection. I think it was resistant to about 21 different antibiotics. Therefore, it is not simply a case of increasingly having to combine antibiotics and other treatments to deal with these drug-resistant infections; we have to try to ensure that we reduce the threat.

The UN document, published on Monday, also said:

“The challenges of antimicrobial resistance are complex and multifaceted, but they are not insurmountable”.


That goes to the heart of this debate. From looking at the list of speakers, I know that this afternoon we will understand that there is a range of approaches, all of which have to be pursued. I do not for a minute say that the issues I propose to focus on are more important than others on which we have to work. Antimicrobes in the environment and so on are very important but I do not propose to dwell on them. None the less, it demonstrates that the original national action plan published in the United Kingdom and the international work that has been done have focused on a one-health approach. However, it is terrifically important that we understand that we have to work across the environment, animal health and human health to make progress. The joint publication by the Secretary of State for Health and Social Care and the Secretary of State for Environment, Food and Rural Affairs demonstrates the Government’s commitment to working on a “one health” basis.

I will focus on one sentence from page 74 of the Government’s January report, which relates to the development of new therapeutics. The report says that one of the Government’s objectives is the development of “alternative strategies” to try to ensure that we can bring forward new therapeutics to deal with and combat antibiotic resistance. Part of that means that we therefore need to understand how we can develop new therapeutic agents. Part of that is academic research; it is not just about therapies, but diagnostics—I think in the last debate the noble Lord, Lord Rees, instanced the Longitude Prize which Nesta was pursuing. That continues, four years later, with the objective of delivering additional diagnostics. Prizes for academic research seem to be stimulating a range of teams to try to respond. Not only do we have to promote and fund academic research but pull the fruits of that initial academic work through to therapeutic agents we can deploy in practice for human health.

We seem to be going backwards on this. I think three major pharmaceutical companies have ceased their antibiotic research activity in the last 18 months—including Novartis, which is notable given its scale and reputation. In America a start-up company was developing a therapy that was given FDA approval in July 2018 for the use of plazomicin in complex urinary tract infections. This company filed for bankruptcy in early April. Over the course of last year, it secured no more than about $1 million of business. What is happening here? A new drug is approved for use and there is no revenue to support it. This is exactly the problem for antibiotics. Novel antibiotics such as these get a relatively narrow indication for use, because antibiotics are not broad-spectrum—they are very targeted. Also, as they come into use, they are pretty much a last-line therapy for use in rare circumstances, so they do not get bought very much. This company, like many pharmaceutical companies starting out, could be supported across the so-called valley of death by the funding support of CARB-X, only to find that there is a desert. There is no funding to make this happen.

That is where the Government in this country are looking to develop a new business model that helps bring through those new therapies, but that is a way off. A project team is being established and it will probably be something like another 18 months beyond that before we see what this business model may look like. We need more urgency. We need to think about what this model looks like, and at least put preparations in place, even if we have to add data and specifics to it as the work goes along.

The noble Lord, Lord O’Neill of Gatley, published a seminal review and report on this. First, he said that we want play and pay. That is, those in the pharmaceutical industry should be either engaging in this research—that is, playing—or paying. Frankly, I do not think that will work. It will just be treated as a tax on the pharmaceutical industry. He now seems to have said that he is rather giving up on this and that therefore the Government should take it over. I am afraid there is no evidence to support the proposition that Governments are better at innovation than the private sector. We need to combine in public and private partnerships. In that context, we need, as I think the Government intend, to recognise that this is about giving those bringing forward new therapeutics the confidence that they will be paid for. From the Government’s point of view, that has to be a proportionate and reasonable amount, and it has to be attractive.

The UK represents 3% of the global drugs market. We will not be able to do this on our own. That is why I return to the point in the Government’s national action plan that we have to work internationally—not just as the Government do with the Fleming Fund, promoting national action plans and better prescribing globally, which is absolutely right and very valuable, but through the richest countries coming together. They have to establish, effectively, a global fund. We have a global fund for HIV/AIDS and tuberculosis at the moment; perhaps they could enhance and add to that— it would be a substantial enhancement—to pull through the new therapies that will enable us to combat antibiotics.

That will require action from America, Japan and ourselves. I should declare an interest as chair of the UK-Japan 21st Century Group, and I particularly mention Japan because it has the presidency of the G20. In Osaka at the end of June, for the first time Health and Finance Ministers will meet together shortly before the Heads of Government do. Health and finance should be talking together, because in so many contexts the economy and the health of the nation fundamentally depend on each other. That is a moment. I know my counterpart in Japan—who, as it happens, is a former Japanese Health Minister—and his colleagues would be very interested in working together through the G20 in Osaka to launch an initiative that would enable us to deliver on a major programme for issuing prizes for research and determining the price that will enable us to pull through new therapeutics for the future.

