I beg to move,
That this House
has considered the effect of leaving the European Union on the UK’s health and social care sector.
It is a pleasure to serve under your chairmanship, Mr Bone. I thank the Backbench Business Committee for agreeing to the debate, and all hon. Members who have come along to take part in it. I put on the record my sincere thanks to Robert McGeachy of Camphill Scotland, to Craig Wilson and Gareth Jones from the Scottish Council for Voluntary Organisations, and to Andrew Strong of Alliance Scotland, for all their help and support in preparing for the debate.
The debate’s origins are in my private Member’s Bill, which I tabled in November 2018. It sought from the UK Government provision for an independent evaluation of the effects on the health and social care sector of the United Kingdom’s withdrawal from the European Union. Like many others, my Bill will almost certainly fall this Friday, without ever seeing the light of day or being debated. I was always prepared for the likelihood that the Bill would fall because of a lack of time, so that does not surprise me. What did surprise me, however, was my Bill’s impact on the organisations that deliver vital health and social care to so many vulnerable and needy people day-in, day-out right across the United Kingdom.
Currently, no fewer than 102 different third sector organisations, trade unions and charities have publicly supported the measures in the Bill. Not a single one of those organisations believes that Brexit will be good for the health of the people of these nations. Moreover, they all support the idea that an independent evaluation of the effects of Brexit on the health and social care sector should be carried out, and that it should examine the sustainability of public funding, the challenges faced by the workforce, and the efficiencies and effectiveness of the sector.
I will not test everyone’s patience by naming all 102 organisations that have lent their support, but I can assure hon. Members that they cover every part of the United Kingdom. They include the Western Isles Carers, Users and Supporters Network, which is based in Stornoway, the Northern Ireland Council for Voluntary Action, Disability Wales, and the London-based Mentor UK, which does great work with young people on alcohol and drug misuse. Those organisations share my concerns, and I want to put on the record my sincere thanks to each and every one of them for contacting and supporting me.
In the light of the extremely high levels of concern among those delivering services at the sharp end, I did not want this hugely important issue simply to disappear from the radar on Friday, when my private Member’s Bill will almost certainly fall because of a lack of time. I felt that I owed something, not just to those organisations, but to the most vulnerable in our society: those with disabilities; children and young people; older people; unpaid carers; those living with long-term health conditions; and those who rely on the vital contributions made by the highly valued EU citizens who provide for our health and social care needs right across these islands. Their voices are not being heard, or their views properly considered. I felt that I owed it to those people to ensure that the very serious issues that the health and social care sector will face post Brexit are examined and discussed in this place so that, 18 months from now, no one can claim not to have known what the sector or the service users were saying.
Every one of us knows that there is already a crisis in social care across the United Kingdom, with a seemingly relentless pressure on funding. Our population is ageing and has increasingly complex care needs, and we face major challenges in the retention and recruitment of the workforce required to meet those needs. One would have thought that, in the immediate aftermath of the EU referendum in June 2016, the Government would at the very least have made a top priority of safeguarding the health and care of their citizens. Guaranteeing a secure supply of the vital medicines that are manufactured in the EU, or that have to be transited through it, would have been a good starting point, particularly as the Department of Health and Social Care’s own estimate states that two thirds of the medicines that we use in the UK come from or via the European Union.
One would have thought that securing access to the essential pool of labour that we require now, and will increasingly need in future, would have been at the top of the to-do list, or thereabouts. Yet in March 2019, just 10 days from possibly crashing out chaotically, we are still discussing the dangers that the weakest and most vulnerable in our society will face as a result of Brexit, and particularly the type of Brexit that the UK Government have chosen to pursue. It is one in which their ideologically driven, self-imposed red lines will deliberately sever the essential link between the health and social care sector and the pool of labour on which it depends. Exactly two years ago, Professor Ian Cumming, the chief executive of Health Education England, said:
“Our biggest risk in the short term, as a result of Brexit, may be in the non-professionally qualified workforce across health and social care”.
Without exception, every single organisation that offered me support for this debate or prepared a briefing ahead of it highlighted the enormous damage that Brexit, and particularly the end of freedom of movement, would do to their ability to deliver care and undertake essential medical research—every single one. They include Cancer Research, CLIC Sargent, the Local Government Association, the Northern Ireland Council for Voluntary Action, researchers from the University of Birmingham, Macmillan Cancer Support, the British Medical Association and Age UK, to name but a few. They have all said that the health and social care sector values and wants to retain its EU staff, and wants nothing to stop it recruiting more of those hugely valued and important staff members in future.
It is timely that the hon. Gentleman is bringing this issue to the forefront once again. On healthcare, one of the things that certainly worries my constituents and me is the potential for the national health service to be open to predators post Brexit. As I am sure he knows, on one hand, the care side of the NHS is vastly underfunded, while on the other hand, people cannot afford care to look after their families, including elderly parents and others. Research and development in medicine and collaboration with Europe are also important, and two universities in Coventry that engage in a lot of that have voiced concerns to me about it. Does he agree with those concerns?
The hon. Gentleman is absolutely right. The fear in the sector and among care users is palpable. A recent article in The Lancet, which backs up his points, states:
“All forms of Brexit involve negative consequences for the UK’s leadership and governance of health, in both Europe and globally”.
For me, that sums up the hon. Gentleman’s point exactly. I hope that he agrees.
We cannot get ourselves into a situation in which there is a barrier between the health and social care sector and that pool of labour. Age UK recently said that
“our care workforce is in no position to withstand the loss of good…care workers, wherever they come from.”
The King’s Fund said:
“Widespread and growing nursing shortages now risk becoming a national emergency and are symptomatic of a long-term failure in workforce planning, which has been exacerbated by the impact of Brexit and short-sighted immigration policies.”
The message from the sector to the Government is therefore clear and unambiguous: we simply cannot afford to cut ourselves off from the labour markets on which we have become so reliant and on which we will depend more and more in future. One look at the frontline of the health and social care sector and its delivery, and it is easy to see how heavily it depends on workers from outside the United Kingdom. Without access to those workers, the UK home market will be required to fill the gaps, but people are not queuing up to fill the vacancies that exist now, so do the Government believe that somehow post Brexit people will suddenly become available for work in the care sector?
I congratulate the hon. Gentleman on securing the debate. He talks about the workforce, but is it not natural that as the economies of other countries get stronger, the workers who would have come here will be lost to natural erosion as they no longer want to come to the UK? The emphasis needs to be placed on training our own young people and making it advantageous for them to join the health service.
