Sunbed Use: Health Implications

Martyn Day Excerpts

Wednesday 13th February 2019 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is always a pleasure to serve under your chairmanship, Mr Hosie.

One of the great pleasures of being in Parliament is that I learn new things on a regular basis. I must confess that, prior to coming to this debate, I had, as a peely-wally, fair-skinned, red-headed Scotsman, always avoided the sun and had no experience of sunlamps. It was fascinating to learn about them, and I am grateful to the hon. Member for Mid Derbyshire (Mrs Latham) for securing this debate and for her informative presentation, taking us through the history and many of the health problems. She presented some fantastic statistics, including the fact that sunbeds are used by 3 million people and that they cause three times the DNA damage of sunlight. Her case studies brought home the very human nature of this problem.

There is no doubt that UV rays from sunbeds can damage DNA in skin cells, which, building up over time, can cause skin cancer. The International Agency for Research on Cancer—IARC—accepts that there is enough evidence to show that sunbeds cause melanoma skin cancer, and further states that sunbeds provide no health benefits. That is a fundamental point. It also highlights that sunbed use before the age of 35 significantly increases the risk of melanoma; both earlier speakers used statistics, and the statistics I found last night put the range at 59% to 79% more likely. I do not know the actual figure, and I am interested to hear whether the other Front Benchers have a firmer handle on it. Either way, those figures are frightening.

Those figures are, however, hotly contested by the sunbed industry, which points out that, when professional sunbed use is separated from home use, it has no increased melanoma risk. The industry also highlights the benefits of UVB radiation in treating vitamin D deficiency. While I have no doubt that professional sunbed use will be safer than home use, it is no safer than exposure to the sun. The World Health Organisation classifies sunbeds as a group 1 carcinogen. A WHO director, Dr Maria Neira, says:

“There’s no doubt about it: sunbeds are dangerous to our health”.

I certainly take that warning very seriously.

The Scottish National party recognises the potential harmful effects of sunbed use—or misuse—and has taken action. The Public Health etc. (Scotland) Act 2008, implemented under an SNP-led Government, contains provisions to regulate sunbed use, as well as measures that include prohibiting unsupervised use, banning the use of sunbeds by under-18s and banning the sale and hire of sunbeds to under-18s.

It is imperative that people using sunbeds realise the health implications and risks of doing so, so that they can make an informed decision about their use. The 2008 Act has provisions requiring all sunbed premises to display a health notice visible to anybody entering them and to provide information to customers on the risks, allowing them to make an informed choice.

A Scottish Government leaflet highlights those risks, and reading it earlier in the week gave me my first pieces of information about sunbed use—I have to say that it ticks quite a few of the boxes that would frighten me off ever going on a sunbed, and I encourage the public to have a serious look at it. In addition to the higher risk of skin cancer, it highlights the risk of eye damage—including the higher risk of cataracts if appropriate eye protection is not worn—and of accelerated skin damage, including premature ageing of the skin, which was well covered by the earlier speakers. The leaflet concludes:

“These health risks outweigh any potential benefits in using sunbeds to supplement vitamin D.”

There we have it. There are plenty of warnings about sunbeds, and I will certainly avoid using them. Indeed, I slap factor 50 sun cream on if I walk along Princes Street on a slightly cloudy day. I will leave my remarks at that. I thank hon. Members for an informative debate. I have learned a considerable amount about this issue.

Draft European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018 Draft European Qualifications (Pharmacists) (Amendment etc.) (EU Exit) Regulations (Northern Ireland) 2018

Martyn Day Excerpts

Tuesday 29th January 2019 General Committees

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful to the Minister and the shadow spokesperson for their comments today. I will confine my comments to the lead statutory instrument and will not discuss the Northern Ireland instrument.

This SI is about repealing the EU system of qualification assessments and replacing it with something that in my opinion is nowhere near as robust, but instead worryingly ad hoc. Having read the legislation, I believe the new automatic system sounds like anything but automatic. A lot of this seems to be about offloading the risk of assessing the ongoing relevance of applicants’ qualifications for healthcare positions in the UK away from Government. The regulations put enormous amounts of responsibility on the designated UK health regulators to decide which EEA and Swiss qualifications are no longer comparable, with no apparent framework other than that they are allowed to designate non-comparability based on the course, the institution or even just the country itself.

Those regulators have also been given the discretion to decide how to treat the EEA and Swiss qualifications that they assess to be non-comparable. I therefore have some questions. Are the regulators happy with that? Have the Government checked that the regulators are happy to take on that burden of responsibility, and what preparations are taking place? Will new guidance need to be put into place to support that? As this will amount to regulators taking on the burden of making decisions that they have never had to make before, will there be a detrimental impact on the UK health and social care services workforce?

The explanatory memorandum states:

“The amended legislation will no longer include obligations on regulators to abide by the Directive training standards when setting standards for UK qualifications, although regulators may use the Directive as a guide when setting standards in the UK.”

That sounds like the UK could be put at a competitive disadvantage to the EU, through the creation of different standards between the two, again potentially wreaking havoc with our workforce. The transition provision goes nowhere near far enough to protect those currently going through the process. Saying that the UK will

“allow applications which have been made before exit day to be concluded under current arrangements as far as possible”

is no comfort whatsoever.