With apologies for the many other issues that need to be covered—I know that many noble Lords will want to raise them—I will focus on that one. I hope the Government will use the global leadership that the United Kingdom has already demonstrated, not least with the marvellous work done by Professor Dame Sally Davies, who is due to retire in the autumn—knowing her, I do not think she will be letting go of this at all. We will welcome her to Cambridge in the autumn, but I suspect that she will continue to travel the world pushing this issue forward. We have the research, the capacity, some of the resources and the ability to take a lead internationally to bring new therapeutics and diagnostics through to the marketplace, and demonstrate that we can stem the tide of antibiotic resistance. I beg to move.

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, this has been a fascinating debate and revealed again the depth and breadth of the knowledge and passion your Lordships’ House has on this issue. I thank the noble Lord, Lord Lansley, for initiating the debate and the Library and many other organisations for their helpful briefings. I feel I should declare that I am a member of a CCG. I say that because it is rare to see a subject that is the victim of as many acronyms as the NHS, but this field certainly challenges that, combining as it does health, farming and the environment, the research and science communities, pharma businesses and international organisations. I was very grateful for the list of acronyms at the front of the Government’s five-year paper.

As noble Lords have said, we know that AMR currently results in 700,000 deaths globally every year, that by 2050 that could be 10 million, and that it threatens to turn back the clock on a century of medicine, rendering modern surgery, organ transplantation and chemotherapy too dangerous to use. Preventive treatment is needed, as the report says, to curb the spread of bacterial diseases requiring antibiotics. As the noble Baroness, Lady Walmsley, said, vaccines are the most effective preventive health tool in human history. We therefore need to expand the use of existing vaccines to have a better impact.

One of the most serious issues in the fight against AMR, which almost every noble Lord mentioned, is that no new class of antibiotics has been introduced for more than 30 years. Antibiotics are quite unlike any other category of drug, because every dose of antibiotics poses the risk of encouraging bacteria to adapt and develop resistance. That was illustrated by the noble Baroness, Lady Masham, in her description of the fight she has been having, which we have discussed on several occasions over the past year.

The Government’s five-year action plan is indeed an impressive document and a step along the road. I join the noble Lord, Lord Lansley, in saying that we may not be moving as quickly as we should. That has been echoed across the Chamber. Of course, it is not the complete solution, and serious questions have been asked in the debate. I join the noble Baroness, Lady Miller of Chilthorne Domer, in saying that the plan is disappointing in that it fails to give a clear commitment to incorporate into domestic law the European Union’s recently agreed legislation that bans routine preventive use of antimicrobials. It is a pertinent question at this point. Article 107.1 provides:

“Antimicrobial medicinal products shall not be applied routinely nor used to compensate for poor hygiene, inadequate animal husbandry or lack of care or to compensate for poor farm management”.


That is not being incorporated into UK law, as far as we can tell. I agree with the noble Baroness that the answers given to questions in the Commons were ambiguous, to put it mildly. Perhaps the Minister could take this opportunity to clarify the issue.

When I discussed the five-year plan with my noble friend Lord Winston, who regrets that he cannot join us this afternoon, he said two things to me. The first was that meeting this challenge will be well-nigh impossible given the dearth of lab, technical and science staff in the NHS at this moment. Secondly, he said that investment in research needs to be much greater and the follow-through more effective. My noble friend would have put those points more eloquently and, probably, more forcefully than I have, but neither of those issues is new; they have been articulated in your Lordships’ House over a long period.

Part of the NHS long-term plan talks about the delivery of the five-year plan we are discussing today. Will the staffing review address technical staff, of which there is a terrible shortage? They are essential for the delivery of both the NHS long-term plan and this plan. We know that the issue of research is not just about funding to deliver ground-breaking research. The UK does a great job in training PhD students, but loses a lot of talented people because the post-doctoral period is so unstable. We need continued support for interdisciplinary networks to strengthen research and develop capacity. Does the strategy address that issue as robustly as the emergency that we are facing requires?

Many noble Lords mentioned market failure, which the noble Lord, Lord Lansley, dwelled on in his opening remarks. According to Professor Dame Sally Davies, the reason for that is in part that the easy wins have been made and there is now a fundamental failure of the market for new antibiotics. Given the growing threat of AMR and the need to conserve and use current and future antibiotics carefully to preserve their effectiveness for as long as possible, it is clear that pharmaceutical companies are aware that any new antibiotic they bring to market will be prescribed only very sparingly rather than as a first-line treatment during its patent life, thereby reducing its profitability. I found that idea very dispiriting because it seems that we must address market failure. The report of the noble Lord, Lord O’Neill of Gatley, also recognised and addressed this issue.

That is even more discouraging when one realises that, over the past five years, we have seen pharmaceutical companies withdraw further and further from the development of antibiotics. In June last year, the latest company, Novartis, exited the market, bringing the total number of companies involved in antimicrobial drug development to six. The issues of market failure and disinvestment are incredibly important; therefore, the Government’s scheme to delink the price paid for antimicrobials from the volume sold is also crucial.

