Covid-19

Ian Murray Excerpts

Monday 16th March 2020 Commons Chamber

[Matt Hancock]

The answer to the second question is yes. The answer to the first is yes, people should go outside. Walk your pets. People in household isolation should go out, but they should try to avoid other people. It is very important that we look out for others in our communities and that people get the exercise they need.

[Ian Murray (Edinburgh South) (Lab)]

I realise that this is not in the Secretary of State’s remit, but he announced that the Government will advise people not to go to pubs, clubs, restaurants and so on. Unless the Government mandatorily close them down, they cannot claim on their business insurance. Will he please get a diktat from the Government that formally closes such businesses down?

[Matt Hancock]

We have set out the advice today, and I will look at the point the hon. Gentleman raises.

Oral Answers to Questions

Ian Murray Excerpts

Tuesday 19th February 2019 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

7. What progress his Department has made on contingency planning for the UK leaving the EU without a deal.

[Ian Murray (Edinburgh South) (Lab)]

17. What progress his Department has made on contingency planning for the UK leaving the EU without a deal.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Leaving the EU with a deal remains the Government’s top priority, but we are preparing for every eventuality. I am confident that if everyone does what they need to do, the supply of medicines will continue unhindered.

--- Later in debate ---

[Matt Hancock]

Yes. Whereas across all medicines we have requested that the pharmaceutical industry has an extra six weeks of supplies in case of a no-deal Brexit, in the case of insulin the two major providers have already made stockpiles of at least double that. That shows that those with concerns about access to insulin can know that the plans we have in place for insulin are being enacted even more strongly than elsewhere.

[Ian Murray]

But the Secretary of State is refusing to provide any reassurance to constituents up and down the country, and particularly to my constituents. I got an email yesterday from a constituent—I have no shame in quoting this—who said:

“I have type 1 diabetes, as does Theresa May, and the supplies of insulin, needles and blood testing equipment all come from Europe. Insulin is perishable. Without it, so am I.”

Will the Secretary of State come to the Dispatch Box and say to my constituents that, whichever disease they have and whichever medical supplies they require, they will get them even if we leave the European Union with no deal? Would not the best thing to do be just to rule out no deal?

[Matt Hancock]

I have already given the assurance that if everybody does what they need to do, I am confident that supplies will be unhindered. In the case of insulin, the stockpiles are already double what we requested. However, on the point about the deal, the hon. Gentleman has a really important point about ruling out no deal being the best thing for people’s supply of medicines. He knows as well as I do that if we want to rule out no deal, we need to vote for a deal, so he and everybody in this House should vote for the deal.

Oral Answers to Questions

Ian Murray Excerpts

Tuesday 15th January 2019 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

2. What progress his Department has made on contingency planning for the UK leaving the EU without a deal.

[Ian Murray (Edinburgh South) (Lab)]

3. What progress his Department has made on contingency planning for the UK leaving the EU without a deal.

[Tommy Sheppard (Edinburgh East) (SNP)]

18. What preparations his Department has made for the UK leaving the EU in March 2019.

--- Later in debate ---

[Matt Hancock]

It is incumbent on me as Health Secretary and on my team to ensure that we prepare for all potential scenarios. Of course, because of the overwhelming vote of the House in favour of the withdrawal Bill, no deal is the law of the land unless the House does anything else. If the hon. Gentleman is so worried, the best thing that he and all his friends can do is vote for the deal tonight.

[Ian Murray]

Would it not have been a better use of taxpayers’ money to have spent hundreds of millions of pounds on frontline patient care rather than on no-deal planning? The Secretary of State has just said to my hon. Friend the Member for Ilford North (Wes Streeting) that the Government have to prepare for all possible scenarios. A responsible Secretary of State would rule out one of those scenarios, which is no deal.

[Matt Hancock]

As I said, thanks to the votes of Members in all parts of the House, no deal is a matter of the law of the land. They can’t get away from it: if they don’t like no deal, they need to join me in the Lobby tonight, and vote for the Prime Minister’s deal.

Paediatric Cancers of the Central Nervous System

Ian Murray Excerpts

Monday 22nd October 2018 Commons Chamber

[Chris Elmore]

I agree entirely with the hon. Gentleman. I hope my speech will go some way to highlighting that more work is needed, and to paying tribute to parents and families who have lost children through this horrendous condition.