The hon. Gentleman makes a valid point, but we have to compete for workers and to have an attractive package for people to come here to work, but if we take ourselves out of the game, we are no longer in the competition—we will have cut ourselves off. There are issues relating to retraining and getting people into the sector, but unfortunately the demographics are incredibly skewed against that happening, certainly in the short and medium term. I will come on to some of the statistics.
At the end of June 2018, NHS England had more than 100,000 unfilled posts. The NHS regulator has stated that such vacancies will become even more commonplace during the remainder of 2018-19. Both the Care Inspectorate and the Scottish Social Services Council have found that 40% of social care organisations report unfilled staff vacancies. There is no professional analysis out there that does not estimate that the demand for care will only increase in future. The King’s Fund, the Health Foundation and the Nuffield Trust have predicted that NHS England staff shortages could rise from 100,000 to almost a quarter of a million by 2030. That is more than one in six of service posts. At the end of last year, Care England estimated that by 2035 an additional 650,000 care jobs will be required just to keep pace with the demands of our ageing population.
I congratulate the hon. Gentleman on securing the debate. On the statistics, did he establish whether it also estimated what the level of vacancies was likely to be were we to remain in the EU over that 10-year period, given that there are 100,000 vacancies now, despite the UK being a member for 40 years?
I realise that many things have been blamed on the European Union, but the demographics and the population outcome of the UK cannot be blamed on it. What one can say about the present situation, however, is that we can predict that it will not get any better in the short or medium term. I think that Skills for Care has calculated that a quarter of the health and social care workforce are aged 55 and over. They will be due to retire sometime in the next 10 years, which will mean another 320,000 vacancies that need to be filled.
Let us not kid ourselves: we are facing a looming crisis. Equally, it is a crisis of the UK Government’s making, because they chose to go down this road of a hard Brexit. They want to take us out of the single market and the customs union; they chose to end the freedom of movement that has done so much to enhance the social, economic and cultural wellbeing of the UK over the past 40 years; and they did so knowing the consequences that such actions would have.
I therefore look forward to the Minister explaining exactly why the Government allowed that to happen and what their long-term plan is to fill those hundreds of thousands of vacancies facing health and social care in the coming years. If that plan includes yesterday’s launch by NHS England of the campaign to encourage GPs to come out of retirement, then heaven help us.
The primary purpose of this debate is to focus on the enormous challenges that will face our biggest asset, the people, whether they work in or rely on the sector, but as important as recruitment, retention and the level of care we provide is the issue of medicines and access to research. As I said, I have been inundated with representations from charities and third sector organisations, which are all extremely worried about the future of medical research and the ability to source vital drugs and treatment, particularly if we have a chaotic crashing out of the European Union. Who would have believed that in 2019 we would have a UK Government advising people to stockpile medicines? Those medicines might be life-saving, but we all took it for granted that they would be there if and when necessary. Now people are stockpiling, in 2019—it beggars belief.
The hon. Gentleman ought to be absolutely clear: we are not advising people to stockpile medicines. That is alarmist, and he should not be saying it. That is not what the Government are doing.
I will rephrase that. The Government are advising the stockpiling of medicines—perhaps not by individuals, but the Minister and the Government have advised the stockpiling of medicines.
Perhaps the Minister will answer that when he gets to his feet to respond.
How in the name of the wee man did the United Kingdom ever end up in this appalling, self-inflicted mess, in which the sick, the elderly and the vulnerable do not know who will be there to look after them, while healthcare professionals are unable to provide the comfort to their patients that everything will be all right? Only last week, Professor Andrew Goddard, president of the Royal College of Physicians, said that
“the public rightly expects candour from health professionals, and we have ultimately been unable to reassure our patients that their care won’t be negatively impacted by the UK exit from the EU.”
“there is no clearer immediate threat to the nation’s health than the impact of Brexit.”
Does my hon. Friend agree that part of the reason why members of the public and our constituents are so concerned is that we have no guarantee against predatory procurement in the NHS or against an interrupted supply of medicines, so how can people be reassured?
I could not have put it better myself. I thank my hon. Friend for that intervention.
Much more could be said on this topic, but I am keen for other Members to have their say. I will conclude with a number of questions, in addition to my earlier one, for the Minister to address when he gets to his feet. What assurances will he offer to each of the 102 organisations that supported my private Member’s Bill that the health and social care sector will not be adversely impacted by the UK leaving the European Union? What plans are being put in place to guarantee that the sector will be able to recruit the workforce it needs post Brexit? Will he support moves to amend the £30,000 minimum income threshold proposed for the immigration Bill, which will be so devastating for those seeking to work in the sector? Will he confirm once and for all that there will be no detrimental impact on the supply of medicines or devices if the UK proceeds to leave the European Union in a catastrophic crashing out? Finally, will he support my call for an urgent, full and independent evaluation of the effects of leaving the European Union on the UK’s health and social care sector?
It is a pleasure to serve under your chairmanship, Mr Bone, and to follow Brendan O'Hara. Above all, this debate allows a reasonable discussion of the issue, which I hope we can have, but I was struck by the similarity between it and last night’s debate in the main Chamber. Like the hon. Gentleman, I am aware of constituents who have expressed their great problems in getting drugs for two conditions, in particular: insulin for diabetes and the drugs required for cystic fibrosis. Cystic fibrosis is a particularly horrible disease that requires a continuous supply of drugs, so I can understand the concerns.
Throughout all the discussions on this matter, I have been conscious of the lack of objectivity from anyone, including the medical profession. The hon. Gentleman seems to think that those in the profession can stand aside and take an independent line, but I do not believe that is true or that what they say is necessarily helpful. Allow me to pick up where the Minister left off: the guidance published by the Government for pharmacists and members of the public is not to stockpile medicines. As part of the Brexit contingency measures, the Department of Health and Social Care has asked drug manufacturers to ensure they have a six-week buffer stock, on top of the three months already in place, but the public do not need to stockpile medicines.
The hon. Gentleman has much more leisure time than me, as he can still watch the BBC. I cannot remember when I last watched it, but I am pleased to join him in condemning its attitude. He makes a strong point. During the Brexit campaign, the health sector was dominated by the promise on the side of the famous bus, but equally, the remain campaign has lied through its teeth in saying many things. I have no real confidence that, if we were to have a second referendum, we would at any stage be able to have a debate free of exaggeration.