Even more depressingly, Professor Dame Sally Davies argued that the industry needed to step up and act in a socially responsible way, pointing out that tackling AMR was also in its interest. In her evidence to the Commons Select Committee, whose report I found extremely useful, she said:

“I am disappointed by the number of them”—


pharmaceutical companies—

“who have said quietly over a drink, ‘Well, Sally, we know you’re going to solve this. The Government will have to pay, so we’re waiting until you pay’”.

Where is the social responsibility? What terrible short-sightedness. To go back to the point about losing modern medicine, what is the point of developing the world’s greatest cancer portfolio if there are no antibiotics to rescue the patients? Yet industry expects us in government and the public sector to fund this, or that it will happen through somebody else being corporately responsible.

This market failure might lead to catastrophic consequences, as referred to on pages 74 and 76 of the five-year plan. It rightly states:

“The UK cannot solve such market failures alone”.


I question that because I should not like to think that the idea that we cannot solve this alone because we are 3% of the world market means that we do not try to do things in this country to turn this round. Our NHS has huge purchasing power: it pays billions of pounds to pharma, which makes billions in profit from these sales, for the drugs and treatments we need. We must have some leverage here. I ask the Minister: if a UK university or small pharma company found a new antibiotic, surely our Government would find a way to make sure that it was developed and brought to market. They would not wait for this to happen on the world stage, would they? I really want to hear that we will not have a repeat in the UK of the situation described in the MRC report, as referred to by the noble Lord, Lord Lansley. I received that report; the story of Achaogen was a graphic one of market failure in developing a new antibiotic. However, the noble Lord did not ask something that I wish to ask: what will happen to that drug? Achaogen developed a drug that can treat the most serious superbugs; therefore, it is not much needed so the company did not make enough money and went bankrupt. Where has that drug gone? What has happened to it? That is an important question.

[Lord Lansley]

As I understand it, the company is up for sale so, effectively, people would buy the patent and the drug.

[Baroness Thornton]

Let us hope that the people who buy it are public-spirited enough to know that they need to develop it and that that can be done. That puzzled me when I read the fascinating article, which I recommend to noble Lords. I thought, “A new antibiotic is out there and it is not available to us, for goodness’ sake”.

I congratulate the Government on the five-year plan. It is important, however, that the impetus behind it works, that the incentivisation schemes unlock investment in AMR, that we do not face the same issues being faced in America, and that implementation of the plan is speeded up.

--- Later in debate ---

[Lord Lansley]

My Lords, I thank the Minister for her excellent response to a really good debate. I am very grateful. I said at the outset that I hoped that the debate would bring forward a range of expert views relating to the “one health” concept, and it did exactly that. I am most grateful to all those who contributed to enable that to happen. The debate demonstrated the complex and multifaceted character of the problem. I share the Minister’s hope that it is indeed surmountable.

I shall say just a couple of things. First, on growth promotion and trade, the issue is that only now are some countries beginning to recognise that they have to stop antibiotic use in growth promotion and its widespread prophylactic use in animals. That happened in Europe in 2006, but it happened in 2017 in America for growth promotion and only now are the Indian Government bringing forward proposals in this respect. There is an international aspect that we need to work on.

My final point is that I entirely understand what the noble Baroness, Lady Thornton, said. The point of the national action plan is to be the best in the world—the best in class—and to demonstrate what can be achieved. If we can achieve those targets, it will be fantastic, but it has to happen elsewhere. Not only turning a national action plan into its equivalent in other countries but creating international global action, which was the burden of my contribution, will be central to a more effective response overall, which we all want.

Motion agreed.

House adjourned at 4.37 pm.

Social Media and Health

Lord Lansley Excerpts

Tuesday 30th April 2019 Lords Chamber

[Lord Lansley (Con)]

My Lords, my noble friend referred to the discussion with the social media companies about vaccination, but the Statement did not refer to any specific commitments on their part or even acceptance of a responsibility in relation to disinformation about vaccination. Does my noble friend agree that it is important to understand why immunisation rates and vaccination coverage have dipped? I was Secretary of State when we reached the highest level of, I think, 94% for MMR following a period from 2007, bringing it up from 80%. It has not dipped back to those levels, but we need to understand why this has happened. If it is about disinformation on social media, what have the companies said about this up to this point?

[Baroness Blackwood of North Oxford]

The social media companies accept that they have a responsibility to deal with anti-vaccination misinformation, harmful information relating to eating disorders and general health-related misinformation that can be found online. The Health Secretary has been clear with social media companies that they are expected to address these harms. The Department of Health looks forward to working with them on it. My noble friend is right when he says that our levels of vaccination are extremely high compared to other countries’, but we must not be complacent and must ensure that we not only maintain the current vaccination rates but drive them further and do not tolerate any further permeation of the pernicious anti-vaccination messaging which is starting to leak out online.

