Childhood Obesity Strategy: Chapter 2

Lisa Cameron Excerpts

Monday 25th June 2018 Commons Chamber

[Steve Brine]

As my hon. Friend will remember from my speaking to the Health Committee, I have also been to Amsterdam, but unfortunately not for as long as the Committee members were. The whole-systems approach taken by Mayor van der Burg and Amsterdam is very impressive and has resulted in a 13% reduction in child obesity. Local authorities can learn from their attempts to market their cities, areas and regions, and I would suggest that having a good, healthy community and a good, healthy look when people walk out of the airport and do not see massive adverts for unhealthy fast food is an important part of that.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I welcome the Minister’s statement. Will he encourage supermarkets to offer free fruit to kids coming into the store? Nothing has changed my supermarket shop more than my local store doing so; when kids go in, they now ask for their free clementine rather than their chocolate.

[Steve Brine]

That is an easy one to agree with. Tesco has been doing that for years, and my children regularly avail themselves of the opportunity.

Gosport Independent Panel: Publication of Report

Lisa Cameron Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

I think we have made progress when it comes to whistleblowing because every trust now has a “freedom to speak up” guardian—an independent person inside the trust whom clinicians can contact if they have patient safety concerns. That is a big step forward, which was recommended by Robert Francis. Where I am less clear that we have solved the problem is in relation to having someone for families to go to if they think that everyone is closing ranks, and we now need to reflect on that.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I refer the House to my entry in the Register of Members’ Financial Interests and my history of working in the NHS.

A brave nurse came forward all those many years ago to highlight a concern, but the concern was not taken forward adequately at that time. Often in these circumstances, the NHS closes ranks, management remove the individual who raises the concern—the clinician in this instance—and allows the system to continue. Is there some way of monitoring the types of concerns raised by clinicians, ensuring that the staff who raise these concerns are not themselves penalised and that the system then takes accountability forward?

[Mr Hunt]

The hon. Lady is absolutely right to raise that matter. The nurse concerned, Anita Tubbritt, talks in the report about her concerns and the pressure that she was put under, and it was a brave thing to do. When the hon. Lady reads the report, she will see that nurse auxiliaries and others who were not professionally trained clinicians also came forward with concerns and were also worried about the impact that doing so would have on their own career. That is what we have got to stop because, in whatever part of the UK, getting a culture in which people can speak openly about patient safety issues is absolutely essential.

NHS Long-Term Plan

Lisa Cameron Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

I totally take on board what my hon. Friend says. I am happy to engage with him and with NHS England. As he knows, we have taken the politics out of that particular process by giving it to NHS England, which I think is the right thing to do. I know NHS England would be happy to engage with him on that.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I welcome long-term planning in funding for the NHS, which is needed. However, as chair of the all-party group for disability, I know there are concerns that the learning disability workforce has fallen by a third, learning disability training is not yet compulsory and there are 1,200 avoidable deaths in the learning disability population annually. In Learning Disability Week, people are asking to be treated well. Will the Secretary of State prioritise this area and make sure our most vulnerable people with learning disabilities are no longer left behind?

[Mr Hunt]

I thank the hon. Lady for asking that important question. We have introduced a £10,000 golden hello for postgraduates who go into the learning disability field. She is right that we have had particular pressure on the learning disability workforce. In the aftermath of Mid Staffs, there has been a whole range of measures to improve hospital ward staffing ratios for nurses and that has had an impact on learning disability nurses. That is absolutely something we hope to address with this new funding.

Acquired Brain Injury

Lisa Cameron Excerpts

Monday 18th June 2018 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is an absolute pleasure to speak in this debate on behalf of the Scottish National party. I worked in the NHS as a psychologist for many years, and I was involved in carrying out assessments of people who had acquired brain injuries. This is often a hidden disability. I would describe it as invisible much of the time and that contributes to much of the discrimination. It can have a major impact on people’s cognition, their personality—particularly if it is a frontal lobe injury—and their planning ability. It can have an impact on individuals’ speech. Some have to relearn vocabulary and the names of people they once knew. In severe cases, it can have a significant impact on someone’s memory. Consequent to all that is the impact on people’s mental health and their confidence.

