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.

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

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…