Vaccine Hesitancy

Lord Lansley Excerpts

Monday 1st April 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is right that we should have great confidence in experts and ensure that young people coming through our education system have that same confidence. This is why we can be proud of the high uptake of vaccinations in this country. A number of key components have achieved the high coverage of vaccination. They include national co-ordination of our vaccination programmes, fully trained staff and access to relevant information. We must ensure that this continues so that high level of confidence among parents and patients continues.

[Lord Lansley (Con)]

My Lords, in the study the noble Lord referred to in his Question, the correlation between populist voting and vaccine hesitancy in the United Kingdom was less than in a number of other European countries, but a study in America demonstrated that what was most likely to lead to a positive response from parents was time spent with paediatricians. That is about finding doctors who have the time to explain the purposes of vaccination and to respond to any parental concerns. Will the Minister look at the extent to which family doctors can have that time incorporated into, for example, their Quality and Outcomes Framework remuneration?

[Baroness Blackwood of North Oxford]

My noble friend is quite right that one of the things that was highlighted in the recent survey about public trust in vaccinations was that 93% of parents trust NHS staff and advice and that 93% of parents remain confident in the immunisation programme. So in order to cover that last percentage, we need to ensure that those parents have access to a GP programme. I therefore encourage parents to speak to their GP or a health professional about vaccinations and to look to credible sources, such as NHS Choices, for their information. I will certainly consider the point raised by my noble friend.

Healthcare (International Arrangements) Bill

Lord Lansley Excerpts

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My Lords, the Bill’s delegated powers and their global application have been a source of spirited debate since this Bill’s introduction, and noble Lords have rightly given considerable scrutiny to this matter. A number of amendments were tabled in Committee, including those by the noble Baronesses, Lady Thornton and Lady Jolly, the noble Lords, Lord Patel, Lord Kakkar and Lord Marks, and the noble and learned Lord, Lord Judge. This issue has concerned Peers across the House. I am pleased to say that the Government have listened carefully and tabled an amendment that significantly curtails the scope of the delegated powers in the Bill.

Amendment 9 directly addresses the concerns raised by restricting the exercise of the delegated powers, and, as we have already discussed, limits the global scope. The Bill is intended to support the implementation of comprehensive reciprocal healthcare arrangements with countries within and outside the EU, and to implement possible future partnerships. It was drafted to fulfil this purpose in a number of different scenarios, and that remains the Government’s intention, but we have listened closely to the points raised by Peers both inside and outside of this Chamber, as well as to the views of the DPRRC and the Constitution Committee, and concluded that the regulation-making powers that can be used to set up schemes for unilateral healthcare overseas should be time-limited.

The powers in Clause 2(1)(a) and Clause 2(1)(b) would primarily be needed, in the event of a no deal, to mitigate any detrimental effects of a sudden change in healthcare access for UK nationals living in the EU. These powers would be required in the event that reciprocal arrangements are not in place. Our aim remains to reach an agreement on reciprocal arrangements, but as a sensible Government, we need to plan for all eventualities.

In the unprecedented event of leaving the European Union with no deal, we would need to have the option of establishing support mechanisms for people in exceptional circumstances where there would be a serious risk to their health should any member state not agree to maintain reciprocal healthcare. However, we have listened, and want to ensure that while the Government have the ability to provide for people in this unprecedented time, we are still respectful of the constitutional roles of Parliament and the Executive. In response, we feel that the delegated powers that implement healthcare arrangements outside of reciprocal healthcare agreements with other countries should be sunsetted.

During the five years before the sunset, we will retain the flexibility to deal with exit scenarios using regulations under Clause 2(1) as appropriate. These powers can be used to offer UK nationals reassurance and certainty, which we intend through this Bill. After the sunset, making use of the regulation-making powers under Clause 2(1) would be limited to Clause 2(1)(c) only, which provides the Government with a mechanism to give effect to future complex global healthcare agreements. However, it is important to state that this amendment will mean that it is not possible for the Secretary of State to set up any long-term scheme to unilaterally fund mental health treatment in Arizona or hip replacements in Australia, as has been suggested. Of course, this is not something a reasonable Government would intend to do, but I am happy to provide that reassurance. However, we would want to remove any perceived risk regarding this power, and that is the intention of this amendment.

In tabling the amendment, the Government have sought to clarify the intended use of the important powers in Clause 2(1)(a) and (b). This represents a significant restriction of the Government’s use of delegated powers, in direct response to concerns raised by parliamentarians across this House. It also represents a significant check on the global scope of the Bill. On that basis, I beg to move.

[Lord Lansley (Con)]

My Lords, my noble friend will forgive me if I ask for a point of clarification. If Amendment 9 is passed, after the sunset clause is implemented, powers could only be made in relation to a healthcare agreement. However, Clause 3 says that a healthcare agreement can concern either healthcare provided outside the United Kingdom and paid for by the United Kingdom, or healthcare provided in the United Kingdom with another country paying. It does not require reciprocity. Is that quite the restriction my noble friend was suggesting, since it could still be unilateral, not reciprocal?