I pay tribute to the agencies that work so hard with those individuals and their families, because a systematic and systemic family approach is what is needed to support individuals. The hon. Member for Strangford (Jim Shannon) is absolutely right in that regard, as he is in so many others. It is important to provide support to all members of the family. I also pay tribute to the hon. Member for Rhondda (Chris Bryant), who has played a crucial role in bringing this debate to the House. He is vociferous on this important issue, and he has again made sure that we have time to debate it.

My own husband suffered a head injury when he was serving in the armed forces many years ago, when his tank was overturned. He was a member of the Royal Electrical and Mechanical Engineers and is now a local veterans’ spokesperson. He was fortunate to have fast, intense rehabilitation. It is important that that is provided not only to those in the armed forces, but to the general population. I am interested in what the Minister has to say about medical spending on our veterans and their access to rehabilitation services in this regard, alongside our NHS trauma units.

There are also difficulties in relation to welfare benefit assessments, particularly for employment and support allowance and for personal independence payments. Those with an acquired brain injury often feel that their difficulties are not understood and not well assessed under the current procedures, so we need not only further training for assessors, but possibly to review the assessment process itself. Assessment sometimes does not pick up the fine changes that can have such a crucial impact on the daily living skills of people with an acquired brain injury. Support will be necessary because it can be difficult for those with such injuries to complete forms, gather adequate evidence and so on. The Minister for Disabled People is in her place this evening, so I will be grateful if she will meet with me, as chair of the all-party parliamentary group for disability, to discuss that further.

[Jamie Stone]

Does the hon. Lady agree that there is some evidence that the mobility aspect of PIP is not being recognised in this regard?

[Dr Cameron]

Yes, that is a fair point. Mobility is about not just how far someone can walk, but being able to plan a journey and many other aspects of day-to-day living skills that people can find so difficult. People may require support for such things, but that may not currently be picked up properly by an assessment.

Psychology is important in the assessment of such cases, because access to neuropsychology means that individuals can have memory and cognitive assessments at the time of injury and six and 12 months later to examine which functions have been recovered. That is important because different parts of the brain can take on functions that have been lost and because the individual’s pattern of recovery can be mapped, meaning that a rehabilitation plan can be specifically adapted to their needs. Access to neuropsychology is a key part of rehabilitation, so I will be interested to hear the comments of the Under-Secretary of State for Health and Social Care on neuropsychology services, particularly for those with an acquired brain injury.

Prisoners have been mentioned. Yes, there is a high level of acquired brain injury within that population and that has an impact in three ways: acquired brain injuries can increase impulsivity, they can lead to people making the wrong decisions and not thinking through the consequences, and they can lead to difficulty in undertaking the normal treatments available in prisons, such as cognitive behavioural therapy, meaning that such treatments may have to be adapted for prisoners to benefit from them. I am unsure whether that is occurring in our prison system, but it should happen right across the United Kingdom if cognisance is taken of such difficulties.

[Mr John Hayes]

This will be my last contribution because I know that others want to get in. The change in a person’s cognitive function, which is often perceived as a change in their ability to do things, is often also about them knowing how to do things, what to do, when to do it and why. That is different from losing a skill. It is about losing the ability to order things and to prioritise them, and that has a dramatic effect both on education and on their subsequent ability to work.

[Dr Cameron]

Individuals with a frontal lobe injury find planning extremely difficult and, in fact, may never again be able to plan in the way they once could. These are some of the issues that treatment would have to take on board, and perhaps further support will be required. The types of cognitive behavioural treatment that rely on people thinking things through in a sequence, which is particularly difficult for those with a brain injury, will not always be appropriate and may need to be adapted.

So many Members want to speak on this important issue, so I will finish by mentioning the funding for a new Scottish trauma network. Since January 2017, four major trauma centres, in Glasgow, Edinburgh, Aberdeen and Dundee, have been working extremely hard to try to ensure a good care pathway for those in Scotland who suffer brain injury. It is incumbent on us all to communicate and to find evidence-based practice right across the United Kingdom.

