Trade Bill

Lord Patel Excerpts

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Thursday 1st October 2020 Grand Committee

[Lord Patel (CB) [V]]

My Lords, I am pleased to support Amendment 51, in the name of the noble Baroness, Lady Thornton, to which I have added my name. I also look forward to the comments of my friends, the noble Baroness, Lady Noakes, and the noble Lord, Lord Lansley. Under normal Committee circumstances, we would have enjoyed debating some of these amendments.

In my view, this is the most important amendment for our highly valued NHS. Any trade deal that allows someone to own and manage or have access to any patient data, in no matter how small a way, is a threat to our NHS. The greatest perceived or real threat is from a trade deal with the USA that includes any part of the NHS. Our health service is free at the point of need; the USA healthcare system, on the other hand, is based on ability to pay. That in itself defines what the motives will be for any USA organisation wanting to get involved in any aspects of our NHS.

The Government repeatedly say that our NHS will not be on the table and that it is not for sale. What does that mean? The Government and NHS England already allow private contractors to bid for health services. Recent examples are Deloitte and Serco, for Covid-19-related services. Tennessee-based Acadia runs nearly a third of mental health beds, and the Priory Group has won many NHS contracts. Centene, a subsidiary of Centene Corporation, a tech and logistic provider, works with many GP practices. Palantir, an American data-mining company, is contracted to track, model, and analyse data from Covid-19. Optum, a subsidiary of the giant US health provider UnitedHealth, has contracts with many CCGs.

It is said that the citizens of the UK are not bothered who provides the service, as long as it is free when they need it, but they will if the taxes have to go up, services become poor and they have to pay for extras. While our health service is not perfect in every way, we get a bigger bang for our buck, despite being one of the least funded of OECD countries. Commercial companies may not wish or be allowed directly to run clinical services, but may be interested in managing the services. NHS England is moving to integrated care services, devising systems to be able to run such services. American companies such as UnitedHealth and other IPOs may well be interested in running regional services, with a contract that allows them to keep any surplus as profits. They could do that only by cutting services, particularly in secondary care.

The jewels in the crown of our NHS are information and data. A national health service that in the near future will be completely digitised is a goldmine of data, estimated to be worth well over £10 billion a year —data that is a goldmine for developing artificial intelligence, robotics and so on. No one in the world has such a database. Add to this the genomics data that UK has for both patients and population that is unique in the world makes the NHS highly attractive for developing and testing of personalised medicines. Digitised patient information is of immense value for doing clinical trials with stratified patients. There is no other country in the world that can so quickly identify patient groups required for such trials, as demonstrated recently in a clinical trial of a US-manufactured drug, conducted with speed and lower cost, mostly in the United Kingdom. It is this kind of information that makes our NHS is so valuable; any pharma, biotech, medical devices or diagnostic company would be mad not to want to get its hands on it.

The Government have said that they would welcome companies to come and help innovate. That is an invitation. The unicorn companies we wish the UK to develop will become a reality, but the UK will not be the owners. Of course, it could all be for good, except that it will be profit driven. Why is it that USA has the most expensive healthcare system in the world and delivers one of the worst outcomes in health? The big pharma companies say that we pay too little for our medicines, as already mentioned, through our regulatory system and medicines reimbursement regime. While I accept that NICE methodologies need a review, pharma would want much more than that in any UK-USA trade deal. I declare an interest here: in October 1997, I submitted a paper developed by the Academy of Medical Royal Colleges to establish a national institute of clinical effectiveness, which became the NICE of today, to the then Minister of Health in the Lords, the noble Baroness, Lady Jay of Paddington. So I may have some right to comment on the methodologies of NICE.

As the noble Baroness, Lady Sheehan, said, even when medicines patents run out, US pharma would seek data exclusivity to prevent cheaper drugs being produced. For all those reasons, why would any country negotiating a trade deal not wish to have any aspects of our NHS to be part of it, particularly the USA? To be able to get a share of delivery of service, manage or procure for any part of NHS is a profitable prize in itself; to be able to get hold of even a part of the health and patient data, with the possibility of owning it, is a prize measured in billions of dollars.

The only way to keep our NHS in our hands is to rule out any possibility of it being included in any trade documents maybe through mechanisms of positive listing or legislation in the Bill. I hope that the noble Baroness, Lady Thornton, will be committed to do this at Report. I look forward to the Minister’s comments.

[Lord Fox (LD)]

It is a great pleasure to follow the noble Lord, Lord Patel. I shall speak to Amendment 51, to which I am a signatory. Before I do that, I commend my noble friend Lady Sheehan, who spoke eloquently on her Amendment 75, one part of which was about the dangers of price gouging. She mentioned a number of different ploys, as did the noble Lord, Lord Patel. But there is another one, whereby companies gain control of the generic and the replacement for the generic, then seek to phase out the generic. That has been happening recently. Perhaps the Minister can explain how, in trading terms, we can combat that kind of behaviour.

The dangers of ISDS, which were set out by my noble friend Lady Sheehan and the noble Lord, Lord Bassam, are real and present. I look forward to the Minister’s response to their speeches on that issue.