[Baroness Thornton]

I thank the Minister for tabling this sunset clause; she is quite right to do so. I had not thought of the question asked by the noble Lord, Lord Lansley, but it is a good one. However, we support the amendment.

--- Later in debate ---

[Baroness Brinton]

My Lords, I support the amendment moved by the noble Baroness, Lady Thornton. Without repeating our debates at previous stages of the Bill, it would be helpful to have reassurance from the Minister that the content of the list in the noble Baroness’s amendment is exactly the sort of detail we need. It is important to reassure people on exactly how any financial arrangements for healthcare will be made.

[Lord Lansley]

Further to that point, I think following the list exactly may be the most difficult thing for the Government to do. Amendment 16 sets out to commit to a report on payments. We have healthcare agreements with, for example, Australia and New Zealand where no money changes hands. As I understand the way in which these agreements work, it would be very difficult for numbers of British citizens in Australia or Australian citizens here to be collected to be reported. The noble Baroness, Lady Brinton, asked for the list to contain exactly the sort of information we need. While the list may indicate the sort of information we are looking for, if it is not available, it is not available.

[Baroness Brinton]

Under current arrangements, the National Audit Office is able to tell us exactly the costs of the reciprocal arrangements with Europe. I am therefore struggling to understand why we might not be able to do this elsewhere in future.

[Lord Lansley]

The costs are exactly what the Government are proposing to report on. The Australian agreement, for example, does not involve payments to and fro. So costs do not arise. We have mutual, reciprocal agreements about treating each other’s citizens in our domestic healthcare system.

[Baroness Brinton]

I am sorry to prolong the point but, surely, we would be clocking up those costs in the NHS, even if they were not reclaimed.

[Lord Lansley]

The Minister may wish to advise on this. I understand that we probably do not—because there is no requirement to recover the money—whereas, under an EU agreement, we collect the data because we are required to charge the Governments who are the competent authorities for those patients.

[Baroness Brinton]

I am really sorry to prolong this point but, if we are trying to make sure that new reciprocal arrangements are effective, this is exactly the sort of data collection that we should be seeking. Even if it is not used initially, the whole point is that we want to understand the costs of each arrangement.

[Lord Lansley]

I am making a simpler point: it is no good asking for information that is not collected. There is a good reason why it is not collected. Although, this might happen in future, at the moment I do not think anybody is proposing to switch the Australian and New Zealand agreements to ones where there is reciprocal reimbursement. In this case, I do not think the information is being collected.

[Baroness Manzoor]

My Lords, I am grateful to the noble Baroness, Lady Thornton, for her amendment and to the noble Baroness, Lady Brinton, and my noble friend Lord Lansley for their contributions. I am not sure I want to go down this route. However, if the noble Baroness, Lady Brinton, wants me to write to her to clarify the point she raised, I will certainly do so. From what I have seen, my noble friend Lord Lansley is correct in saying that we have a reciprocal agreement with the countries he mentioned, where money does not exchange hands.

I can reassure the noble Baronesses, Lady Thornton and Lady Brinton, that—as I indicate—the Government have listened to the need for greater transparency in the administration and implementation of reciprocal healthcare arrangements. I welcome the support around the House for our intentions. We understand the importance of presenting this information in a clear and accessible document, which is why we propose to go beyond the current reporting requirements. Our initial commitment to the DPRRC is contained in the amendment that the Government have tabled on this matter.

As I said, the government amendment directly addresses concerns raised by noble Lords. I hope it reassures noble Lords and demonstrates that we have listened to the clear request for increased scrutiny of the use of public money.

The amendment of the noble Baroness, Lady Thornton, would ensure that specific requirements are reported on. The detailed content of the financial report should—and could only—be determined, once reciprocal healthcare agreements have been made and technical and operational details are known. We do not know what these agreements may be in future. If we accepted the amendment, we would be placing a statutory duty on future Administrations to collect and report on data we have not yet agreed to exchange with other countries. This is not appropriate.

Our amendment is a more feasible way of reporting on future healthcare arrangements that does not pre-empt their nature or how they may be implemented, but still allows for transparency and accountability, which the noble Baroness, Lady Thornton, and other noble Lords seek. It is a baseline, and we intend to go further than just reporting on payments, but we cannot provide a statutory obligation to do so.

The Department for Health and Social Care is currently working to ensure that UK nationals can continue to access healthcare in the EU in the same way they do now, either through an agreement at EU level or through agreements with relevant member states. In either case, we will have to agree how eligibility is evidenced, how—and how frequently—that information is exchanged and the reimbursement mechanisms that will govern those new agreements. Such agreements will have to take into account the operational possibilities and limitations of each contracting party to ensure the smooth operation of reciprocal healthcare arrangements. This should include how NHS trusts in the UK can evidence eligibility for the treatment of non-UK citizens in the most efficient and least burdensome manner.