Fortified Flour

Lisa Cameron Excerpts

Wednesday 16th May 2018 Westminster Hall

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Hanson, and to take part in this debate, which has been profound and poignant so far. I thank the hon. Member for Pontypridd (Owen Smith), who gave an extremely good, well-researched, evidence-based case for the fortification of flour with folic acid. There is scientific evidence, and when we know that we can do the right thing, there is no reason not to do so. His case was strong, clinically based and backed by the royal colleges and practitioners we should be listening to.

We heard that every week two children are born with spinal neural tube defects and that, as a result of potential defects, many terminations occur. As someone who has experienced a number of miscarriages in my life, there is nothing more horrendous than losing a baby: you question every single thing that you have done and everything that you could have done. If something like this could make a difference for those individuals who find themselves in that traumatic situation and do not seek terminations and for those who have unexplained miscarriages, we should be doing it.

There is absolutely no cost that can be put on losing a baby that you very much want to have. Often the tragedy of it is that it is unexplained. It is not until it has happened four times—another issue that we must address—that there is even any research into why it might have happened, or happened repeatedly. There are many individuals who may be or have been affected, who might not even know that a simple step such as this could have made the difference. That is certainly a step we must take.

As we have heard, the scientific basis is there. The countries that are leading now and protecting their populations by fortifying their flour with folic acid—I say again, such a simple step—have found no adverse consequences. Those countries have implemented the policy over a long period of time; they are looking at the health benefits and finding that any concerns about health costs were unfounded. The research is unequivocal in that regard and must be listened to.

As has been noted, the Scottish and Welsh Governments have both written to the UK Health Secretary, urging him to take action and introduce mandatory fortification of flour with folic acid on a UK-wide basis, because that is what is required. I am often in debates where there is little consensus across the four nations, but this seems to be one of those unique debates in which we are all saying, “This has to happen,” from across parties and across nations. There seems absolutely no logical reason for not taking this matter forward timeously, to protect families from the trauma of that unexplained miscarriage or of finding out that they have a baby who is very sick, and perhaps having to have a termination that they never wanted, or a difficult discussion regarding how to care for a young child who they want to see reach their full potential and want to give all the love in the world to, but who will have medical complications throughout their life.

I thank the right hon. Member for Belfast North (Nigel Dodds) for an extremely profound and personal account in memory of Andrew. We must pay heed to people’s personal accounts. That is what must guide policy. They are real people who are being affected; we are talking about families, and we must do the right thing. I also thank my hon. Friend the Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), who has done a lot of fundraising in this regard—even running a marathon, which is something I commend him for doing, and unfortunately not something I will ever be able to do myself. The hon. Member for Strangford (Jim Shannon), who is a health spokesperson for his party, made a good speech and asked important questions of the Minister, and the hon. Member for Newport East (Jessica Morden) advocated excellently for her constituents. For once, we are singing from the same hymn sheet. These are small nudges that we can make—small changes that make such a great difference. I urge the Minister to act.

Oral Answers to Questions

Lisa Cameron Excerpts

Tuesday 8th May 2018 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

2. What role his Department has in supporting people with mental health problems to access help in relation to housing, debt and employment. [R]

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

The Department is working with the NHS and across the Government to increase the support available for people with mental illness and on related issues. This includes investing £39 million to double the number of employment advisers in IAPT—increasing access to psychological therapy—as well as reviewing the practice of GPs charging for evidence of patients in debt crisis and the introduction of a duty under the Homelessness Reduction Act 2017 for the NHS to refer people at risk of homelessness to the local authority.

[Dr Cameron]

A quarter of people experiencing mental health problems are also in problem debt, and eight out of 10 mental health practitioners surveyed have said that they have less time to deliver clinical care because they are being asked to assist with the task of writing up debt management plans. Does the Minister agree that to ensure the best chance of recovery, commissioning groups require to integrate advice alongside mental health care, particularly for those in problem debt?