Cian was first diagnosed with an atypical teratoid/rhabdoid tumour in 2015, when he was four years old. This type of tumour, often called an AT/RT, is a very rare and rapidly growing tumour of the central nervous system. Cian’s primary tumour was found on his spine, with seeds of the cancer also found in his brain. In the majority of cases, AT/RT is associated with a specific genetic mutation, INI1, which can occur spontaneously or be inherited. However, genetic testing in Cian’s instance did not indicate that he had this specific mutation. Cian’s tumour was located on his spine. AT/RTs are generally located anywhere in the brain, but are most commonly found in the cerebellum—the base of the brain—and in the brain stem, which is the part of the brain that controls basic body functions. The fact that Cian’s tumour bucked this trend made a difficult medical situation even more complex. AT/RT was previously thought to have been a type of medulloblastoma. However, it is now known that this is a totally different type of cancer and cannot therefore be treated via the same methods.

Mercifully, childhood cancer is rare in itself. The majority of children who are sadly subjected to this disease are diagnosed with a form of leukaemia. Brain tumours are much more rare, and AT/RTs make up only between 1% and 2% of these cases. I hope this illustrates just how tragic it was that Cian contracted not just cancer, but a cancer of the rarest of forms. This, however, is exactly why we have to do something. We have to do something to remember Cian and ensure that his legacy is that other families may be prevented from suffering a similar fate.

[Ian Murray (Edinburgh South) (Lab)]

I congratulate my hon. Friend on his wonderful speech and pay tribute to Cian’s family for all they have done on this issue. Will he join me in paying tribute also to Cancer Research UK, which in the past 12 months has tripled its funding for brain cancer research, understanding that it has been under-researched up to now? Should we not be encouraging the Government and working with them to do all they can to ensure that research into these key cancers continues?

[Chris Elmore]

I agree entirely. I am sure the Minister will set out the extra work the Government here and the Administrations in Scotland, Cardiff and Belfast are doing.

The very fact that these cancers are rare often makes it difficult to get a research cohort together, but we cannot allow that to be a barrier to finding new treatments and even cures for such illnesses. The treatments currently available for childhood cancers in the brain or spine tumours range from neurosurgery to radiotherapy, chemotherapy and steroids, and finally proton beam therapy. The course of treatment is tailored to the individual case, with patients typically undergoing multiple treatments. Sadly, AT/RT patients do not typically have good survival rates, and outcomes are poorer if a child has signs of tumour spread at diagnosis. We cannot accurately predict the outcome for any individual child who has developed such a tumour, but children diagnosed who are less than 12 months old are less likely to be able to fight the disease.

It will come as no surprise to hon. Members when I say that the key to fighting this disease in the long term lies in medical research. There are many competing priorities in medical research, with many historic frontiers yet to be conquered, but we must ensure that all forms of illness that cause pain and suffering receive the attention and the willingness to tackle them they deserve. I welcome the announcement from the Department of Health and Social Care earlier this year that the UK will invest £20 million in brain tumour research over the next five years. In addition, Cancer Research UK is investing £25 million to support that work. Will the Minister say what percentage of that funding will be used specifically for research into paediatric cancers?

Oral Answers to Questions

Ian Murray Excerpts

Tuesday 8th May 2018 Commons Chamber

[Jackie Doyle-Price]

I can confirm that we will continue to look at that. The hon. Lady is right that a large number of countries fortify flour with folic acid, but the UK and other EU countries do not. We have advice that if the intake of folic acid exceeds given levels, that can also bring health problems, but we will continue to look at it.

[Ian Murray (Edinburgh South) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

I would like to give an update on the breast cancer screening failure. I met the Public Health England chief executive this afternoon, and I am informed that 65,000 letters were sent out last week, and the helpline has taken nearly 14,000 calls to date. Further letters are going out this week, and the first invitations to catch-up screenings will go out next week. Due to the lack of clinical consensus about the effectiveness of screening for older women, we will provide advice and support for all who missed scans and support them in making their own decision as to whether to proceed. We will also publish the terms of reference for the independent inquiry shortly, and I can assure the House that no stone will be left unturned in uncovering the truth.

[Ian Murray]

I am grateful to the Secretary of State for that update, but I would like to ask him about the Brexit transition agreement, which cuts the UK out of the European Medicines Agency. Can he give this House a cast-iron guarantee that that will not stop the regulation of new drugs in the UK to help patients, and will not prevent our world-class pharmaceutical companies from basing themselves here to do world-class research and development?

[Mr Hunt]

Yes, I can.

Diffuse Intrinsic Pontine Glioma

Ian Murray Excerpts

Tuesday 14th November 2017 Commons Chamber

[Ian Murray (Edinburgh South) (Lab)]

I thank Mr Speaker for granting me this important Adjournment debate on diffuse intrinsic pontine glioma, a rare form of childhood brain tumour.