The Scottish health sector relies heavily on the EU workforce. This legislation could have a disproportionate and potentially devastating impact on our health sector. I believe it is a terrible piece of legislation that fails to provide a robust framework for transition, any protection for those making applications to our health sector or any assurances that our workforce will not suffer considerably as a result. The fact that the explanatory memorandum says that there is

“no, or no significant, impact on the public sector”

is laughable, and also puzzling, considering that that is directly contradicted on the very next page, in paragraph 12.5, which states that there could be an

“impact on the availability of health and care professionals”.

I have normally taken a pragmatic approach to these Delegation Legislation Committees on emergency exit regulations, saying that we need regulations in place and that I am not opposed, but I find it hard to do that today. Unless I hear suitable reassurances from the Minister, I am minded to try to force a Division on this matter.

Healthcare (International Arrangements) Bill

Martyn Day Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Monday 21st January 2019 Commons Chamber

[Justin Madders]

It is true that there is some concern in the insurance industry about our potential failure to secure bilateral agreements. I think it inevitable that unless those agreements are secured, premiums will rise. That is why the Opposition support the thrust of the Bill.

It is impossible to provide reliable estimates of the costs of the new agreements in advance without knowing who they would be with or what they would cover. The British Medical Association has said that any prediction of costs is likely to be unreliable, and we cannot afford to give the Government carte blanche.

New clause 1 proposes a sensible and very reasonable requirement for the Government to report back to Parliament annually. It would require the Government to provide details of all payments made by the UK Government for all healthcare provided outside the UK to British citizens. It would also stipulate a requirement to provide details of all payments received by the UK Government as reimbursement for healthcare provided by the UK to all non-British citizens. It would also write into law a requirement for the Government to set out any outstanding payments owed to, or by, the UK Government. This would provide an important opportunity to monitor efficiency in this area and may provide an incentive to address some of the concerns raised by the Public Accounts Committee in its 2017 report, “NHS treatment for overseas patients”, which stated that

“the NHS has been recovering much less than it should”,

and

“The systems for cost recovery appear chaotic.”

Even with the Government’s recent funding announcements, the NHS continues to struggle. I am sure that the Minister would not want to see funds destined for patient care swallowed up by the additional administrative burden created by the introduction of a range of complex charging arrangements and a failure to recover the costs that have been incurred. It is imperative that hospital trusts are not required to shoulder additional financial burdens because of the costs of administering the collection of charges. That is why if the Government are, as the Minister said in Committee, committed to transparency and parliamentary scrutiny, new clause 1 should be supported.

Turning briefly to the amendment that I tabled, we have discussed previously widely held concerns about the scope of this Bill that are exacerbated by the fact that the powers contained within it to create regulations will, in many cases, be subject only to the negative procedure. The Delegated Powers and Regulatory Reform Committee in the other place set out very clearly the potential impact of this Bill should my amendment not be accepted today. It said:

“If…the Secretary of State wished to fund wholly or entirely the cost of all mental health provision in the state of Arizona, or the cost of all hip replacements in Australia, the regulations would only be subject to the negative procedure.”

It added:

“Of course, these examples will not be priorities for any Secretary of State in this country”.

I am sure that is the case, but we must consider how the powers could be used, not just how we would expect and hope them to be used.

There is always merit when examining legislation in considering all potential scenarios as well as the stated intentions of the Government at the time, and in such an unprecedented period of uncertainty it is prudent to consider all eventualities. As the Government have included these powers in the legislation we cannot simply consider the world as it is now, nor how it might be in a year or two—indeed, if anyone knows what the world will be like in two or three weeks’ time I will be very impressed. We need to look at what the world might be like in many years’ time and how the powers in the Bill can be used.

If we require further persuasion about the need for caution, the Committee set out in its report a devastating list of reasons why the negative procedure is inappropriate. It said:

“There is no limit to the amount of the payments. There is no limit to who can be funded world-wide. There is no limit to the types of healthcare being funded. The regulations can confer functions (that is, powers and duties, including discretions) on anyone anywhere. The regulations can delegate functions to anyone anywhere.”

The Committee concluded:

“In our view, the powers in clause 2(1) are inappropriately wide and have not been adequately justified by the Department. It is particularly unsatisfactory that exceedingly wide powers should be subject only to the negative procedure.”

Just for good measure, it went on to describe the powers sought in the Bill as “breath-taking”.

Parliament is not alone in having concerns about the scope of the clause and the lack of clarity about how the powers might be used. In the Committee evidence session, Raj Jethwa, director of policy at the British Medical Association said:

“We would like to see much more emphasis on scrutiny of all the discussions in the arrangements going forward.”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 6, Q14.]

Picking up on the Committee’s comments, despite the Government having ample opportunity both on Second Reading and in Committee to justify the need for these exceedingly wide powers, I believe that the arguments that they advanced during the passage of the Bill have not only failed to do so, but have strengthened the case for greater scrutiny. The Minister conceded in Committee:

“The Bill also provides flexibility to fund healthcare even where there is no bilateral agreement, which we might explore using in exceptional circumstances to secure healthcare for certain groups of people.”