[Jackie Doyle-Price]

The hon. Lady makes a sensible point. Of course it is true that people’s personal circumstances are a symptom and a cause of mental ill health. We are doing more to enable those delivering mental health services to signpost people with problem debt to appropriate services. Clearly, that becomes easier where those services are co-located with citizens advice bureaux. In addition, the Breathing Space programme aims to provide a break for people with debt. I recognise, however, that this is a serious problem and that debt problems will cause mental illness.

Learning Disabilities Mortality Review

Lisa Cameron Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

I pay tribute to my right hon. Friend, whose incredible work over many years campaigning on behalf of autistic people up and down the country has made a magnificent difference. She is right to raise this issue. It is of course unacceptable that people with autism have poorer health outcomes, and we are determined to address this. I meet regularly with representative groups and we take on board all their comments about how they would like to see the situation improved.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

The report makes tragic reading. Some of our most vulnerable citizens are four times more likely to die prematurely than the general population, and there have been many avoidable deaths because of systemic failures. The situation cannot continue.

Let me ask the Minister three questions. First, will she look at the Scottish patient safety programme, a national programme that has been running since 2008 and is achieving good outcomes? Secondly, given that the Health and Social Care Committee has heard that learning disability nurses are very scarce, will she redouble the efforts to ensure that training for and recruitment to those roles are prioritised? Picking up symptoms early may be crucial to the prevention of morbidity. Thirdly, staff turnaround in social care is a real issue. Social care staff who know a client well, and can notice early changes such as signs of illness and report them timeously to ensure prevention, are crucial, and consistency in care is therefore critical. How will that be addressed?

[Caroline Dinenage]

The hon. Lady is right to raise those points. The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths might have been preventable had there been different health and care interventions. That is why we set up the learning from deaths programme, and have commissioned an investigation of the issue. We are determined not only to learn from every single one of these tragic and avoidable deaths, but to share that learning with those in trusts up and down the country so that they can take a clear look at what is going on under their noses, and ensure that the terrible incidents that we have seen in the past do not happen again.

The hon. Lady was wise to raise the issue of training. It is important to have specialist practitioners, but it is also important to ensure that all healthcare staff, throughout the country, have the training that they need in order to recognise and support the needs of people with learning disabilities. That is something that we have done very successfully with dementia: we record the number of staff in the country who have received tier 1 and tier 2 training, and we are looking into how we can extend that to address the issues of people with learning disabilities.

Breast Cancer Screening

Lisa Cameron Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

We are absolutely guaranteeing that all women affected who are still alive will be invited to have a screening if they want it. Only those under 72 will automatically be sent a date and time for their screening. Those over 72 will be invited to talk to the helpline so that they can form a judgment as to whether a screening is appropriate, but anyone who wants one will get one.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I should like to thank the Secretary of State for his comprehensive response. Can he advise me how many women who have moved to Scotland might be affected? If not, will he work double time to ensure that those who have been affected and who have moved to Scotland will get their letters timeously within the correct period?

[Mr Hunt]

I believe that the IT work, which is a collaboration between the Scottish NHS and the English NHS, will be completed in the week of 15 May. That is why we are confident that we will be able to get the letters out to people registered with Scottish GPs who have moved from England by the end of May, which is the same timescale as for getting the letters out to people living in England. We will then know that number, and I will of course let the hon. Lady know.

Autism

Lisa Cameron Excerpts

Thursday 29th March 2018 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure to follow the hon. Member for Henley (John Howell), who made excellent points in his very detailed speech. I thank the Backbench Business Committee for once again prioritising autism in this Chamber. It is extremely important for autism to be raised, not just this week but throughout the year.

There are many faces here that I recognise from previous debates on this subject. There are champions across the House and across parties for autism and autism awareness. I thank hon. Members for their contributions and I look forward to hearing some more. In particular, I thank the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan). She is an excellent chair of the all-party group on autism. She has led the way on this issue for many years, from the Autism Act 2009 to the present day. I enjoy working with her very much and hope to continue to do so. Research indicates that there are approximately 100,000 children with autism and 700,000 on the autistic spectrum, including children and adults. That is a large part of our population and it is apt that we discuss their needs and issues, and how to ensure that they achieve their full potential.