A constituent contacted me to say that he had been to a local hospital and was astonished to see that as a result of Brexit—although it has not happened yet—the ward was closing and had lost a large number of staff. I decided I would not let that go, but would find out the facts. I spoke to the matron who ran the ward in question. She said to me, “That is absolute rubbish. We have a full ward; this is a normal cycle of people’s leave and it has nothing at all to do with Brexit.” If we make Brexit arguments we need to ensure we have a rational and objective discussion, which so far we have not been able to have.
To have a rational and objective discussion, we have to rely on experts and take evidence from the people in the field. The contributors are objective: Macmillan Cancer Support, the British Medical Association, Cancer Research UK and CLIC Sargent have come to us to say there is a major problem. I presume the hon. Gentleman would not say that they are partisan players.
I am not sure that I agree with the hon. Gentleman. As politicians, we have the principal duty to explore the situation. There will be times when we need expert opinions, but I am complaining about the debate and discussion in this country where people on both sides use the issue as a football and produce exaggerated claims.
I have a great deal of sympathy regarding mental health, an issue on which I have done an enormous amount of campaigning. Outside the EU, there is another organisation with responsibility for mental health, the Council of Europe, on which I serve as a member of the Parliamentary Assembly. The Council of Europe has an expert committee on mental health, which is nothing to do with the EU. That means that if we leave the EU, there is a body of evidence and recommendations already in place to take forward mental health issues. That expert committee has produced a reference tool to determine the essential basket of potential rights that an individual should have, to consider whether the human rights of a patient suffering from mental disorders can be maintained with a great deal of dignity. That is an important element that we seem to ignore; we pretend it does not exist, yet many of us spend a huge amount of time at the Council of Europe trying to push forward those sorts of rights, not to take the place of the EU—it works the other way around—but to provide a safety net for people who are suffering from mental disorders.
I want to end on the issue of care. In Henley, the Government have spent about £12 million rebuilding a new hospital that is a model of how to integrate care and medical provision. The hospital was built without any beds; the beds are in the care home at the side of it. That has changed the way that doctors look at the provision of care. They do not immediately think that they should simply send patients to a bed when they can be treated better at home. I have taken various Ministers along to look at that hospital. I do not think it will be affected by Brexit in the slightest. The model set up there is one we can all take as a better way for the system to work in future. I extend an invitation to the Minister to come and see that hospital and how it operates. I hope he will enjoy the experience and see the lack of impact that Brexit will have on the provision of service.
The debate is extremely important, since we have had no evaluation, independent or otherwise, of the effect of leaving the EU on the UK’s health and social care sector. I heard what John Howell said, but the Royal College of Nursing pointed out that the Brexit process is presenting new and exacerbating existing
“challenges around workforce sustainability, recruitment and retention of the existing and future nursing community”.
That should be of concern to everyone in Parliament.
We know the health and social care sector already faces a recruitment and retention crisis, for a whole host of reasons, including poor pay, the lack of recognition of the important work and professional commitment of those in the sector, and the statutory and voluntary demands of a growing elderly population. We face similar challenges across the UK, but social care in England faces a critical situation, for a variety of reasons. I am therefore extremely disappointed that so few Labour and Conservative Members are present.
The context of this debate is important. The sector relies heavily on workers from the EU, but we have no plan for filling the gaps that are increasingly being left. I have been told in previous debates that no EU workers will necessarily be forced to leave the UK post Brexit if they have been here for a certain number of years and fulfilled certain conditions, but the Minister must recognise that the environment that has been created around Brexit means we will lose many of those workers, in the health and social care sector and beyond. Why should any worker stay in the UK when they can take their skillset and professionalism anywhere they wish in the EU, where they will be welcomed and appreciated? Sadly, that is something they do not feel very often in the current UK environment.
It is deeply concerning, because it is expected that by 2035 we will need 650,000 social care workers in the UK simply to keep pace with rising demand. That is in a sector that, as we heard from my hon. Friend the Member for Argyll and Bute, already faces a range of challenges. The challenges in England are well documented, but we in Scotland are not immune to them. The Care Inspectorate and the Scottish Social Services Council found that more than 38% of social care services report unfilled staff vacancies, even before Brexit has happened. Around 104,000 of the current health and social care workforce are EU nationals, and at any one time around 110,000 positions are unfilled. In addition, about 320,000 of those working in the sector are 55 or older, so they will retire in the next 10 years or so.
The situation is alarming, and the strains are affecting not just our social care sector but our entire national health service across the UK—our nurses, our doctors and our GPs. The situation could throw rural care in particular into real danger. For example, one in five of our rural GPs in Scotland is an EU national, and it seems likely that EU-qualified clinicians are already located disproportionately in hard-to-fill specialisms and shortage occupations such as radiology.
Medical isotopes are used to diagnose and treat cancers. In 2016-17, the NHS used radioactive materials in nearly 600,000 procedures. Those medical radioisotopes have a short half-life and cannot be stockpiled, even if one was minded to do so. The Royal College of Radiologists is preparing for difficulties in accessing radioactive materials by planning a lighter workload for the week following the date of our exit from the EU. However, that will hit patients who need and deserve treatment of their cancer. I mentioned that very point in a debate in the main Chamber two years ago and I was jeered and accused of scaremongering, despite the fact that I was simply quoting the Royal College of Radiologists. The jeering has stopped, but the challenges posed by Brexit are in no way receding; they are growing.
I do not have the relaxed attitude to these challenges that the hon. Member for Henley seems to have. Throw into the mix the UK Government’s inability to guarantee uninterrupted supplies of medicine, and the future looks grim indeed. That inevitably will affect our ability to look after the vulnerable and ill people in our communities in every constituency—the people who need care and the people who need support. Of course, that is in the wider context of NHS services across the UK being open to predatory procurement, which the UK Government refuse to guarantee will not happen.
No evaluation has been undertaken of the effect of leaving the EU on the UK’s health and social care sector. That is an absolute disgrace. The Government of the day have a duty to serve and protect those they seek to represent. Too little attention has been given to the calamitous situation that awaits us unless this Brexit madness, which has been characterised by confusion, incompetence, a complete breakdown of Cabinet responsibility and not a little arrogance, ends. Those who will bear the brunt and pay the price have not featured prominently enough in this unfolding tragedy. Today, their voices and concerns are being set out clearly. The Government should—they simply must—listen and do all they can to protect our health and social care sector, on which we all at some point will rely.