That is the nub of it: we know the well-rehearsed and necessary reasons why the Bill is required to secure the continuation of arrangements as we leave the EU, but it is on the record that the Bill can potentially do far more than that. We do not know what those exceptional circumstances are, and we do not know who those groups of people might be, and even if the Minister were able to set out here and now what he was referring to in that statement, he cannot bind a successor to that. The Bill gives the Secretary of State what I might describe as Martini powers: any time, any place, anywhere. If he is to have such wide powers they must at the very least be subject to the affirmative procedure.

The Minister also said in Committee that not only would the Bill encapsulate existing healthcare agreements but that it

“will potentially add to their number as part of future health and trade policy.”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 29 November 2018; c. 23-24.]

That is also a concern. I do not know whether the Minister intended it to come across as it did, but it sounded very much to me as if the Government were intending to couple trade negotiations with access to healthcare. I hope that that is not the case.

Many people have expressed concern over a number of years that the Government appear willing to open up the NHS to American private healthcare companies as part of trade negotiations, but I am not sure that many people imagined that the Government also had designs on opening up the NHS to patients around the world as part of a strategy to secure trade deals with other nations. Perhaps I am wrong about that, but it is clear that the Bill can be used in that way, which is why any arrangements ratified under it need proper scrutiny.

We also to consider the impact of new arrangements on the NHS. Alastair Henderson, chief executive of the Academy of Medical Royal Colleges, said in the Committee evidence session:

“Both clinicians and health organisations are concerned that we could end up with a system that is both administration-intensive and time-intensive.”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 3, Q4.]

We went through some of the implications of that when discussing new clause 1.

Finally, there is a practical element to this. As we know, under the negative procedure, once an instrument is laid in draft it cannot be made law if the draft is disapproved within 40 days. This would be done via a prayer against, usually by way of an early-day motion. If that is not invoked then the legislation is passed. Under the negative procedure, that is still a 40-day process in the best-case scenario, and if we leave without a deal the Secretary of State in the next three weeks will have to reach agreement with each of the 30-plus other countries, sign those agreements, draft statutory instruments and lay them before Parliament so they are with us no later than Friday 15 February, the last date on which they could be laid in order for them to be passed by 29 March—and that is assuming they are not prayed against.

If we assume this Bill completes Third Reading today, that gives the Lords about three weeks to complete their consideration—and the Minister will no doubt be crossing his fingers that they do not table any amendments. That seems to be a tall order, and given the Committee’s comments on this amendment the Lords may well be minded to send the measure back to us, but in either case it all seems rather a tight, if not unrealistic, timetable. I therefore urge the Minister to think through the practicalities of this; the affirmative procedure could be significantly quicker than the negative one, and it has the advantage of being far more transparent.

The Minister tried to reassure me in Committee that there would be adequate scrutiny by virtue of the Constitutional Reform and Governance Act 2010, but I am afraid that that just does not cut the mustard. Under that Act, there is a specified process enabling Parliament to object to a treaty being ratified within 21 days, but that does not automatically lead to a debate and a thorough examination of the issues of concern. The Act simply says that in the event of an objection the Government must issue a statement setting out why they still want to ratify; this process could apparently be repeated ad infinitum, and crucially under the Act there is no requirement for a debate. It would be open to either Government or Opposition to set aside some of their allotted time to facilitate a debate, but there is no requirement to do so. In addition, there are exceptions that enable the Government to ratify treaties outside the Act—for example, if there are “exceptional circumstances”, which of course is a judgment that is within Government’s gift. The measure does not cover memorandums of understanding either, and some of the older reciprocal healthcare arrangements fall within that description.

Putting new agreements into force in these extraordinary circumstances is necessary, but we simply cannot accept the clause as it stands. No matter how well-intentioned everyone might be now, once that power has been given away it is not easily taken back. Do Members want us to fund hip replacements in Arizona? Are Members comfortable with access to the NHS being used as a bargaining chip in trade deals? Of course they are not, so why do they not vote for the amendment tonight?

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I suspect this debate will be slightly less contentious than the earlier statements, and probably a lot quicker.

The Bill basically gives powers to the Secretary of State to agree reciprocal deals. However, I believe that we will not get a better reciprocal arrangements than those we currently have. We recognise the need for all these arrangements to continue, and the Scottish Government will do all they can to work with the UK Government to ensure that they do, and of course we note the legislative consent motion that has been granted. Through the Joint Ministerial Committee we believe a common framework system can be achieved that ensures these specific health arrangements can be administered through common agreement between the UK and Scottish Governments. Clearly, Brexit threatens the loss of reciprocal healthcare arrangements for millions in Scotland and across the UK. The Bill’s impact assessment makes this conclusion in relation to a no-deal scenario:

“If UK citizens in the EU are treated as 3rd country nationals (i.e. they cease to have rights of movement and access to services in EU Member States, and are treated like citizens coming from non-EU countries) some may face additional financial costs or difficulties accessing healthcare services, with potential implications for their health and wellbeing.”

Diabetes

Martyn Day Excerpts

Wednesday 9th January 2019 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing the debate, for his very knowledgeable introduction and for the consensual nature of the debate that has taken place.