I applied for this debate to raise awareness of DIPG, to highlight the need for more research and development, to try to get better treatments and to bring to this Parliament the heroic story of seven-year-old Luke Stewart, his mum, Jennifer Ure Stewart, his dad, Mark and his grandfather, Robert Ure. DIPG is an aggressive form of tumour on the brain stem. Fewer than 40 children a year in the UK develop them, but they account for 10% to 15% of all brain tumours in children. In October 2017, it has been reported officially that 38 children died of DIPG, and there is no cure.

Although rare, DIPG is actually the second most common type of primary, high-grade brain tumour in children. It originates in the area of the brain stem called the pons, the area of the brain that is responsible for a number of critical bodily functions, such as breathing, sleeping and blood pressure. Not all cases of DIPG are identical, and it can affect each child differently, including through pressure on the cranial nerve, long tract or cerebellum. Childhood brain tumours are classified according to the type of cells—whether they are diffuse or focal—and the grade of aggressiveness. These particular tumours are high-grade, aggressive and relentless, growing extremely quickly, often spreading throughout the brain stem and into the spinal cord. Sadly, this means that they are very dangerous, difficult to treat and have a poor prognosis. Although it is not yet known what causes DIPG tumours, there is currently ongoing research aimed at discovering their genetic causes, which could help early detection and the development of future treatments.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this important issue to the House at such a late hour. DIPG is one of those diseases for which there is no treatment, no cure and no survival rate, but if we are to find a way forward, we need research and development. I hope that the Minister will respond positively to the hon. Gentleman’s request. Does he feel now is the time for that research and development to take place?

[Ian Murray]

I thank the hon. Gentleman for his intervention. I shall come on to the subject of research and development. I have been in the House for seven years, and I live in hope of receiving a positive response from the Treasury Bench. Perhaps tonight we will get that far; indeed, I am sure that we will.

I welcome the research that is being done, but the current lack of sufficient research, available information, awareness of the condition and effective treatments can make DIPG all the more distressing for those diagnosed with it, as well as their extended families.

When it comes to treating the tumours, patients are usually offered courses of radiotherapy over three to six weeks. Because of the dangers of operating on such a critical area of the brain, surgery for some is simply not an option. In the UK, various studies show that chemotherapy is ineffective in treating childhood DIPG, although it is used in innovative ways in other countries, such as Mexico. I shall say more about that shortly.

Because the treatment options are extremely limited, the prognosis for children diagnosed with DIPG is poor. Although each child’s condition is unique, 70% of children with DIPG are not likely to survive for more than a year after diagnosis, and 90% do not survive for two years. The lack of knowledge of the condition means that children and their families are living from day to day. Greater investment in research on the condition might bring us one step closer to finding out more about the specific genes and molecules involved in DIPG tumour formation. That vital research could go on to create innovative new treatments, meaning that 40 more children each year—those who are struck down by the disease—could go on to become the doctors, scientists and even politicians of the future. It is important that we give those children the opportunities that they deserve, and give their families the hope that they need.

The famous astronaut Neil Armstrong’s daughter Karen died of DIPG 40 years ago at the age of just two, yet to date there have been very few advances in the treatment offered, which is devastating for parents. One such story is that of Luke Stewart. Luke is a seven-year-old boy who is happy, healthy, active, kind and caring. He comes from a loving family—mum, dad and two little brothers: Lewis, who is five, and Lochlin, who is just one. In January this year, their world was blown apart when Luke was diagnosed with DIPG. Doctors advised Luke’s mum and dad that he could survive for six to nine months if he received radiation treatment, the only option offered by the NHS in the UK. I cannot imagine what that kind of news does to a parent.

The family were informed that radiation treatment would prolong Luke’s life by only a few months, and that, although it would make him more comfortable, he would not survive. They were advised by the NHS that there were no other treatments available worldwide, or any clinical trials, that could help their son, and that on completion of the radiation treatment he would receive only palliative care. They were broken by that news, but they knew that they had to keep fighting for Luke, so they began to search for hope elsewhere. That was the start of their incredible journey to Mexico to save their son’s life. The journey to Monterrey began when, during a visit to the Chelsea football club training ground, they met a family from London whose daughter had the same condition. They had known of each other from Facebook conversations, but were totally unaware that both families would be at the venue at the same time. The London family were leaving for Mexico within days so that their daughter could receive a new, ground-breaking treatment.

