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My Lords, it is rare that I disagree with the noble and learned Lord, Lord Brown, but I am afraid that I do. I regret that he seems to have settled for the lowest common denominator, which is a surprise to me. I urge the noble and learned Lord to lift his eyes and think that we could do better than this, and indeed I think we could.
This week, pioneering transplant surgeon Paolo Muiesan is returning to Italy after 1,000 operations and 26 years in the UK. The reason, he says, is Brexit. He is not the first surgeon to leave the same transplant unit in Birmingham. Undine Gerlach, a fellow consultant, is now working in Berlin. Anna Zampetti, a consultant dermatologist, returned to Rome last year, saying that at least one of her patients became glacial because she was not an English consultant and the whole process was hurtful following the Brexit vote. I could give many examples of the skilled European medical and nursing staff who are leaving the UK. Many report feeling unwelcome and they have no confidence in the statements of Theresa May and her colleagues. They feel that they and their families were a bargaining chip in the Brexit negotiations. The welcome came too little and too late, and it came on top of the corrosive tone of the Brexiteers’ campaign which has condoned and fed some very unsavoury racism in our society in general and which expresses itself in suspicion and hostility to our fellow European citizens, as mentioned by the noble Lord, Lord Newby.
I spoke about health and social care issues during the passage of the Brexit Bill and sought reassurance from the Government on matters such as reciprocal healthcare arrangements, the free movement of medical and nursing staff, the regulation and supply of medicines, and clinical trials and research whose conduct, regulation and access to the portal, about which I will speak later, is so vital to patients across the UK and Europe. I talked about warnings about communicable diseases, illegal drugs, unsafe medicines and transplant organ and blood donations meeting high standards, to say nothing of course of food, animal welfare and farming, which are not in my brief.
I share the concerns that were expressed yesterday by the noble Baroness, Lady Watkins of Tavistock. She spoke about the terrible and growing shortage of nurses, midwives and care workers from the EU and the damage this is causing to our NHS and social care, as well as to individual patients and their families. I agree with the analysis of the noble Baroness and note the absence of a paper on immigration which is so important in this sector. I do not agree with the conclusion of the noble Baroness, which is to stick with this very unsatisfactory proposal being discussed by both Houses at present.
The political declaration makes no reference to how UK-EU clinical trials will operate after Brexit. This is of significant concern. Cross-national clinical trials are vital to ensuring that patients have access to the most innovative treatments. This is particularly true for rare and paediatric cancers where patient populations in single countries are often insufficient for trials. The UK has led or participated in the largest number of pan-EU paediatric clinical trials. Following the earlier debates and excellent lobbying by many organisations such as Cancer Research UK and the Wellcome Foundation, the Government previously made very welcome commitments to align with the EU’s forthcoming clinical trial regulation. I thank Cancer Research UK, Wellcome and others for their excellent analysis of the political declaration and its effects on the future funding and framework for research in the UK.
Agreement must be reached in negotiations on UK participation in the single assessment procedure and access to the portal and database which underpin this regulation. No access to the portal would severely reduce the ease of UK-EU trial set-up and hurt our thriving life sciences environment and business. Clinical trials take years to plan and run. As things stand, UK researchers will enter the implementation period unsure about what regulatory conditions they will be faced with when they exit it. What are the Government doing to resolve this issue with necessary urgency? Is the Minister aware of the cost of failing to do so? The deal as it is expressed now does not achieve access to the portal.
More than a quarter—28%—of the clinical trials funded by Cancer Research UK involve at least one other European country. The UK is very active in this area, conducting the highest number of phase I clinical trials. Negotiating access to the EU’s clinical trials portal and database will provide certainty for patients and researchers in the UK. It will also ensure that the UK remains a global leader in medical research and pioneering clinical trials. It is imperative that the Government should reflect the need for the UK to continue to attract, recruit and retain global scientific talent at all levels in their forthcoming immigration Bill.
I turn now to medicines. The political declaration states that the UK and the EU will explore the possibility of the co-operation of the UK with the European Medicines Agency. The EMA covers an area responsible for 25% of global pharmaceutical sales while the UK accounts for just 3%. Without alignment, the UK risks being deprioritised by pharmaceutical companies bringing new drugs to market. For example, Switzerland is about five months later than the EMA area. Without the ability to act as a lead assessor in this, there could be ramifications for patients around Europe, given the loss of MHRA capacity and expertise. Again, this could undermine the UK’s world-leading science environment.
We know that because of uncertainty, the Government and the industry are planning to secure the supply of medicines in the short-term, which is bizarre and rather shocking. Is the Minister aware that novel medicines are not easily stockpiled? However, the agreement does not offer the clarity needed on how the Government intend to secure the supply of novel investigational medicinal products which are used in clinical trials. Many of these are used in cancer clinical trials. They would be very difficult to stockpile and they would suffer from delays at borders, causing significant disruption to trials and suffering for patients.
Our proposed exit from the EU next year is fuelling an exodus of European workers from our island, which might be said by some to be one of the outcomes sought by those who voted to leave the EU in 2016. However, their departure highlights how Brexit is rippling through our economy, worsening labour shortages in critical industries and sectors such as health and social care. This deal does not secure the future of the NHS and it does not put patients first, let alone make more funds available—the big lie of the Brexit campaign. We need to ensure transparency and honesty about what this deal and the Government intend to inflict on patients and the NHS. We need to know that this deal and the Government will reduce the UK’s jewel in the international crown of medical research to something much less significant. That will be to the detriment of patients, to our NHS and to our economy.
It is time to call a halt on the terrible agreement and the threat to fall off a cliff. Neither are acceptable for health and social care in the UK. It is time for transparency and honesty and to seek a different way forward. That is being offered to begin with by the amendment tabled by my noble friend Lady Smith to the Motion tabled by the Leader of the House.