I want to touch on access to diagnosis, which other hon. Members have raised, for both adults and children. Unfortunately, this continues to be a postcode lottery across the United Kingdom. It has been raised repeatedly in evidence to the Health Committee and I am aware from my own constituency surgeries that there are still barriers to families, children and adults attaining a diagnosis within an appropriate time span. It has been mentioned that as MPs we are leaders. It is therefore important that, locally, we seek to help constituents to overcome those challenges. I recently wrote to the chief executive of our local NHS trust to find out about waiting times for adults and children. I was pleased with the response, which presented quite an optimistic picture. However, that is not commensurate with people’s experience on the frontline so we then have to go back and look at the difference between what services should deliver and are expected to deliver, and what they say they are delivering and can deliver. What additional support can we give to the services? What are the challenges preventing children and families on the frontline from accessing the services in the way that they should and as we expect? Those challenges are still in the system and it is important to overcome them.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the hon. Lady and my colleague on the Health and Social Care Committee, who always brings such expertise and experience to these debates and to the Committee. Does she agree that it is not just the variation around autism, but the scale of that variation that is so striking? Children cannot access any of the other services that might be available without the initial diagnosis.

--- Later in debate ---

[Dr Cameron]

That is an apt intervention, and I agree entirely. It is not just the postcode lottery, but the widespread variation right across the United Kingdom. Through the all-party group, we hear that people from different parts of the UK feel that they have to battle the system repeatedly at every stage. This is very important. In Health questions, I have asked the Secretary of State whether the Department might consider putting individuals who can diagnose autism into every child and adolescent mental health services team. I know that the Department is looking at data and waiting times. That is so important to getting some degree of stability in the services provided and to ensure that everyone has adequate access moving forward. Knowing where we are to start with can only be a good thing when we look at the progress being made.

As has been mentioned, autism spectrum disorder affects people across their lifespan, so it has to be at the core of policy across many Departments, including those responsible for education and community. This is also about our surgeries. I have taken on the excellent points made by the hon. Member for Bristol West (Thangam Debbonaire) and I will start my own such surgery in the near future. We have discussed it since our last debate on this subject and it is an excellent idea. I recommend that, as MPs, we all move forward in the same manner, walking the walk, not just talking the talk.

The management of our local shopping centres have been positive about having autism-friendly opening hours so that families can come at particular times. The setting will be made appropriate and people will feel included and relaxed when they go about their daily life. There is so much more to be done. On employment, the autism employment gap is so much higher than the disability employment gap. We must take that forward.

[Dame Cheryl Gillan]

Has the hon. Lady heard about the autism exchange programme, which Ambitious about Autism developed in partnership with the civil service? It has found that employers are pleasantly surprised at the benefits they get from employing people with autism.

[Dr Cameron]

That sounds like an absolutely wonderful initiative, and I hope that it is rolled out to many more organisations. We should all be working with local business communities to champion the potential of people with autism in the workplace. They have great skills to offer and should certainly be given the opportunity to be part of our workforce.

Before I finish, I want to touch on mental health and criminal justice. The last such debate that I took part in in the Chamber was about people who have not only autism, but mental health issues. That is extremely important; it is another reason why they should not be excluded from services—they need quick access as a priority. The Royal College of Psychiatrists estimates that those on the autistic spectrum are seven and a half times more likely to commit suicide. That is an absolutely startling statistic. If we put up barriers before people get to services and support, that figure can only rise. I ask the Minister to address access to services and the understanding of comorbidity within primary care.

On criminal justice, I recently met the Minister of State, Ministry of Justice, to discuss this issue, because I feel that those on the autistic spectrum are often lost in the criminal justice system and are very vulnerable within it. They are subject to bullying and have difficulty adapting and coping in that situation. We must do all that we can, so I was pleased to meet him and discuss some issues and practices from Scotland, and to share best practice right across the United Kingdom on special witness measures, support for those going through a court process and pre-arrest. In my constituency, we have a wonderful police training college at Jackton. I spoke to Police Scotland, which assures me that all its officers have undertaken mental health training and autism awareness training. That is excellent and just what is needed. We must continue to build on that.