It is always a pleasure to speak about this issue. I congratulate Brendan O’Hara on setting the scene, and I support his request for the Minister and the Government to look at this issue. When I look at my constituency and at Northern Ireland more widely, I understand the criticality of this issue. So many Brexit issues need attention and urgent answers, but over and above Brexit, the NHS requires immediate attention.
I am pleased to see the Minister in his place; he seems to have been a fairly regular presence in Westminster Hall this last while in debates about issues that are his responsibility. It is also nice to see the shadow Minister, Julie Cooper, in her place. I look forward to her contribution, too.
My heart sank when an NHS staff member said to me, “Jim, being in the A&E is like living and serving in a war zone.” That shocked me and underlined the fact that we need urgent changes and more support for our NHS, not simply with respect to Brexit but to ensure the survival of that incredible system, which is overloaded, overworked and underfunded.
I am gravely concerned about the mental health of our NHS staff on the frontline, because of the sheer volume of stress they face. John Howell referred to mental health issues, in which I have a deep interest, as do other Members present. We should consider the mental health not only of patients but of staff. There is a lot of stress in Westminster at the moment because of Brexit, but stress among staff on the frontline of the NHS is at an all-time high.
Nurses are working on their off days; they feel so guilty that colleagues are working on understaffed wards and they are so interested in the job—it is a vocation for them—that they stay on, sometimes without the remuneration they deserve. That may be admirable in the short term, but in the long term it means we have exhausted staff, who work too many hours without enough rest. Their home lives and their family lives suffer as a result. The long-term mental health implications for those who are so focused on helping others that they neglect themselves must be addressed.
To address that, we need better working conditions, less reliance on the bank, and simply more staff working on the floor in wards and taking appointments. We need more GPs, so people can see a doctor when they need to instead of going to A&E because the next doctor’s appointment is not for three weeks. We must ensure that all NHS staff are able to stay in place, or that scenario will worsen. I welcome the Government’s recent NHS long-term plan, which confirmed that the workforce implementation plan expected in April will set out arrangements to help overseas recruitment. The Government have acknowledged the issue and are seeking to act in a positive way. When he responds to the debate, perhaps the Minister will provide some idea of where that is going.
EU nationals make up a sizeable proportion of the health and social care workforce and represent 10% of doctors, 8% of social care staff and 6% of nurses in the UK. They are an integral part of the NHS workforce. It is therefore recommended that the Government take steps to understand any potential impact of ending freedom of movement on the health and social care workforce. There are many options for how best to shape that workforce after the UK leaves the EU, but given our historical reliance on the recruitment of EU workers, it is important that the impact of ending freedom of movement is understood, and we must start a conversation immediately about how best to future-proof the sector. This debate provides us with an opportunity to highlight those issues, and it allows the Minister to respond with, I hope, the answers we seek.
The hon. Member for Argyll and Bute referred to many organisations—there are a large number of such organisations, and it would probably have taken him five or 10 minutes to name them all if he had tried. Specifically, however, Macmillan Cancer Support highlighted that improvements in the diagnosis and treatment of cancer mean that more people are surviving it or living for longer. Some 2.5 million people across the UK live with cancer, and that number is expected to rise to 4 million by 2030. Such figures are great news because they show that there have been significant advances in cancer research, cancer drugs and care, and that our NHS and healthcare system can do lots of good things and help people.
Given the need to support our growing population, we need an immigration system that complements the NHS’s long-term ambitions to improve cancer care across the United Kingdom of Great Britain and Northern Ireland. Across the wider workforce, primary and acute medical and social care staff shortages are impacting on people’s access to cancer care in hospitals and the community. There is a significant variation in vacancy rates, which in many places can be as high as 15% for chemotherapy nurses. In some areas, those shortages in cancer nursing staff are exacerbated by the fact that there is an ageing workforce—the hon. Members for North Ayrshire and Arran (Patricia Gibson) and for Argyll and Bute referred to the fact that the workforce is ageing, and we must prepare for that as well.
In many cancer services, more than 40% of professionals are due to retire in the next 15 years. That issue poses a significant challenge for our current workforce so we should focus specifically on those services, and on those who will be retiring and those who will replace them. That is why this debate is so important. There is a clear need to recruit and train younger staff in specialist and chemotherapy nursing, and that would go some way to countering that shortfall. Will the Minister consider that issue? Will he also consider writing off the student debts of those who serve in local GP clinics for five years? Similarly, the nursing bursary should be reviewed and uplifted, and perhaps we should also consider perks to encourage occupational health therapists to stay in their positions.
I think we have to consider something new when addressing these issues. This is not just about ensuring that immigration fills some of the gaps in our workforce, because we must also address the needs of local people and provide opportunities. Given the nature of our society and jobs, perks can be a methodology for doing that—it is not wrong to offer such measures, because if they bring in the right calibre of staff and help people to stay in their posts, that must be good news. In conclusion, all the issues that I have raised must be priority considerations for the NHS, especially in the light of us leaving the EU, and I seek clarification from the Minister about how they will be addressed.
It is always a pleasure to see a fellow member of the Procedure Committee in the Chair, Mr Bone. I pay tribute to my hon. Friend Brendan O’Hara for securing this debate and for the immense amount of work that he has put into his excellent European Union Withdrawal (Evaluation of Effects on Health and Social Care Sectors) Bill, which I wholeheartedly support.
I had not intended to mention stockpiling today but, like my hon. Friend Patricia Gibson, I was taken aback by how relaxed John Howell was about the issue. My wife has type 1 diabetes and relies on insulin to stay alive, so we in the Linden household are not quite as relaxed about the possibility of insulin shortages. I will leave that point with the Minister.
Despite what some might say, there is no good Brexit, and no deal is as good as the one we have now as members of a 28-strong bloc—I am pretty sure the Minister agrees with that. As my hon. Friend the Member for Argyll and Bute said, our withdrawal from the European Union will have profound effects on the health and social care sectors. This morning I will focus my remarks solely on the impact of limiting free movement of people, and the disastrous consequences that that will have on the health and social care sector.
As Members of Parliament and leaders in our communities, we have a responsibility to be up front and enthusiastic about the benefits of immigration. If we are not, major challenges will come down the track, not just for our economy and public services, but especially for social care. For example, we know that the number of people with dementia is expected to increase by about 40% over the next 12 years, which could mean more people living in care homes. Who will provide that care?