We have had a number of contributions; I will just touch briefly on the main speakers. The right hon. Member for Knowsley (Mr Howarth) reminded us of the importance of recognising the two different types of diabetes, which cannot be emphasised enough. I was also interested in his comments on the artificial pancreas. The hon. Member for South West Bedfordshire (Andrew Selous) raised the risk of diabetes being normalised and the impact of obesity, and the food industry’s contribution to exacerbating the problem. The figures he quoted on sugar intakes were genuinely frightening and should be a lesson to us all. The hon. Member for Rochford and Southend East (James Duddridge) gave his personal experience of his diabetes being under control. The very interesting thought of what we would say to our younger selves is one that we need to take out to our constituents in order to make an impact on the problem.

Health, of course, is a devolved matter. Consequently, it seldom features in my casework as a Member of this Parliament. That said, many of my friends have diabetes, either type 1 or type 2. It is the fastest growing health threat of our time and a critical public health matter. Diabetes is increasing rapidly, and one person in 20 in Scotland is now diagnosed with the condition—I stress diagnosed, because there will be many others who are undiagnosed. The latest figures published by Diabetes UK show that more than 3.5 million people in the UK were living with a diagnosis of diabetes in 2016-17, with just less than 290,000 of them in Scotland. Diabetes UK also reported that if nothing changes, more than 5 million people in the UK will have it by 2025. That is a figure that a number of people have used, and it is worth repeating to emphasise the impact of this health crisis.

In the Forth Valley area, which covers part of my constituency, more than 14,500 people are living with diabetes and there are more than 9,000 people with diabetes in West Lothian, which covers the other part. That helps to put the issue into perspective across a number of constituencies.

It is estimated that more than one person in 16 across the UK has diabetes, either diagnosed or undiagnosed, and it is worth remembering that around 80% of diabetes complications are preventable. I believe that in Scotland around 10% of NHS spending goes on diabetes—I think the English figure is fairly similar. If 80% of that is preventable, think how much we could save by tackling this problem, in addition to the benefit to people’s lifestyles that could be achieved. Many of those complications are preventable or can at least be significantly delayed through early detection, good care and access to appropriate self-management tools and resources, of which access to diabetes technologies is a fundamental part.

When I last spoke about diabetes, a couple of years ago, we talked about technologies. I confess that at that time I had not really witnessed much of them first hand, so I was pleased over the festive break when I saw one of my friends, Paul Kingsley, who has lived with diabetes for some time. He has a Libre patch sensor and an insulin pump. He showed me how that worked, which was interesting to see. It has made a real change to his life. I can remember when he had to do the prick tests and take his needles with him everywhere he went. Technology is making a big difference to people’s lives.

With the challenge of the increasing numbers of people with diabetes, access to the technology to help those living with the disease becomes ever more important. There are 19,000 new cases of diabetes diagnosed every year in Scotland and numbers are set to increase year on year, particularly with rising levels of obesity. Early results from ongoing research, led by Mike Lean at the University of Glasgow and Roy Taylor at Newcastle University, showed that it is possible for some people to put their type 2 diabetes into remission using a low-calorie, diet-based, weight management programme, delivered by their GP. I believe that, as a result of those promising results, NHS England has committed to piloting a remission programme for 5,000 people with type 2 diabetes in 2019, and the Scottish Government, through their “A Healthier Future” plan, pledged £42 million to the prevention, early detection and early intervention of type 2 diabetes. There is a lot we can learn from each other from these processes and as the results of these tests come out.

NHS boards in Scotland will be able use that funding to deliver programmes to prevent type 2 diabetes and to put it into remission. One such programme that receives funding from NHS Forth Valley is the Braveheart Association, a Scottish charitable incorporated organisation based at Falkirk Community Hospital. The Braveheart programmes have been designed to provide resources to support and improve the health and wellbeing of Falkirk communities. They create community-led activities and outreach health services to improve the health of local people. One of the initiatives is Braveheart Plus peer support groups, which focus on those living with type 2 diabetes and coronary heart disease. One beneficiary of Braveheart’s walking project is a lad called Ali, a sufferer of heart disease and diabetes, who was initially reluctant to take part. Through participation, he now leads his own bi-weekly group, enjoys meeting new people and is able to manage his health conditions much better.

There is little doubt that eating a poor diet and being overweight or obese cause serious health problems, such as type 2 diabetes, cancer and heart disease, and it is clear that we must take decisive action. The SNP has an ambition to halve childhood obesity in Scotland by 2030, which is one reason the Scottish Government are consulting with the public, and food and retail industries on restricting in-store marketing and promotion of foods high in fat, sugar or salt, with little or no nutritional benefit. That is very important; I think we have all been tempted.

[Andrew Selous]

On that point, does the hon. Gentleman agree that it would be good to hear from the Minister about when we will get the consultation on the 9 pm watershed and on promotions? Both are promised, but we do not yet have a date for them.

[Martyn Day]

I fully agree; that would be very useful to have.

I think we have all been guilty of impulse purchases when out shopping. It is always worse if we shop when hungry and there is a temptation to get fast food and a quick fix. We are all more than capable of cooking good quality meals, but convenience and lifestyle often get in the way of that. There is a lot we could do if there was a better marketing regime. The consultation in Scotland is part of the diet and healthy weight delivery plan, which will inform an assessment of impact and possible legislation.

No debate these days can be complete without some reference to Brexit, and why should this one be any exception?

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

We were so close.