I am pleased to speak in this debate, but the more I speak about autism, the more I realise how much more work we have to do. I am pleased to be moving forward on a cross-party basis. I will always be a champion for autism in my constituency and I like to work with like-minded Members across the House, of whom there are many and of whom I am very proud.

Leaving the EU: NHS

Lisa Cameron Excerpts

Thursday 22nd March 2018 Westminster Hall

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure and privilege to serve under your chairmanship, Mr Stringer. I thank the Backbench Business Committee for enabling this important debate, and the right hon. Member for Exeter (Mr Bradshaw), my friend and colleague from the Health and Social Care Committee, for his detailed and valuable contribution. He outlined the grave concerns that most of the Committee have heard and feel themselves on some of the issues relating to Brexit and the NHS. It is important to our Committee that the Minister is listening, that the report is taken seriously and that our recommendations are taken forward.

This is a solemn day. I echo the sentiments of other Members who have spoken. It is a year since we lost PC Keith Palmer, who sacrificed his life in preserving our democracy here at Westminster. My thoughts are very much with his family and with everyone who has been affected by that horrific attack on Westminster and our democracy. It is important that we also remember Jo Cox and her extremely poignant words: we do have much more in common than sets us apart. I wish to take those sentiments forward. No matter what happens, if we work together and take things forward constructively, there is always a positive way ahead to defeat extremism and terrorism.

I come to the topic of the debate. My constituents are finding it difficult to have continued interest in the Brexit debate, given how lengthy it has already been, but when it comes to the NHS that is entirely different. The NHS is fundamental to our values. I have never met anyone who has tried to say that it is not such a valuable institution or the bedrock of our society, or who does not greatly admire and understand the dedication of the NHS staff who serve us all so well. We all—our friends, family and ourselves—rely on the NHS at the most vulnerable points in our lives. The NHS is therefore different for most of our constituents across the United Kingdom. It must be treated with priority and preserved, and all steps must be taken to ensure that any impact of Brexit on our NHS is fully mitigated. We rely on the NHS, and we will continue to do so. The first point I make to the Minister is to emphasise the importance of our NHS.

My second point is on the workforce, which has already been touched on by many Members. I have been sent a report by the British Medical Association. I refer the House to my background as a psychologist, having previously worked in the NHS. There are real concerns about the workforce and Brexit. The BMA highlights in its report its concerns that highly skilled doctors and professionals will choose to leave the UK because of the ongoing uncertainty in the negotiations. Like other hon. Members, I think it is important that the Department reassure those staff about how valuable they are and about how much their contribution is wanted and needed moving forward. It is imperative that we continue to retain their services for our populations.

Quite astoundingly, nearly half of EEA doctors—45% of them—surveyed by the BMA in November 2017 said that they were considering leaving the UK following the referendum vote. Those are critical numbers. I believe that in England 7.7% of the workforce, or 12,029, are EEA graduates. The figure I have been given in Scotland is 5.7%, or 1,339—it is 8.8%, or 550, in Northern Ireland, and 6.4%, or 624, in Wales. These are high numbers of people working right on the frontline to preserve our healthcare and we need to make sure that they can continue to do that.

Some might say that there has been a shortage or a short-termism in our own training of medical staff, and that issue also has to be addressed in the future. However, it takes a very long time to train doctors and nurses. We must therefore consider the much-needed and valued services that we have at this time and at least for the next decade in relation to our staffing model.

The next issue I will talk about is mutual recognition of professional qualifications. The BMA is calling for the maintenance of reciprocal arrangements, such as mutual recognition of professional qualifications, after Brexit, which would enable professionals who qualified in one member state to practise their profession in another. So what are the Minister and his Department doing in relation to that issue? It seems crucial for the next decade or so that we maintain the workforce that we have and that we ensure we can continue to attract highly skilled professionals to come to the UK to work.