It may be a harsh reality, but the vast majority of people with whom I went to school do not generally like the idea of working in care homes. Quite simply—I would have put this point to David Simpson, but he is no longer in his place—for many people of my generation, the idea of personal care, serving meals or feeding people is, sadly, not attractive. I wish to change that perception, but given the current economic climate, we must understand that young people are not moving towards caring as a career choice. The Government should work to tackle that, but it is a reality we must face. If we do not confront the reality of our ageing population, we will have serious difficulties with workforce planning and meeting the demographic challenges in the years to come.
I also wish to mention some concerns raised by charities that I am proud to work alongside, particularly Children’s Hospices Across Scotland, which does amazing work for children who have life-shortening or life-limiting conditions. Hon. Members will also be aware of the sterling campaign by CLIC Sargent on child cancer costs. We know that leaving the EU without a deal could lead to significant disruption to the economy in the short and medium term. CLIC Sargent has raised legitimate concerns that the impact of Brexit on the economy, and any associated increase in food, travel and energy costs, will lead to increased costs for young cancer patients and their families. When he responds to the debate, will the Minister outline what assessment has been made of the financial impact of leaving the European Union on young cancer patients, and what measures are being implemented to mitigate that?
I am concerned that Brexit will undermine our efforts to meet those profound social care challenges, which is why it is vital that the Bill sponsored by my hon. Friend the Member for Argyll and Bute receives Government support and is expedited through the House. He is right to say that the shambles of the private Members’ Bill process makes it likely that the Bill will die at the end of the week, but if the UK Government are serious about Brexit meaning Brexit, and about us making a success of it, they should support the Bill and ensure that we confront these challenges. If we ignore them, people will look back on us and say, “That was the Parliament that abdicated responsibility.” By taking part in this debate, I wish to place firmly on the record that I did my bit to make sure that we face up to those challenges.
It is an absolute pleasure and a privilege to serve under your chairmanship, Mr Bone. I thank my hon. Friend Brendan O’Hara for his thorough and passionate account of why a clear focus on the health and social care system is so important. That will be true beyond Brexit, but Brexit is our immediate concern, which is why we must give it serious attention.
The NHS does fantastic work. I had the privilege of working for four years in Argyll and Bute, covering the hospital there as a forensic psychologist. Rural hospitals in Argyll and Bute are excellent and innovative in their practice. Even 10 to 15 years ago, when I was working there, we were grappling with the internet and how to engage in therapy on timescales that would best suit patients. The use of technology in those rural areas was innovative, and I commend the NHS staff I worked with, many of whom still work there, for their work to provide fantastic patient care.
Two weeks ago there was an extraordinary meeting when seven all-party parliamentary groups came together to look at health and social care. I am fortunate enough to have been the chair of the all-party parliamentary group on disability since the 2015 general election. The chairs of the all-party groups were there and we brought in carers and service users to speak about their concerns. There is growing concern in Parliament about the NHS, and about the implications of a no-deal Brexit, particularly on medicines regulation and our ability to staff hospitals and provide excellent care, as we always have. It was an important and informative meeting and I suggest to the Government that a further meeting might come out of it, with the all-party group chairs, to hear the views of the service users and carers who attended, and to take forward some of their recommendations. They are on the frontline and know what happens day to day in our services. I am sure that they will be extremely informative and constructive if they have an opportunity to meet the Minister.
When I was a member of the Health and Social Care Committee, we conducted an inquiry into Brexit, medicines, medical devices and substances of human origin. A particular concern was raised about our ability to lead on research trials, and about patients’ ability to participate in trials, particularly on diseases that are perhaps less common but where there is a need to pull in subjects or participants from a huge area such as the EU. Currently, patients here can participate in such trials, and we can also lead on some of them. That has brought some of the best scientists and researchers to the United Kingdom. I would be interested to hear from the Minister how we will ensure that continues. Also, how will our constituents continue to have access to such important trials, rather than having to wait until some way down the line to get new and innovative medications?
During that inquiry, the Select Committee urged the Government particularly to look at regulatory alignment and the implications of no deal. We raised concerns about the lack of references to Brexit in the Department’s single departmental plan. It would be useful to have an update from the Minister on that work, which I am sure is ongoing. There was also some concern about protecting the UK’s position globally in relation to pharmaceuticals. On the matter of full membership of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, reassurance was sought that that matter would be taken up at the earliest opportunity. It would be extremely helpful if the Minister gave an update on that.
The Select Committee recommended negotiating a close relationship with the EU, including associate membership of the European Medicines Agency, and supported the Government’s intention in that respect. Our report stated:
“Failure to achieve an ongoing collaboration would signal the triumph of political ideology over patient care.”
I say firmly to everyone involved, from all parties in Parliament, that patient care must be placed firmly before political ideology. The NHS is one of our most prized institutions—for everyone across the United Kingdom—and must remain so. Our overriding message was that almost all the evidence received suggested that
“the UK should continue to align with the EU regulatory regimes” for medicines and devices. An update from the Minister would be helpful.
Mr Cunningham, who is not currently in his place, made an interesting intervention about predatory procurement. I understand that we do not want to be alarmist in Parliament, but patients bring such concerns to us, so reassurance from the Minister would be helpful. John Howell spoke eloquently about his constituency and talked about diabetes and cystic fibrosis. Many constituents go to their Member of Parliament seeking reassurance about the implications of Brexit for their medicinal needs. The hon. Gentleman also spoke about mental health, which we cannot speak about enough in Parliament, because for many years it was never broached. I am the Scottish National party’s spokesperson on mental health, so I thank him for raising it, because I consider it important for it to be mentioned in as many debates as possible. It has an impact in every part of our lives, and if we are to provide holistic care it must have parity with physical health in all we do.
My hon. Friend Patricia Gibson spoke about medicinal isotopes. There is a huge pharmaceutical industry presence in my constituency, and I have been in touch with those business in the past month. There continue to be grave concerns about alignment and regulation for the industry. I think it is the continuing uncertainty that puts such a burden on businesses.
My hon. Friend the Member for North Ayrshire and Arran also said that one in five GPs are EU nationals and talked about our heavy reliance on workers from the EU, who do a fantastic job in the NHS. A number of witnesses to the Health and Social Care Committee told us just the same. We of course do not want to lose their valuable skills and expertise. They have built bonds with patients—or, if they work in the social care sector, with the people they care for—over a long period of time, and that cannot be overestimated. We must never undervalue their contribution. They need their place to be secure. Many of those workers do not earn over the £30,000 threshold, so we need a specialist case to ensure that the expertise stays in the country to support those vulnerable constituents of ours who need it.