[Martyn Day]

Yes, but it had to come in, given the requirement to stockpile insulin. Diabetes charities have warned that lives could be put at risk without reliable supplies of insulin, as the UK imports the vast majority of its stocks of the medicines. In response, stockpiles have been increased, which is good. Dan Howarth, the head of care at Diabetes UK, said in September:

“Insulin and other diabetes medication aren’t optional extras for the millions of people in the UK who rely on them. It’s incredibly important that the companies involved in their production and distribution, and those involved in guaranteeing their entry into the UK, work together so that supply continues uninterrupted.”

I would be grateful for reassurances from the Minister that that will indeed happen and about how long our supplies will last should we face the worst-case scenario.

Draft Human Fertilisation and Embryology (Amendment) (EU Exit) Regulations 2019 Draft Quality and Safety of Organs Intended for Transplantation (Amendment) (EU Exit) Regulations 2019 Draft Human Tissue (Quality and Safety for Human Application) (Amendment) (EU Exit) Regulations 2019

Martyn Day Excerpts

Wednesday 19th December 2018 General Committees

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I appreciate that these are emergency draft regulations, and I will not oppose them, but I think it is madness that we have been brought to the point of having to rush through hundreds of these regulations because of the Brexit process. All this could have been avoided if we had stayed in the single market and customs union or—better still—if we were not leaving the EU at all.

However, I have one question. We do not know what the exact process will be for licensed establishments to apply for a new import-export relationship. The Government need to make that process clear as soon as possible, so that those establishments can prepare if they need to. Will the Minister elaborate on that?

Healthcare (International Arrangements) Bill

Martyn Day Excerpts

Wednesday 14th November 2018 Commons Chamber

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Clearly, Brexit threatens the loss of reciprocal healthcare arrangements for millions in Scotland and across the UK. As a bottom line, the Scottish National party believes that all current reciprocal health agreements must remain intact, regardless of what form Brexit takes. The Bill is yet another rushed job on the part of the Government. In their panic, they have woken up to the fact that millions across the UK and thousands of expats abroad, particularly pensioners, could face having either no access to healthcare within the EU or paying exorbitant costs for treatment. It is another example whereby no contingency planning was done prior to the Brexit referendum.

With an estimated 900,000 to 1.2 million UK citizens living in the European economic area and 3.2 million EEA citizens residing in the UK, Brexit will potentially have severe ramifications for them and the NHS. Approximately 27 million active EHIC cards are in circulation as of September 2017. They are used to pay for around 250,000 medical treatments each year. Ensuring that all current reciprocal health agreements remain intact and in place must be the bottom line regardless of what form Brexit takes.

The consequences of a no-deal Brexit on healthcare are yet one more example of why this extreme Tory Brexit is not worth the cost. In evidence to the House of Lords EU Committee, a representative from the Association of British Insurers gave a rough estimate that in a no-deal scenario, travel insurance premiums for EU travel could increase by 10% to 20%. A no-deal scenario will end up restricting the travel arrangements of those with underlying health conditions and disabilities. In such a scenario, the British Medical Association said that the insurance issue will be

“a particular concern for those with disabilities or long-term conditions, as the cost of health and travel insurance for those with pre-existing conditions could be prohibitively high.”

The Bill’s impact assessment concludes that in a no-deal scenario:

“If UK citizens in the EU are treated as 3rd country nationals (i.e. they cease to have rights of movement and access to services in EU Member States, and are treated like citizens coming from non-EU countries) some may face additional financial costs or difficulties accessing healthcare services, with potential implications for their health and wellbeing.”

That is something none of us wants to see.

Reciprocal healthcare arrangements must not be viewed as affecting only those who live or travel abroad. The impact of a no-deal Brexit would have a devastating effect on our NHS services at home. The agreement in the joint report does not provide long-term assurances regarding the future of the EHIC. As things stand, health insurance will stop for millions of UK citizens post-Brexit.

While the UK Government have stated their commitment to securing ongoing access to the EHIC, the EU has been unwilling to agree to that due to the Government’s stance on freedom of movement post-Brexit. The UK would also be a significant outlier were it to retain access to reciprocal schemes while ending freedom of movement. The SNP position on single market and customs union membership would, of course, remove all such obstacles.

If these healthcare schemes were removed, it would inevitably lead to massive pressures on the NHS, as UK citizens return home to receive treatment. Those pressures are compounded by the impact of the health workforce reduction, which has seen England and Scotland lose 19% and 14% of EU doctors respectively and a 90% drop in EU nurses registering to work in the UK.

As we have heard, the UK contributes around £630 million annually towards UK citizens’ care and receives £50 million—I think the Minister mentioned £60 million—for care provided to EU nationals in the UK. The BMA and the Nuffield Trust has estimated that if the UK did not conclude a withdrawal agreement with the EU, and were all these pensioners to return to the UK, the NHS would need some 900 additional beds and 1,600 nurses to ensure sufficient capacity. All in all, providing this additional healthcare would amount to somewhere in the region of £1 billion.

Current EU nationals living in the UK could face losing access to health facilities. First, their residency was threatened and now their healthcare rights are in danger; we must give them peace of mind and security. Were the UK to lose access to existing reciprocal arrangements and no alternative be established, EEA citizens living in or visiting the UK would also face a significant change in their access to care. Depending on the deal secured between the UK and the EU on citizens’ rights, this could mean that EEA residents might face the same costs and terms of access to the NHS as other non-EEA visitors and migrants do currently.