Reciprocal healthcare and the European health insurance card, or EHIC, have already been mentioned. It seems very important, particularly for people who have the most chronic illnesses and who are moving from the UK to the EU, or who are on holiday, and for those coming here from the EU, that we have some form of arrangement in that regard for the future. I must say that I have had some difficulties with the EHIC in the past, with my own family, in being able to utilise it appropriately in some countries. However, it is not until something is lost entirely that its merit and value are realised. I do not think that it has been a perfect system by any means. However, it is certainly something that we want to retain and ensure is still available to us in future, particularly for some of the most vulnerable people, who still wish to be independent and to travel but who may find it extremely difficult to afford insurance, and therefore might otherwise put themselves at risk.

The Committee heard a lot of evidence about life sciences when producing this report. I have been astounded by the evidence we have been given about just how world-leading our life sciences are. I have to say that that is not something I was acutely aware of, even given all my years in the NHS, but we have world-leading life sciences. We have some of the top researchers and we have been involved in, and leading, some of the most crucial clinical trials. We must ensure that we hold that position in future. That is a real issue, because there is a concern that if those who are very much at the top of their game in research are unable to continue to lead on clinical trials from the UK, they might seek to leave. We cannot allow that to happen, because it would plunge our world-leading life sciences sector into the depths.

I would really appreciate it if the Minister spoke about how we will maintain our life sciences at their current level and how we will ensure that our fantastic university hospitals—I have one in my constituency: Hairmyres hospital—continue to support the great research work they do alongside their clinical work, and that they have all the amenities and the top professionals they need in the future.

It was Rare Disease Day just a few weeks ago, and I took part in it. We sang outside Westminster tube station to raise awareness of rare diseases. Rare diseases are of course rare, so many people do not experience them. However, there are many types of rare disease, so it is quite usual that some of us will know at least someone who has experienced or is living with a rare disease. It is crucial that people with rare diseases participate in clinical trials, because we need them in order to make progress on prognosis and find the best treatments. We need to ensure that we maintain that collaboration with the EU, because otherwise patients on the ground will suffer.

Patients with rare diseases might already feel quite isolated; they will have few other people they can speak to who are experiencing the same difficulties or have the same diagnosis. However, they need to be included in clinical trials, which cannot be conducted in the UK alone. Will the Minister comment on how we will ensure that that collaboration continues, particularly on rare diseases?

On medications, the Committee heard evidence about time-sensitive supply chains and the potential risks to them. The need to ensure that sufficient stock is on the UK market could mean the stockpiling of those products, and manufacturers might not supply certain products to the UK until only a few weeks before they are needed, so the supply chain is crucial. This work is time limited. Distributors of medicines in the UK usually keep about 10 days’ worth of stock, but many manufacturers can stock medicines for up to four months in wholesale warehouses. How will that work, depending on the negotiated arrangement? We need to get medicines timeously to patients who need them—particularly, as has been mentioned, radioisotopes for those who suffer from cancer and other illnesses.

These issues are crucial. When I speak to constituents, Brexit seems like a hypothetical thing, way in the distance. However, as soon as we start to home in on what it will mean in their day-to-day lives for their health and wellbeing and that of their families, and for our NHS, Brexit comes to the front of their minds. That is why the Minister has the weight of the world on his shoulders, because he is required to take forward these vital issues for everybody who depends on the NHS and our services. I look forward to his reply. On medical radioisotopes, I led on the cancer strategy in the main Chamber just a month or so ago. It is vital that we get this right for our cancer strategy, to ensure that all the other work that it underpins can move forward in the way it is supposed to.

I will finish by briefly speaking about qualified persons, which is something I did not know much about before the inquiry. I am led to believe, from the evidence that we heard, that they are already a scarce resource. There has to be mutual recognition of the training of qualified persons between the EU and the UK, so that these qualified persons, who we need to ensure the safety of medications, remain in the country and can do that vital work. What progress has the Minister made on work relating to qualified persons?