Something that was repeatedly raised with the Select Committee—Jim Shannon also mentioned this—is the fact that we have come to rely on high levels of staffing from the EU and elsewhere. It has been mooted that if we cannot attract staff from the EU, we could attract them from India or perhaps Africa. Those places in particular need their trained staff, and something must be done about training for young people in this country who want to go into health and social care settings.
My hon. Friend makes a good point, but she will be aware that many people who have qualifications are currently not allowed to work by the Home Office. Two of my constituents worked in a care home and it would have loved to have them back, but the Home Office says no. Does she share my frustration that the Government say one thing on the one hand, and then something else on the other?
My hon. Friend makes an excellent point. Things have to be joined up exactly so that we can provide the continuity of care that patients need so much. There are thousands of excellent, high-achieving students who particularly want to study medicine, as well as psychology, occupational therapy and other occupations that are badly needed to support our NHS and our community health services. We must invest in these young people as we go forward. That point was made strongly by the hon. Member for Strangford, who is always an extremely good advocate for his constituency.
I look forward to the Minister’s response on social care, on medicines regulation and on the other issues we have spoken about. My hon. Friend David Linden also expressed concern about social care and those working in care homes. We must make that a more attractive occupation for people coming from school. I did it for a few years before going into clinical psychology; it is a rewarding occupation where carers build a real bond with those they care for. I ask the Minister to meet the APPGs, and I say to him very sincerely that we want to collaborate in a constructive way.
It is a pleasure to serve under your chairmanship, Mr Bone. I am grateful to Brendan O’Hara for bringing this time-sensitive subject to the Chamber for debate. It is my pleasure to speak on what must be the most important subject of the day.
It is true that in June 2016, the majority of people in the UK voted to leave the EU. However, they did not vote for a worsening of health and social care provision, for reduced access to medicines or for fewer nurses, doctors and care workers. They did not vote to damage medical research or to leave vulnerable people without social care. It is therefore important that we turn to some of the specifics and seek reassurance on behalf of the British people.
The question of medicines has been much talked about, not least this week in this place. Coming from a pharmaceutical background, I am extremely worried about the Government’s complacency. This is not about scaremongering; it is about listening to the real concerns of patients, patient groups and medical professions. Contrary to the comments made by John Howell, it is not only helpful but vital for those groups to raise their serious concerns. I agree with the Minister that not only is it not Government advice to stockpile medication, but it is dangerous for patients to do so. One can understand why they might be driven to do so, however; it is an indication of the Government’s failure to provide reassurance on that point.
Medication forms an important part of NHS care. Each year, 1 billion prescriptions are dispensed by community pharmacies. For patients with long-term conditions, such as diabetes, asthma, epilepsy and many more, daily medication is an essential part of staying well. Whether we are talking about medication to treat cancer or heart disease, medication for the management of high blood pressure or the occasional prescription for antibiotics, we take it for granted that the medication that we need will be available when we need it.
The pharmaceutical industry is, by definition, an international business. Key ingredients are often manufactured in India and the far east, and transported to specialist manufacturing plants. Many of the plants that supply the UK are located elsewhere in Europe, and the finished products have to be imported into the UK and distributed to hospitals and pharmacies for use with patients. The entire process has to be carefully managed to ensure that everything happens in a timely way. That is particularly true for medicines with short shelf lives, such as the lifesaving EpiPens needed by those with severe allergies. It is also true for medicines with special storage requirements, such as insulin, which has to be kept refrigerated.
A number of us are deeply concerned that because some people in this place are enthusiastic about Brexit, they are wilfully blind to some of the challenges that the hon. Lady is talking about. Does she agree?
I absolutely agree. We cannot dismiss concerns just because we do not like their implications; it would be irresponsible to do so. Delivery into the UK is currently a just-in-time service for the pharmaceutical industry, for many of the reasons I have mentioned. It is true that in the long term, there is some manufacturing capacity in the UK and we could change the way we get our supplies, but that is not going to happen overnight. It would take a considerable amount of time, given the stringent safety requirements involved in the manufacture of safe medicines, for us to be able to do that.
I am not convinced that we have sufficient supplies or that sufficient steps are in place to ensure an uninterrupted supply. People, including those who rely on insulin, are legitimately worried. Breast cancer care organisations have raised the issue of access to radioactive isotopes needed in the vital treatment of breast cancer. It would be irresponsible of them not to raise that. It is extremely worrying, given that we have only 10 days until the UK leaves the EU, that there are still no arrangements in place. There is no doubt that the UK will need time to establish new supply chains, which is perfectly possible. It is not scaremongering. [Interruption.] I thank the Minister for the comments he has just made from a sedentary position, but we are not convinced. It we were to leave without a deal, the effects would be catastrophic.
The hon. Lady is absolutely right that we should be worried. Just last night, the Government made changes to the human medicines regulations to bring in a serious shortage protocol, under which Ministers would be able to add medicines to a list and designate a shortage. In practice, it will mean that pharmacists can replace prescribed drugs with others at the pharmacy if there is a shortage. Does that not illustrate what she is saying?
The hon. Lady makes a really important point. I would be the first to speak up for the skills of community pharmacists, but that measure is a passing of the buck. It does not put the interests of patients and their safety first and foremost, which is very worrying.
I move on to the life science industry and research, which several Members have touched on. The UK is a world leader in life sciences and a major centre for research. The sector employs 220,000 people and attracts some of the finest research talent in the world. Four of the world’s top six universities for the research and study of clinical and health topics are based in the UK. Biotech company clusters and partnerships are found across the country, making up the largest biotech pipeline in Europe. It is a fact that the UK has been the recipient a bigger share of EU research funding than any other EU nation. It is hard to overstate the importance of the EU to the biomedical sector in the UK and the health outcomes for British patients. Shared initiatives—such as the “New Drugs for Bad Bugs” programme, which aims to tackle antimicrobial resistance—in which pharmacologists from across the EU work together for mutual gain are incredibly important for the future. As we leave the EU, we risk losing the benefits that arise from being a hub for world-class research. The investment, the talent and the infrastructure, including jobs, are all at risk. The removal of those benefits has begun, and arrangements are already in place to relocate the European Medicines Agency from London to Amsterdam.