The Scottish Government have never been opposed to common frameworks, but these must be agreed in discussion and with the consent of the devolved Administrations. I was grateful to hear the Minister’s commitment to working with the devolved nations in this regard. We all understand the desperate need for all these reciprocal healthcare agreements to continue and the Scottish Government will work with the UK Government to ensure that they do.

Through the Joint Ministerial Committee, we believe that a common framework system can be achieved that ensures these specific health agreements can be administered through common agreement between the UK Government and the Scottish Government. Many issues need to be resolved for this to happen effectively, particularly if we are forced to deal with a no-deal Brexit. For instance, in Scotland, unlike in England, certain categories of resident non-EU overseas patients are exempted from healthcare charges, including the self-employed, volunteers and students. In Wales and Northern Ireland, regulations provide similar exemptions, and in Northern Ireland they clarify that entitlements are applicable both to primary and secondary care.

As Professor Jean McHale told the Lords inquiry on this very issue, post-Brexit

“if there are no reciprocal agreements on healthcare made with other EU member states and treatment is sought other than in an emergency situation then certain EU citizens could be exempt from NHS charges for secondary care…if they are living in Scotland, Wales and Northern Ireland whereas this would not be the case in relation to those resident in England.”

In conclusion, I am not opposing the Bill, as it basically just gives powers to the Secretary of State to agree reciprocal deals, and I look forward to the Bill Committee where we can progress those further. However, I point out that today’s business is another example of otherwise unnecessary work related to Brexit coming before us. This prompts the question of just how much time and effort is being put into such work that could have been used for other things, had we not been going through the Brexit fiasco. I believe that we will not get a better reciprocal arrangement deal than we currently have.

Hospice Funding and the NHS Pay Award

Martyn Day Excerpts

Wednesday 31st October 2018 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Heywood and Middleton (Liz McInnes) for securing the debate and for her knowledgeable and informative speech. The hon. Member for St Ives (Derek Thomas) also made a sympathetic and informed contribution using personal and constituency examples, which we all benefit from.

There is little doubt that hospices play a vital role throughout the UK in providing palliative and end of life care, and that demand for care is increasing. We have heard that hospices face many of the same challenges as the NHS in terms of recruitment, and have to compete with pay levels to recruit and retain a good calibre of staff. Attracting and retaining the right people and raising the status and image of social care as a profession is key to delivering quality care.

In Scotland, health is devolved, and getting health and social care right for people is a key element of the Scottish Government’s health strategy. In 2015, the Scottish Government committed through the strategic framework for action on palliative and end of life care, or SFA, that by 2021 everyone in Scotland who needs palliative care will have access to it. Hospices play a vital role in meeting that aim and in ensuring that by 2021 all who would benefit from a key information summary will receive one. These summaries bring together important information, such as future care plans and end of life preferences, to support those with complex care needs or long-term conditions. The availability of care options will be improved by doubling the provision of palliative and end of life care in the community. That will result in fewer people dying in a hospital setting, which I am sure none of us would want to experience. As part of the Scottish Government’s 2016-17 budget, we have allocated a further £250 million to health and social care partnerships, to protect and grow social care services, and to deliver our shared priorities.

Historically, hospices have led the development and provision of palliative care. Their specialist expertise has often supported non-specialist services at the end of life and hospices can typically able t attract high numbers of volunteers and to generate significant levels of charitable income from within their communities.

In 2016-17, hospices in Scotland supported 19,000 people of all ages, ranging from newborn babies to centenarians. In the briefing sent round for today’s debate from Together for Short Lives, the UK’s charity for children’s palliative care, there was a request for parity in the contribution to charitable costs by children and adult hospices, and palliative care charities. That is a very reasonable and sensible suggestion, and the Scottish Government have committed to bring about such parity and to fund 50% of the agreed charitable costs of children’s hospices, in line with the adult provision.

During 2016-17, a total of 12,000 people in Scotland received hospice care in their homes. Over the past decade, a significant amount of work and investment has gone in to supporting older people and people with disabilities to live well in their own homes for longer. When hospice care is needed, the Scottish Government have clear standards that meet the needs of patients and respect their rights. And of course Scotland continues to be the only country in the UK that provides free personal care, benefiting over 76,000 older and vulnerable people. In addition, legislation has been approved to extend free personal care to under-65s, which will come into force from April next year.

Much of today’s debate focuses on NHS pay and its impact on the hospice sector. What does it mean for staff in Scotland? Staff on the Agenda for Change scale will benefit from an increase. Such staff include registered nurses, lead nurse managers, ward sisters, clinical nurse managers, clinical nurse specialists, senior nurses and nurse managers. The Scottish National party Government agreed a three-year pay deal linked to reform discussions that are due to be completed by December, meaning that most Agenda for Change staff will make more than their English equivalents.

For adult social care workers, the Scottish Government require all public sector employers to pay at least the Scottish living wage, so health and social care partnerships will have to pay the Scottish living wage, too. I stress that in Scotland we are committed to paying everyone in social care the living wage, and anything additional would be an arrangement agreed between the integration authorities and hospices. Those discussions are ongoing and I look forward to hearing their outcome.