That gave the Stewart family renewed hope. They researched the entire programme, which is called intra-arterial chemotherapy. Catheters are placed in the basilar and femolar arteries, and systematically deliver drugs approved by the Food and Drug Administration into the brain stem. The treatment has also been combined with intrinsic and T-cell immunotherapy. The Stewart family left for Mexico at the beginning of May, when they witnessed Luke’s condition deteriorating rapidly. This was the only hope that they had to offer him at that time: it was their last hope. Not only were they in emotional turmoil, having to deal with such a devastating situation, but they had to fundraise continually to secure money for the treatment.

[Wes Streeting (Ilford North) (Lab)]

The London family to whom my hon. Friend referred are constituents of mine, the Lau family. No one can imagine what a family goes through following a diagnosis of this kind, but I have been struck by how much more pressure is placed on families who are willing to move heaven and earth—and literally move across the earth—to ensure that their children have access to treatment that could potentially extend their lives, but at considerable cost. Does my hon. Friend agree that the Government should look urgently at what can be done to make sure that no families who can have access to treatment are prevented to do so by financial barriers?

[Ian Murray]

Absolutely, and that is one of my key asks of the Government. Indeed, when a family are put in a situation where they are about to lose their child, they only have the hope of trying anything they can find, and many families, including my hon. Friend’s constituents, have made the journey to Mexico.

When Luke arrived in Mexico with his family, it made him the seventh child worldwide to receive this ground-breaking treatment; he was also the second child from the UK. The website makingdipghistory.com is where people can see more about this condition and its history.

Luke’s clinical condition on his arrival in Mexico was extremely serious. This once active, confident and independent little boy could not walk properly, was constantly falling over, and was always tired, and his previously happy demeanour had changed completely. During this period, he regularly talked to his parents about dying—no words a parent should hear from their child.

The family spent four months in Mexico. During this time Luke received six IA treatments and four immunotherapy treatments. The costs associated with these treatments and all living and travelling expenses were self-funded by the family as the result of the generosity and financial support they received through their justgiving.com page.

During this period, Luke’s clinical condition improved dramatically; he was outgoing, happy, walking without any risk of falling over, running, playing with his brothers, communicating normally with his family, and making no further mention to his parents about dying. In the time that Luke had been receiving his treatment, his tumour had shrunk, the cancer activity was lower, his new cell generation was high, and his cyst had shrunk and become pure fluid. His clinical improvement means that he can live life as a seven-year-old in the knowledge that he is 11 months past diagnosis, a point at which the NHS said he would not survive. As if it was a miracle, he is now back at school. It is too soon to tell, but Luke’s improvement is an enormous step in the right direction. Cancer treatments are by their very nature evolutionary, so do we not need to embrace this treatment instead of ignoring it? Luke’s parents had no hope—their son would die. They had to at least try. Luke and his mum, and often his grandad, Robert, now require to go back to Mexico every five weeks for a period of five days to ensure that he continues to receive these ground-breaking treatments.

Before and after each treatment, Luke gives a sporty thumbs-up to tell the world on Twitter that he is okay, and now people from all over the world are posting selfies at #thumbsupforluke. We can follow everything about Luke at his Facebook page, “Help Luke make history”.

It is important to highlight the incredible resilience of families, just like Luke’s, who do not take no for an answer and carry on fighting, searching for access to treatments that could save their child’s life. The family have asked me to express their heartfelt thanks to all who have supported Luke’s crowdfunding campaign, which has managed to raise over £180,000 of the £350,000 to fund his treatment in Mexico. There is no NHS or other Government resources to financially support families when they have to have treatment elsewhere outside the NHS.

So what about the future? Not only do advances in research help progress new treatments, but that will also allow us to instil awareness of this rare condition throughout our healthcare system. This will help us improve the level of support we provide to the family. It is usually left to the parents and families to search the internet for ways to find help, with most healthcare providers in the UK left with their hands tied, with limited treatments to offer. As I have mentioned, Luke’s family were incredibly lucky to have such a successful crowdfunding campaign, but that is not available to everyone, and they still need more help.

The level of support for families is simply not good enough. We need extra support as soon as a child is diagnosed, and it must be support which recognises the fast-acting nature of the disease. Families will experience extreme pressure on their relationships, as they have to come to terms with understanding such a rare condition, as well as the huge financial turmoil that can come with a diagnosis. DIPG, as well as other childhood brain tumours, have a huge impact, and that is why I am asking for more investment, and more research and development to create that awareness and hope of a cure.