Time is short, and there are many issues of concern about this subject. One key concern is workforce. I agree with Dr Cameron, and I thank our NHS staff for the tremendous work that they do. I pay tribute to the excellent service that we still enjoy, in spite of the many challenges. It is because of that excellent service that we feel so passionate today; we do not want to lose it. I also put on record my thanks to the care workers, especially those who have helped me to look after my mum. It just so happens that they come from Poland and Latvia, and they are amazing, but their status is at risk.
Hon. Members have talked about the existing challenges in the workforce, and rightly so. We already have a workforce crisis in the NHS and in social care. There are many reasons for that, including some that have already been mentioned: we do not train enough staff; we put up barriers to training, including the removal of bursaries; and working conditions and pay are often not what they should be, as Jim Shannon said. There is no doubt that making it more difficult for EU health professionals and EU carers to work in the UK will not help the situation we face.
The scale of the contribution from the EU cannot be underestimated: 5.6% of the total NHS workforce come from the EU. In addition, we already have 100,000 care workers from the EU working in this country, and we know to our shame that we currently have 1 million vulnerable people with unmet care needs. I appreciate the points that the hon. Member for Henley made about the excellent work in his constituency, but I point out to him that the majority of care for vulnerable people is delivered in their homes—or not delivered, in many cases, which is a massive problem for us.
To replace the EU NHS staff and the contribution that social care workers from the EU make would be extremely costly to the NHS. It certainly will not be a saving to the nation. The worst situation we could face would be if the Government failed to prevent a no-deal situation. There are ways of coping with all the other areas, given time and a transition period. I am keen to stress to the Minister that this is not about scaremongering, but about sensible concerns and a reassurance that sensible provision is in place.
I want to touch on future trade deals. People rightly raise concerns that many of the current problems experienced in both health and social care have arisen as a direct result of the fragmentation and privatisation of provision following the Health and Social Care Act 2012. There is a risk that future trade deals will add to the problem of privatisation.
In the months leading up to the referendum, the people of this country were promised that there would be a Brexit dividend for the NHS, and the figure of an additional £350 million per week—surely the biggest exaggeration of the Brexit campaign—was irresponsibly promoted. However, the reality is that in the light of the Government’s own predictions of low economic growth, there will be less funding for the NHS after we leave the EU. The Government are also very clear that if we leave the EU next week with no deal, the economic cost to our nation will be even greater.
It is our duty to respect the result of the referendum, but as public servants it is our highest duty to ensure that our constituents’ standards of health and wellbeing are protected. The NHS is regularly cited by the British public as one of the greatest achievements of—I have to say—a Labour Government. Brexit was sold as a way to protect the NHS, and no matter how misguided that promise was, as servants of the people we must deliver on it. Protecting the NHS is also the will of people, as they have shown in many elections.
To protect the NHS and to respect the will of the people, can the Minister provide assurances on the specific points that have been raised today? Can he confirm that the Government will rule out no deal and minimise the potential for negative impact on the NHS and social care sectors? Can he demonstrate that he is not ignoring the legitimate concerns raised today and out there in the community, from Members of this place, from patients and their representatives and from healthcare professionals? Can he demonstrate that the Government are listening and have sensible provisions in place, and that they will take every step to avoid a no-deal Brexit next week?
It is a pleasure to see you in the Chair this morning, Mr Bone. I will start by addressing the remark by Julie Cooper. She should know that the whole of the Department of Health and Social Care, and indeed the whole of the Government, are absolutely committed to ensuring that there are in place detailed plans, which I hope I will be able to outline and reassure hon. Members about, to ensure that in any post-Brexit scenario the health and social care of our country’s citizens is our top priority.
I thank Brendan O'Hara for securing the debate and commend him for his private Member’s Bill. He will know that the Government do not support his Bill—although we support the spirit of it—in part because, as the contribution from the SNP Front Bench showed, it is unnecessary. He is arguing for an independent evaluation and careful analysis of Brexit, but I thought the contribution from Dr Cameron, frequently citing the Health and Social Care Committee, proved that there is a huge amount of independent evaluation, accountability and scrutiny of the plans.
The hon. Member for Argyll and Bute raised a number of questions. I have with me a prepared speech, but I am not sure I will get on to it, because I want to address as fully as I can some of the concerns that hon. Members have raised. He raised a number of concerns about the social care sector, and he is right to do so. Brexit or no Brexit, it is a fragile sector and any event could hinder care provision. That is why, in the light of Brexit, we are working with the sector and local authorities to ensure that we have contingency plans in place.
I will speak more, if I have time, about what we have done regarding EU nationals in the short term, but I want to stress, as the hon. Member for Burnley did, my thanks to all EU nationals who work in either the healthcare system or the social care system. They play a crucial role in delivering high-quality health and social care, and we all recognise that. It is a fact, of course, that the number of EU nationals in adult social care has increased each year, from about 5% in 2012-13 to 8% in 2017-18, but that is no reason to be complacent. That is why we have put in mitigations regarding the EU settlement scheme and are implementing long-term policies to deliver the workforce and address the supply-demand gap that exists.
The hon. Member for Argyll and Bute will of course have noticed the recent recruitment plan, Every Day is Different, which started only last month. As he challenged me directly on this, I can say that we are currently in discussions with the Home Office about the salary threshold for social care.
My hon. Friend John Howell spoke eloquently, as he always does—I have heard him speak in several of these debates—about Henley and other matters. He challenged me to visit Henley, which I would be delighted to do—perhaps on a Friday in July, when other events are on as well.
Patricia Gibson asked a number of questions. I made this clear at the start of my speech, and I will make it clear again directly to her: we value all the professionals who work in the national health service and the social care sector. We are putting plans in place, both short term and long term, to ensure that our words are followed by actions and there is practical support, and to ensure that people know how much they are valued. I heard her charge of arrogance, but she might like to reflect on the fact that some might consider it arrogant to suggest in any way that this Government are not putting in place all the necessary preparations to protect the NHS.
I will not take an intervention. If the hon. Lady listens carefully to my remarks, she will understand why some of us feel that her charge was unfair.
I am about to, if the hon. Lady will give me time, which is why I will not take her intervention.