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Alan Brown (Kilmarnock and Loudoun) (SNP)]

12. What assessment he has made of the potential effect on access to new medicines of the UK leaving the EU.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

20. What assessment he has made of the potential effect on access to new medicines of the UK leaving the EU.

--- Later in debate ---

[Matt Hancock]

Not only does the UK bring a huge amount to the table in terms of research, but we fully intend to make sure that we have a robust and seamless system in place. A consultation is out at the moment and we will respond to it very shortly.

[Martyn Day]

The Government have stated that the new EU clinical trials regulations will not be in place before March, but have committed to aligning with it where possible. What progress has been made regarding data sharing to ensure that clinical trials continue and pharmaceutical and research firms do not leave the UK after Brexit?

[Matt Hancock]

As part of the EU deal we are negotiating, the relationship with the EMA will be extremely close, so I am sure that that will be a part of our agreement.

Tobacco Control Plan

Martyn Day Excerpts

Thursday 19th July 2018 Commons Chamber

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to take part in today’s debate, and I welcome the one-year anniversary of the tobacco control policy for England. A great deal of progress has been made in reducing smoking prevalence across the UK. As has been pointed out, whereas in 1974 more than half of adult males and more than two in five women smoked, the latest figures from NHS Digital suggest that smoking rates in the UK are now 15.1%. So I say congratulations on that achievement.

The figures on smoking prevalence in Scotland, where I come from, vary as between sources, but the Office for National Statistics has suggested a prevalence rate of 16.3% in 2017. Since 2010, Scotland has seen the largest decline in the proportion of smokers of the four UK jurisdictions, with a reduction of more than eight percentage points. That said, there are still about 10,000 smoking-related deaths per year and 128,000 smoking-related hospital admissions in Scotland.

The Scottish Government published their new five-year tobacco control plan in June. It goes a little further than the tobacco control plan for England, in that it not only puts forward a vision of a smoke-free generation but sets a date, 2034, by which we wish to achieve that vision. If Scotland is to achieve its vision, it requires action by the Westminster Government on issues that are not devolved, such as tax, illicit trade and smoking in the entertainment media. Page 14 of the tobacco control plan for Scotland commits the Scottish Government to

“continue to work with the UK Government to address the representation of tobacco use in the media.”

That is not something that the Scottish Government can do on their own.

A clear causal link has been established between exposure to smoking on screen in the entertainment media and smoking initiation in young people. The greater the exposure, the greater the risk of smoking uptake; yet smoking remains common in entertainment media viewed on screen by young people, including prime-time TV, videos, and films. A recent survey for ASH found that in all media for which questions were asked—TV, films, music videos, computer games and online—the 11 to 18-year-olds who had tried smoking were significantly more likely than those who had never smoked to report exposure to smoking imagery. The highest level of young people’s exposure to smoking imagery was in films, with 81% of 11 to 15-year-olds and 88% of 16 to 18-year-olds reporting seeing smoking. An analysis of UK TV programmes broadcast between 6 and 10 pm in 2015 found that 12% of all programmes featured tobacco use, which was the same proportion as in 2010. In both 2010 and 2015 the frequency before and after the 9 o’clock watershed was roughly similar. Only a very small minority of the content could be justifiable on historical accuracy or other grounds.

The relevant regulators are Ofcom and the British Board of Film Classification. Ofcom, which has a statutory responsibility to protect the under-18s, has much more stringent rules than the BBFC. However, both regulators appear to be more concerned about how smoking is depicted than the overall amount of the exposure taking place. Will the Minister endorse the following recommendations and ask his colleagues in the Department for Digital, Culture, Media and Sport to work with the Department of Health and Social Care to put them into effect through revised Ofcom and BBFC codes? First, Ofcom and the BBFC should monitor youth exposure to depictions of tobacco use on screen on the channels that they regulate and publish the data in their annual reviews; secondly, Ofcom and the BBFC should revise their guidelines with respect to smoking on screen in entertainment media viewed by under-18s, to discourage any depictions of tobacco use and require action to mitigate any remaining exposure; and thirdly, if smoking features in any programme or film likely to be widely seen, heard or accessed by under-18s, an anti-tobacco advertisement must be displayed at the beginning and in any advertising breaks.

When I spoke in the debate on the tobacco control plan in October last year, I focused heavily on the illicit trade, which the Minister will remember, and encouraged him to ensure that the UK ratified the illicit trade protocol in time for the meeting in October this year, so I am absolutely delighted that the UK did indeed ratify it. In fact, we were the 40th country to do so and thereby triggered the entering into force of the treaty. I congratulate the Government on that.

However, the UK Government still need to do more to tackle the illicit trade. In 2016-17, the size of the illicit market for cigarettes had remained roughly stable since around 2010, although as smoking prevalence has declined significantly, it has made up a higher proportion of the total market. Because taxes have increased over the years, the total tax revenue lost as a result of illicit trade has grown from £1.9 billion in 2010 to roughly £2.5 billion today.