Once those administrative details are known, the Government will be able to speak confidently to the specific measures that can be reported on for each country. There is an annual reporting mechanism in the government amendment to provide such detail. I acknowledge that the amendment of the noble Baroness, Lady Thornton, is well meaning and agree with its spirit, but the level of detail proposed in it could constrain or create unnecessary burden when administering future healthcare arrangements that have not yet been negotiated.

It is in the interest of neither the Government nor Parliament to force unnecessary administrative burdens on the NHS, which the amendment could inadvertently cause. The level of detail required in the amendment may create new reporting requirements on front-line NHS services.

As always, should the noble Baroness wish, the Minister or others from the department would be very happy to meet her to talk further about the issues, once we have a clear understanding of future negotiations and how they progress. I hope I have reiterated the Government’s commitment to accountable financial reporting, and that the noble Baroness and other noble Lords feel reassured on our commitment to ensuring that sufficient and appropriate checks and balances are in place on reciprocal health agreements. I hope she will agree that her amendment, which places a statutory duty on future Administrations to collect and report on data we have not yet agreed to exchange with other countries, is inappropriate. I hope I have reassured her and other noble Lords and she feels able to withdraw her amendment.

Healthcare (International Arrangements) Bill

Lord Lansley Excerpts

Committee: 2nd sitting (Hansard): House of Lords
Thursday 21st February 2019 Lords Chamber

I urge her to bring pressure to bear on other members of the Government to extend that kind of sensitivity to this Bill, and to accept that the principle is applicable here and that allowing for future regulatory change to primary legislation on an unrestricted basis, as this Bill does, is unacceptable and unconstitutional. I beg to move.

[Lord Lansley (Con)]

My Lords, I shall speak to Amendments 37 and 39 in this group, which are in my name. The noble Lord, Lord Marks, has helpfully introduced them in the point he made towards the latter part of his remarks about the distinction made in the EU withdrawal Act between retained direct principal EU law and retained direct minor EU law.

As the noble Lord said, that principal EU legislation should be subject to the affirmative procedure was recommended for the Trade Bill. That was accepted by the Government but has not been incorporated into this legislation. My Amendments 37 and 39 would do precisely what the Constitution Committee recommended on Monday. Happily, I tabled my amendments last week, rather than waiting until after Monday, as that would have been rather late. The amendments would allow the Government to indicate their support for this process. I hope that they are drafted correctly and that they would do the job, but, even if they do not, we will have the opportunity for that to be remedied on Report. I hope that my noble friend on the Front Bench will say that it is the Government’s intention to make this change.

Participating in the Committee stages of both the Trade Bill and this Healthcare (International Arrangements) Bill gives one an opportunity on occasion to make a positive comparison between the two. However, it is getting confusing. The Trade Bill is intended to roll over existing agreements and specifically does nothing else. Members—not least on the other side—are spending much of their time trying to persuade the Government that it should include reference to how things should be agreed in the future. The Bill before us creates a power not only to roll over existing agreements but to make new ones. On Tuesday, much time was spent on Members of the House arguing that this was inappropriate and should be left to future legislation. As they say: you cannot have it both ways. But it seems that in this instance, at least on this specific point, we can ask Ministers to change the Bill for this purpose.

I commend to the Front Bench Amendments 37 and 39, which would incorporate an affirmative requirement for amendments to retain direct principal EU law.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, I strongly support the amendment of the noble Lord, Lord Marks, and everything he said. I fear that, given the welter of things happening in politics at the moment, this kind of Bill is getting through without proper scrutiny and that many people, in both Houses, do not realise the importance and far-reaching implications of what we are considering. We are therefore very grateful to people like the noble Lord, Lord Marks, for drawing attention to this issue. I am astonished that this has apparently got through unchallenged in the other place. Many of my colleagues—with the notable exceptions of my noble friend Lady Thornton and her colleagues on the Front Bench—have not realised what an urgent matter this is.

I arrived late on Tuesday and was unable to participate in the debate on the first amendment. I missed the wonderful speech by the noble and learned Lord, Lord Judge. He raised the issue again at Question Time today and was answered by the noble Lord, Lord Young of Cookham, who is with us. Astonishingly, as the noble and learned Lord, Lord Judge, said on Tuesday and said again today:

“The harsh reality is summarised in the fact that it is exactly 40 years since the other place rejected a statutory instrument—40 years”.—[Official Report, 19/2/19; col. 2172.]


For the last 40 years, we have been dealing with legislation without the ability to amend it. Whether the procedure is affirmative or negative—I will come to that later—does not matter: we have not had the opportunity to amend it. What happens? The statutory instrument is drawn up by civil servants and put forward to Parliament by the Government. What is Parliament asked to do? You have to agree it or not—and if you do not agree it, you get threats. You get people saying, “This is a killer amendment” or, “This is a killer resolution”. That happened yesterday, I think, on a couple of statutory instruments, and the amendments were not moved in the end.