Amendment 51 is designed to protect the NHS from potential dangers. If we are setting out on the great ship of global trade, it may be a lifebelt. The noble Baroness, Lady Thornton, is right that this Bill is the only game in town for Parliament to exert its views, and this issue is of real concern to many Members of both Houses. That is why we are right to be having this discussion today.

The noble Lord, Lord Patel, was brilliant and devastating as he described the threats to our health service—threats that it is already facing. He described how we are on the brink of serious dangers, which the amendment highlights and seeks to avoid. The stakes are high, as the noble Lord, Lord Purvis, set out when speaking to an earlier group of amendments. The NHS is a huge potential market for any national economy with which we might wish to conclude a trade deal, not least, of course, the United States of America. However, we should acknowledge that it is also clear that the UK is in a position to continue to benefit substantially from the right relationship with international medical service and pharmaceutical companies, and we have to get that balance right between closing and opening our borders.

Trade Bill

Lord Patel Excerpts

Report stage & Report stage (Hansard): House of Lords & Report: 1st sitting & Report: 1st sitting: House of Lords
Monday 7th December 2020 Lords Chamber

[Lord Patel (CB) [V]]

My Lords, I speak strongly in support of Amendment 11, in the name of the noble Baroness, Lady Thornton. The hour is late, and we spent a long time discussing the matter in Committee. The noble Baroness, Lady Thornton, and others have dealt with the subject in detail and eloquently. Hence, I will be brief, as the last speaker before the Front-Bench speakers.

No matter what the Government say about the NHS not being on the table for any trade negotiations with the USA, it is naive to think that that will be so. Members of the US Congress and big pharma have made it clear that they expect the NHS to be part of any negotiation of a United States trade deal. In fact, the chair of the Senate finance committee—a committee that will have a final say in any trade deal that will be made—said that it is clear that all goods and services are part of the negotiation and, furthermore, that the NHS would benefit from competition from US companies. US big pharma has always complained that the UK, with its regulatory and medicines pricing regime, does not pay full price for medicines. It has even suggested that, as a result, US patients end up paying a higher price.

The US data and tech firms see an opportunity in our NHS patients’ records to develop patient management platforms and an opportunity to conduct clinical trials on cohorts of stratified patient and much more. I can quote an example: the company Palantir that has been involved in data mining and in security and intelligence. It was given a contract for the price of £1, at the beginning of the pandemic in March, to develop a platform for Covid-19 data. The contract was to be re-examined three months later. It was extended briefly and now I gather that, without any public debate, it has been granted a contract for five more years. Why would a data mining company be interested in having data related to health and health management? The answer is quite obvious: data is gold. In the absence of any government policy in relation to security and governance of health and patient data, it is an open goal for tech companies.

As I mentioned in Committee, several US firms are already involved in managing services worth billions of pounds. The prize for running services and exploiting patient and service-based data will be worth tens of billions of pounds. In market-driven self-service, the losers will be the patients and taxpayers.

Recently, it was reported that there was a meeting, organised by the Office for Life Sciences, between NHS England and big pharma and big tech with the intention to digitise and use the data of tens of millions of patients. Such an exercise would cost billions of pounds, which might be funded by the tech firms, but there was discussion about who would hold the IP. The risk we run, not only concerning data but also about how the services are managed in the NHS, is that they will be given to overseas companies, particularly American companies, that will benefit and profit from it. The NHS will be the loser, and therefore I strongly support this amendment.

[Lord Fox (LD)]

My Lords, this has been necessarily a short debate, but it has been an incredibly high quality debate. We have heard, from all the speakers, a high level of understanding of the issue and the dangers that Amendment 11 is seeking to address. I speak as one of those who signed Amendment 11. I support Amendment 43 and congratulate my noble friend Lady Sheehan on her eloquent presentation, but I am going to focus on Amendment 11 because it is a really important issue. We heard a lot about data from people who know a lot about data.

Sitting above this is the fact that the Government have no published cross-border data transfer policy. Without that, it seems as though each trade deal will be a series of negotiations without a framework. The noble Lord, Lord Freyberg, and my noble friend Lord Clement-Jones set out the benefits of having constraints and frameworks for this. It is clear from the Japan trade deal that the Government have indicated a level of flexibility around data. Once that has been delivered for one trade deal, it becomes a necessity for the next—and a bit more and a bit more. Even if that is not what will happen, I am sure the Minister understands that this fuels the fires of people’s suspicion and concern about the way in which data is being treated in this country.

From his position of great knowledge, the noble Lord, Lord Patel, set out some specific examples—not of a trade deal but of trade in this country—where data is already being parlayed. One things that has not been said is that, for patients to consent to their data being used, they have to believe that there will be a benefit. They do not want that benefit to flow across these borders through trade; they want it to accrue to the NHS. That is why Amendment 11 is important, and why I hope that it goes to a vote shortly and gets the support of Members from these Benches and beyond.

The noble Baroness, Lady Thornton, spoke very clearly in moving this amendment. Like me, she recognises the benefits of trade, but only when health takes the central place in our trade policy. That is what Amendment 11 seeks to achieve.