Articles 15 and 16 of the tobacco products directive 2014/40/EU provide for EU-wide systems of traceability and security features for tobacco products, to address the issue of illicit trade. There are a lot of good suggestions and lots of good work in that directive. Under the traceability system, all unit packets of tobacco products are required to be marked with a unique identifier, and relevant economic operators involved in the tobacco trade are required to record the movements of tobacco products throughout the supply chain and transmit the related information to an independent provider, with data storage contracts to be approved by the Commission. The data will then be made accessible for enforcement purposes to the authorities of EU countries and to the Commission. Under the security features system, all unit packets of tobacco products placed on the EU market will be required to carry a tamper-proof security feature, composed of visible and invisible elements, enabling authorities and consumers to verify their authenticity. It is therefore, in my opinion, essential to the control of the illicit tobacco trade that the UK should continue to participate in the EU tracking and tracing system after Brexit and that any such system implemented in the UK is independent of tobacco manufacturers as required by the illicit trade protocol.

A study for the tobacco control research group at the University of Bath, published just last month, exposes evidence that the big tobacco companies are still facilitating tobacco smuggling. The protocol explicitly requires Governments to take responsibility for control measures, rather than relying on industry self-regulation, which has failed so miserably to date. The industry must not be allowed to control the traceability system, either directly or indirectly through proxies.

In conclusion, will the Minister commit to the UK remaining in the EU tracking and traceability system for tobacco products after Brexit? Will he report on the UK’s progress in implementing the requirements of the EU tracking and traceability system, and will he confirm that the system of tracking and tracing of tobacco products, which will be adopted by the UK, will comply with the independence requirements set out in the WHO illicit trade protocol?

Phenylketonuria: Treatment and Support

Martyn Day Excerpts

Tuesday 26th June 2018 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Blaydon (Liz Twist) on securing time for this important debate and on her comprehensive and detailed summary of the issue. I am also grateful for the NSPKU briefing she kindly sent round to colleagues in advance of the debate. I must admit I had been in touch with Library specialists before I received the briefing to find out the pronunciation. The hon. Lady sensibly told us how to pronounce it. I will refer to it as PKU for the rest of the debate, despite my hatred of acronyms. It is fair to say that without that guidance, I would have been mispronouncing it.

I welcome the NSPKU members who are here to watch the debate. In preparation for the debate, I found out just how awful the condition is. I am grateful to all Members who have taken part and shared their constituent cases, which have helped highlight how truly horrendous the situation is. For my part, I am aware of no cases in my constituency, but as health is a devolved matter, they would more likely go to Scottish Parliament counterparts.

We have heard that PKU is a rare inherited disorder sufferers of which are unable to break down the amino acid phenylalanine. It is a truly horrific condition, and it is worth putting on record that there is currently no cure. Left untreated, it can cause serious damage to the brain and nervous system, which can lead to learning disabilities and other symptoms. As has been pointed out, the condition affects about one in 10,000 babies in the UK. As the hon. Member for East Renfrewshire (Paul Masterton) mentioned, the situation is worse in Scotland. The stats I have seen suggest that the condition affects one in every 8,000 babies in Scotland, which represents about six or seven cases a year.

Early intervention is vital. Without it, irreversible damage can occur. The Scottish Government take the condition seriously, which is why at around five days old, babies are offered newborn blood spot screening to check whether they have PKU or a number of other conditions. If PKU is confirmed, treatment will be given straight away to reduce the risk of serious complications. If the right treatment is followed, babies with PKU are well in early life and do not develop symptoms. It can be managed with a low protein diet, but as has been pointed out by many speakers today, that is far from an easy option.

We have heard much about access to new treatments such as sapropterin, also known as Kuvan, which is available in 25 countries and has been licensed in the EU since 2008. In May this year, Scotland’s Health Secretary Shona Robison wrote to the Health and Sport Committee to provide a further update on the Scottish Government’s progress in delivering the recommendations from the review of access to new medicines. She confirmed that the pharmaceutical company BioMarin has made a submission to the Scottish Medicines Consortium for sapropterin or Kuvan to be used for the treatment of PKU. The SMC will publish its advice within the next few weeks. Let us hope that we can see progress in the matter as a consequence of the Montgomery review and the definitions of new processes for ultra-orphan drugs.

Decisions made by the Scottish Medicines Consortium are independent of Ministers and the Scottish Parliament, and it is worth remembering that our involvement in that process can be limited, but I would be happy to offer my support to the hon. Member for East Renfrewshire to do any joint working we can to bring pressure to bear, as the drug would be very beneficial for sufferers. The Scottish Government do not intervene in SMC processes, but they have sought to consider with all parties how issues identified in previous submissions could be resolved in new applications to achieve a best-value deal for NHS Scotland.

The Scottish Government have significantly increased access to new medicines in recent years. Between 2011 and 2013, the combined SMC acceptance rate for orphan cancer medicines was 48%. Between 2014 and 2016, the rate was 75% for ultra-orphan, orphan and end-of-life medicines. There are some positives that we can look at in that process. A responsible funding model is key, however. The Scottish Government are actively examining an improved negotiating function that seeks to ensure that the NHS in Scotland pays the same effective price for medicines as in the rest of the UK.

I thank everyone who has taken part. My sympathies go to anyone who is living with the condition. I would be interested in supporting the diet for a day challenge. My diet needs serious improvement at a range of levels, but I would be up for putting in the effort.