So we have a take it or leave it situation with statutory instruments, unlike with primary legislation. When the subject was raised, the noble Lord, Lord Young of Cookham, said that it was a much wider issue—it had been raised in the wider context. A trickle of SIs has become a flood. More and more issues that ought to be dealt with by primary legislation are being dealt with by secondary legislation. The more that happens, the bigger the transfer of power from the legislature to the Executive. That is exactly what the Government are doing. I ask them to think carefully. This Conservative Government will not be in power for ever. I hope some people agree with me on that—somebody say, “Hear, hear”.

--- Later in debate ---

[Lord Patel (CB)]

I thank my Convenor, the noble and learned Lord, Lord Hope, for bringing attention to my amendment. I will be briefer than brief because the noble Lord, Lord Marks of Henley-on-Thames, not only introduced my amendment but spoke to it. My purpose in tabling Amendment 28 was to bring attention to exactly what the noble Lord and the noble and learned Lord have just said: it is an extraordinary power to take. I fear that it is this kind of power that led the Constitution Committee to suggest that the only way for Parliament to scrutinise the Bill subsequently might be to introduce such a draconian provision as a sunset clause; I say draconian because I am worried that it may have other implications. As I said on Monday, I worry that that will affect what the agreements in the future might do, particularly with the EU. But we will no doubt have another opportunity to discuss that.

[Lord Lansley]

For completeness, in relation to Amendment 28, which would remove subsection (3), it should be recognised that the power to which the noble and learned Lord, Lord Hope, referred is for the purpose of giving effect to a healthcare agreement. It is not for any other purpose, so if it was not in pursuance of a healthcare agreement the power would not be available. Albeit that healthcare agreements may in themselves be relatively wide-ranging, the power can be used only for that purpose.

[Lord Patel]

My Lords, I am not too sure about that because the Delegated Powers and Regulatory Reform Committee said in its report:

“The Minister does not give any indication of what primary legislation might in future need to be amended”.

--- Later in debate ---

[Lord Lansley]

But subsection (3) is clear: this is a power to amend primary legislation,

“for the purpose of conferring functions on the Secretary of State … to give effect to a healthcare agreement”.

The noble and learned Lord will know that that at least limits the scope.

[Lord Hope of Craighead]

The noble Lord, Lord Lansley, raises an interesting point. It is something that should be clarified by better drafting. Splitting things into subheads, as is done frequently throughout the Bill, tends in some ways to open up the arguments to which the noble Lord, Lord Patel, has drawn attention. As I think I have mentioned to the Minister outside the Chamber, the way these provisions are drafted in this cumulative form is rather unfortunate because if they are read together in a single sentence they can be narrowed down, whereas if they are separated out it suggests that paragraph (a) has a life of its own, so one may wonder what “any other person” can possibly refer to. I hope that the Minister will take these points away and ask the draftsmen to look more carefully at how the Bill is drafted, particularly when using that style of drafting.

--- Later in debate ---

Moved by

[Lord Lansley]

27: Clause 5, page 3, line 37, at end insert—
“( ) A statutory instrument containing regulations made under section 1 which are not made in respect of continuity healthcare agreements may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, both Houses of Parliament.”

[Lord Lansley]

I am grateful for the opportunity to move Amendment 27, which is linked with Amendment 41. Noble Lords will recall that at Second Reading and again on Tuesday there was considerable debate about the distinction between agreements which are effectively rolled over—existing agreements the purpose of which is to replicate the EU reciprocal healthcare agreement presently in place—and other agreements made under this legislation. In the previous group of amendments, we discussed the Henry VIII power and in what circumstances it should be applied. This is different. From my point of view, this group is about which agreements should be subject to what procedure by way of parliamentary scrutiny where implementing legislation is required in relation to them.

After our debate at Second Reading, it struck me that a clear distinction should be made with what I call “continuity healthcare agreements”, which, as one will see if one looks at Amendment 41, are defined as agreements the purpose of which is to replicate the terms of agreements made presently under the EU social security regulations as there specified. Those are continuity healthcare agreements; they are being rolled over. They are not novel and do not bring new issues to bear. I think that their purpose is entirely agreed: we want to make it swift and certain that existing rights under EU reciprocal healthcare are reproduced in future and implemented rapidly. So it seemed perfectly reasonable for those agreements to be subject to the negative procedure. Therefore, if we could define continuity healthcare agreements in Amendment 41, it would enable those that are not continuity healthcare agreements to be subject to the affirmative procedure. That is what Amendment 27 would do; it would require the additional time and scrutiny to be devoted to where there was a new healthcare agreement—or, as it happened, a substantial amendment to an existing healthcare agreement.