I do not want to take up any more time, because other Members wish to speak, so I will end where I started. Brexit can seem like a concept that is not linked to our everyday lives. When it comes to the NHS, however, that is entirely different. It is crucial to all patients—it is crucial to all constituents, actually. It therefore falls to the UK Government to ensure that the very best outcome for clinical care is negotiated and achieved.

--- Later in debate ---

[Stephen Barclay]

We can see the variability of forecasts, but the OBR’s forecast, which is the one that really matters—there is consensus that the Government rely on it and that Government planning is undertaken on the basis of it—shows a clear trajectory of improvement that is not reflected in much of the doom and gloom that we have heard in recent weeks. The debate is better informed if we tie it into the benchmarking that the Government use when setting fiscal policy.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) commented on the fact that her constituents are bored by the length of the Brexit debate. I am sure that if anyone is watching the debate, that will resonate with them. That is why it is so important for us to look forward. We should look at the areas of real concern where the Department needs to focus, such as maintaining the regulation and considering the mutual recognition of qualifications, which is a real issue that we want to make progress on with the European Union, because it is of concern to people. To look constructively at how we address some of those issues is far better than having groundhog day on the same areas.

[Dr Cameron]

Given the evidence we heard, and given that I have emphasised how critical the NHS is to the public and that it is a key priority for Brexit, I am perplexed that the Secretary of State for Health and Social Care does not have a place at the Brexit table in Cabinet. Far be it for me to try to elevate him even further, but the NHS is crucial and pivotal and deserves to be at the core of Brexit.

[Stephen Barclay]

The hon. Lady is right to recognise the skills and talent that the Secretary of State brings to this debate as to many others. It is no coincidence that he is the second-longest serving Secretary of State for Health. It would be recognised across the House that it is a demanding job. It is to his great credit that he has been in post for such a period and that he has championed patient safety in the way that he has, which the shadow Minister has generously recognised on occasion.

The Secretary of State’s role in Government was further signalled and underscored by the Prime Minister in the recent reshuffle, when the responsibility for social care was added to the Department. As the debate has reflected, social care, and how we address it from an immigration perspective, and from a training and upskilling perspective, is one of the key legitimate areas of the Brexit debate. We are focused on that in our discussions with the Home Office and others.

The hon. Member for Motherwell and Wishaw (Marion Fellows) picked up on the need for a transition period. That point reflects the fact that the Government are listening and have responded constructively. I know from my previous role in the financial services sector in the City that there is a strong desire for a transitional period. That point was also raised by many in the healthcare sector. It is to the great credit of the Secretary of State for Exiting the European Union that those discussions have been conducted in such a constructive way. There has been a lot of doom-saying and negative commentary—“Nothing will be agreed; it won’t work.”—but he has assiduously stuck to his task. While there are some formal processes still to be completed, significant progress has been made on a transition deal, and there is reasonable consensus that it is constructive.

Several colleagues mentioned the impact of leaving Euratom. I simply remind the House that there is nothing in the Euratom treaty that prevents materials from being exported from an EU member state to countries outside the EU, nor do those materials fall into the category of so-called special fissile material, which is subject to nuclear safeguards. We very much recognise the short half-life of medical radioisotopes and the need for rapid delivery, but again there is much that can be constructively done.

The shadow Minister mentioned subsidiary companies. I do not want to incur your displeasure by straying too far from the subject of Brexit and into subsidiary companies, Mr Davies, but as the shadow Minister raised that point, I feel it is appropriate to address it. He asked what TUPE protections there will be. There are TUPE protections now and the Government have absolutely no intention to change that.

For those who sometimes suggest, as Opposition Members occasionally do, that subsidiary companies within the NHS is a form of privatisation, I merely remind the House that this legislation was passed in 2006 under a Labour Government. I was not in the House at the time, but I do not recall—this may be one for those connoisseurs of Hansard—that it was presented by Labour Ministers as a way of achieving privatisation in the NHS. Subsidiary companies are 100% owned by their parent company, which is the NHS family, so they stay very much within that.