Jim Shannon asked about NHS investment. He knows, of course, about the increase in cash terms of £33.9 billion by 2023-24, which reflects, as I said at the outset, our top priority. He also challenged me about the cancer workforce. Baroness Dido Harding, the chair of NHS Improvement, is carrying out a rapid programme of work for the Secretary of State, engaging with relevant stakeholders across the system to build a workforce implementation plan, which the hon. Gentleman mentioned. We have charged her with making sure that her plan matches the long-term plan’s ambitions. The hon. Gentleman will know that the long-term plan superseded previous plans to establish a larger cancer workforce, and Health Education England is now working with Baroness Harding to make sure that is in place.
I listened carefully to David Linden, who asked important questions about insulin and the financial impact of leaving the EU on cancer patients. My officials spoke this morning to insulin suppliers, who have increased their buffer stocks so that they will hold 16 weeks of additional stocks over and above their normal supply. [Interruption.] Yes, it is stockpiling, but it is stockpiling that we have asked the whole pharmaceutical industry to undertake. As the hon. Member for Burnley rightly pointed out, there should be no stockpiling by individuals or pharmacists. I will explain the whole stockpiling issue and why we are rightly putting in place buffer stocks to ensure continuity of supply. The hon. Gentleman asked me whether buffer stocks of insulin are in place, and I can confirm that they are.
The hon. Gentleman also asked me what assessment has been made of the financial impact of EU exit on cancer patients, and what measures are in place to protect services. He will know that the long-term plan contains clear proposals for improving cancer diagnoses. That plan is fully costed. As I just said in response to the hon. Member for Strangford, the workforce implementation plan is putting in place the cancer workforce.
I also listened carefully to the hon. Member for East Kilbride, Strathaven and Lesmahagow, who asked whether my door was open to chairs of all-party parliamentary groups. The answer is yes, of course. If she wishes to contact me, I would be delighted to engage with her, and with chairs of other all-party parliamentary groups.
It is also worth putting on the record the relationship that we are likely to have with the European Medicines Agency post Brexit. The Government are clearly striving for a deal, and in the light of the withdrawal agreement being signed, the political declaration sets out that it is the UK’s intention to explore the possibility of EMA co-operation during negotiations on the future framework. In the event of no deal, we would clearly no longer be any part of the EMA, and the Medicines and Healthcare products Regulatory Agency is ready to carry out EMA functions as a sovereign regulator.
To ensure the continuity of supply, the UK will continue to accept batch testing of human medicines carried out in countries named on a list by the MHRA, including EU, European economic area and European Free Trade Agreement countries, and most third countries with which the EU already has in place a mutual recognition agreement.
I thank the Minister for giving way; I know there is a lot that he wants to say. As he is talking about ensuring the supply of medicines, can he reassure the House that that includes medical isotopes?
I reassure the hon. Lady that we have been working since last August to ensure that companies understand the routes available to maintain continuity of supply, including air freight routes. We will ensure the potential use of those alternative shipping or air freight routes because, as she rightly points out, these are short-life products. The worst-case scenario—no deal—has been looked at, and routes will be available to ensure that medical isotopes can continue to come into this country.
The hon. Lady referred in her speech to the operationalisation of those plans, which is relevant. Normally, if sea routes are used, it can be ensured that medical isotopes or short-life products are at hospitals by 9 am. She referred to the likelihood that, if air freight routes are used, those products would not arrive until midday, which the NHS advises us would mean that some clinics would be likely to be rescheduled to later in the day. People’s opportunities to undergo treatment will not be interrupted.
I hear what the Minister says about making his best efforts to ensure that there is no interruption of supply. However, does he accept that, as of yesterday, health professionals who deal with this were not reassured? We could be in a no-deal situation in just over a week’s time. Will these arrangements hold good in a no-deal situation? Will he assure us that those vital isotopes will be in the places where they need to be?
Had the hon. Lady joined me in walking through the Lobby to vote for the withdrawal agreement—so that Brexit would happen on
In the short time I have left, I will stress the continuity of supply. It is essential that any responsible Government, even if they wish for a different outcome, should prepare for the outcome that they do not want, which in this case is no deal.
I want to give the Minister the opportunity to answer the question I asked about the long-term plan to fill those hundreds of thousands of vacancies now and in future, and to reassure supporters of my Bill that health and social care will not be adversely affected by the UK leaving the EU. I would be hugely grateful if he did so in the next three minutes.
There are so many issues that I could tackle in the next three minutes. However, as the hon. Gentleman will have seen, the long-term plan has ambitions to ensure that there are new routes into nursing and that there are extra doctor training places. I said in response to the hon. Member for Strangford that we have commissioned Baroness Harding to start a workforce implementation plan. I assure the hon. Member for Argyll and Bute that driving down the number of vacancies is a priority for the Government. However, he will recognise that several of those vacancies are not necessarily unfilled posts, because they are usually filled by staff from the temporary staff bank. We need to be clear about what we are talking about. Recruitment into our national health service and our social care system is absolutely a key priority.
My Department has overall responsibility, on behalf of the devolved Administrations, for ensuring the continuity of supply of medicines and medical products. All supply arrangements take into account the whole of the United Kingdom. We have had significant support from, have given reassurance to and are constantly working with the pharmaceutical industry, the whole of the medical supply industry, clinicians and patients, and I am delighted to say that last week we held a roundtable with the devolved Administrations, so that their concerns could be listened to and directly addressed.
Several Members commented on stockpiling. We recognise that if we leave the EU without a deal, the medical supply chain will come under a lot of pressure. Around three quarters of the medicines and more than half the clinical consumables that we use come from the EU. Since last August we have been working with the industry to ensure that, before
We have also advised companies that if they are likely to face difficulties in their supply routes, there are ways of bringing in supplies outside the normal short straits route, either by using existing services or by making use of the additional capacity that the Government have procured. We are reliant on transport and freight being re-routed, but I am confident that, if everyone—including suppliers, freight companies, the health and care system and international partners, all of whom we have worked with since last August—does what they need to do and have committed to doing, the supply of medicines and other medical products will be uninterrupted.
I had intended to deliver a rather longer speech this morning, but I thought it was important to try to answer directly the questions put to me by hon. Members. There is no doubt that many areas of the health and care system will be directly affected by EU exit. We do not have time to address those today. However, it is important that the country knows that the Government are committed to ensuring that, whether we leave with or without a deal, we have in place the contingency plans needed to meet those challenges.
Order. I apologise to right hon. and hon. Members, but time has beaten us. I place on the record my particular thanks to the Minister for not reading a prepared speech and for dealing with the questions that Members asked.
Motion lapsed (