I am not sure that the drafting will necessarily meet with my noble friend’s approval, but my purpose at this stage is to establish the principle that there are two kinds of healthcare agreement. We spent a lot of time on Tuesday arguing whether any extension of the powers beyond existing agreements was desirable and I do not want to re-enter that debate today. However, if we proceed down this path with this Bill, substantially amending existing reciprocal healthcare agreements or adding new ones, we should make a distinction between rollover agreements—that is, continuity healthcare agreements—and those which have substantial changes in them. So I commend Amendment 27 to my noble friend and beg to move.

[Lord Foulkes of Cumnock]

My Lords, I will make a couple of apologies. The first is to my noble friend Lady Thornton. She is absolutely right about our colleagues in the House of Commons anticipating this problem and the wide powers in this Bill. I accept her correction. Indeed, it was my noble friend who alerted me to the powers in the Bill and got me involved—she may be regretting it now, but I am grateful to her. I apologise also to the Minister for not being able to get to the meeting that she arranged with the noble Earl, Lord Dundee, and the noble Lord, Lord Marks. I was invited, but we had a very long Labour group meeting yesterday. I will not go into any of it in any detail whatever, because I am bound to total secrecy—but you can imagine what fun it was.

I want to deal with the distinction between negative and affirmative instruments. In my previous speech I expressed concern that statutory instruments are being used more and more, and inappropriately. Here, at least affirmative resolutions are better than negative instruments. As things stand, the Secretary of State has very extensive powers through this Bill. As the Delegated Powers and Regulatory Reform Committee said, they are of “breath-taking scope”. If all future legislation relating to the Bill were to be laid through a negative procedure, parliamentary accountability and scrutiny would be further—and substantially—undermined. Introducing the made affirmative, as per the amendment, would be in line with the majority of other legislation. Crucially, the Government could not legislate in the knowledge that they would not face parliamentary scrutiny. The Government argue that the absence of scrutiny will relate mostly to administrative actions. However, given the breadth of the Secretary of State’s powers, the negative procedure could easily be misused.

In her concluding remarks at Second Reading, the Minister, the noble Baroness, Lady Blackwood, said that she had heard,

“noble Lords’ preference for wider use of the ‘made affirmative’ procedure, which I will reflect on more as we head towards Committee”.—[Official Report, 5/2/19; col. 1487.]

We are in Committee now, so will she tell us the result of that reflection—or will we have to wait further to find out about it? The BMA echoed this stance and insisted that,

“any new powers granted to the Secretary of State are proportionate, subject to thorough scrutiny, and that all regulations are subject to the affirmative procedure in Parliament”.

I hope that we will get that assurance.

I return finally to that wonderful speech by the noble and learned Lord, Lord Judge, on Tuesday— I have quoted from it twice or three times already. He said:

“I will try not to bang on any longer”.


I will try not to bang on too long as well.

“If we had time and exit day was further away, I should propose that this Bill should be sent packing back to the Government to redraft it and produce a Bill that is constitutionally acceptable”.


“Hear, hear”, I say to that.

“That option is not open. The healthcare of our citizens in Europe, and EU citizens here, must continue and survive”.—[Official Report, 19/2/19; col. 2172.]


That is what we face. It is a gun pointed at our head: “If you do not agree to this, we are going to go out of the European Union with a bang and our people will suffer”. That gun is being put to our head. It is a pity that it is, otherwise I would support the noble and learned Lord, Lord Judge, in getting rid of Clause 5 altogether. In the meantime, all we can do is try to improve it a bit, and I hope that the Minister will give us an assurance that the statutory instruments will be of the affirmative nature rather than the negative one.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

For the implementation of international healthcare arrangements, these powers exist within EU legislation. At the moment we do not have the powers to implement international healthcare arrangements within domestic legislation. That is why they are being introduced.

The department believes that the negative procedure is appropriate for the use of the delegated powers to arrange the specific implementation purposes which I have laid out. That balances the appropriate level of scrutiny with the use of parliamentary time. However, I have listened closely to the discussions in the debate and I take seriously the concerns which have been raised by noble Lords, by the DPRRC and by the Constitution Committee. However, I hope that noble Lords will understand that we need to ensure that the Government have the legislative tools needed to implement the agreements we reach, especially the ones with reciprocal healthcare at EU exit. I would like to work constructively with your Lordships to further consider these issues in detail as we progress the Bill to Report, and I will make myself and officials free to discuss the breadth of the regulation-making powers further at an open session next week. I hope that with this explanation and these reassurances, my noble friend will feel able to withdraw his amendment.

[Lord Lansley]

I am grateful to my noble friend and to all noble Lords who have taken part in this short debate. I thought it was very constructive and I am especially grateful to my noble friend Lord O’Shaughnessy for his support for my two amendments. I thank the Minister for her willingness to think about these issues positively and constructively. We will return to them on Report and I look forward to that. On the basis of her helpful assurance, I beg leave to withdraw the amendment.

Amendment 27 withdrawn.