So may I ask the Minister to look at developing greater incentives for research and development into DIPG, so that families and children can access the support and information that they require at their time of need? May I also raise the critical issue of funding for research as a whole? Following a debate on childhood brain tumours in this House last year, it is very welcome that the Government set up a working group, looking at how to increase the impact and quantity of brain tumour research. I look forward to the group’s second report, which is due to be released imminently; perhaps the Minister can give us some guidance about when this report might be released.

I acknowledge that a significant amount of money is already contributed through the National Institute for Health Research and the Medical Research Council, but much more needs to be done, and quickly. I hope that the Budget at the end of this month will contain an allocation for this kind of research. Some progress is being made with a programme called Instinct, involving pioneering research by experts from Newcastle University, the Institute of Cancer Research and the University College London institute for child health, which looks at high-risk childhood brain tumours, including DIPG. This extremely important effort is led by Dr Chris Jones, who has extensive experience in understanding the genetic basis of these tumours and what is driving tumour growth.

Can the Minister confirm that when the UK leaves the European Union, the UK medical research community will continue to have access to critical EU funding and collaborative programmes once Horizon 2020 has ended? Given Luke’s example, and the fact that the family have had to go to Mexico, it is essential that co-operation on research is global, so that every child in need of help can access it, no matter where they are. Could Luke’s case be the pathway for better treatments and understanding of DIPG here in this country?

The number of children dying from cancer each year in the UK has fallen in the last 20 years, but we must not stop here. Research is the key to our progress. It is not right that the rarer a cancer is, the less attention is paid to the funding of research. There must be a unified approach in applying the progress that is made. The rarity of such conditions means that they accumulate to a far smaller market for pharmaceutical companies, which tend not to supply the drugs that are required. Research and development is difficult, particularly in relation to children.

I know that it would mean a lot to Luke and his family if the Minister or even the Prime Minister could meet them to talk about their experiences and listen to their views on how research, funding and information in this area might be improved to secure a better future for all children with DIPG. Will the Minister make that commitment to meet the family? I would like to finish by paying tribute to the resilience of Luke and his family, and of all the other families who continue to fight for their children. I hope that this debate has made a small dent in raising awareness of DIPG and other killer cancers in children. Luke has a chance, his parents have hope, his extended family have pride, and we all watch and admire their strength, resilience, dignity and love for Luke. Let us use this half hour of valuable parliamentary time to make a difference to all families who are affected by DIPG and similar diseases, and to give those children hope.

--- Later in debate ---

[Jackie Doyle-Price]

I acknowledge the hon. Gentleman’s point, but the stress would be removed if we could actually investigate whether the treatment could be offered here, rather than have people travelling to Mexico. My priority will be to encourage discussions to enable that to happen.

Turning to some of the research that is happening at Great Ormond Street, which is the centre of excellence where we want childhood cancers to be tackled, research is being undertaken to develop T-cell immunotherapy delivery to tumours and selective therapies based on the molecular profiles of tumours. The research centre at University College London is also researching tumour markers and drug uptake. I am pleased to say that the NIHR clinical research network is supporting the NHS to deliver three clinical trials of new treatments for children with diffuse intrinsic pontine glioma. In the summer, Cancer Research UK announced its intention to fund up to two brain tumour centres of excellence to support multidisciplinary research, and the NIHR stands ready to provide full support to those new centres, together with other centres already funded by other charities, in delivering their research in the NHS. The working group is chaired by Professor Chris Whitty, the Department’s chief scientific adviser. The report is being finalised, and it should be ready before Christmas.

We know that early diagnosis is essential for all cancers if we are to provide the best treatment and support from the very start. I therefore welcome initiatives such as HeadSmart, which is working to increase awareness of the common signs and symptoms of brain tumours in babies, children and teenagers. The Department encourages the use of that initiative by professionals to signpost specialist advice, if needed, and the Department has promoted the awareness campaign with colleagues in NHS England, health visitors and school nurses.

The Government are also funding a radical upgrade of equipment to treat cancer, including £130 million to modernise radiotherapy across England. In April 2012 the Government announced a £250 million investment to build proton beam therapy facilities at the Christie Hospital in Manchester and at University College London Hospitals. The more precise targeting of radiotherapy afforded by this treatment means that higher doses can be delivered with fewer side effects and fewer long-term consequences, which is particularly important for paediatric patients.

We support the Less Survivable Cancers Taskforce, which also launched earlier this year. The taskforce aims to raise awareness of five cancers, including brain cancer, where survival rates have remained stubbornly poor for decades. The taskforce is also working to increase the number of clinical trials and treatments approved for those cancers as well as the level of research invested in them.

Despite the difficulties involved in researching new treatments for diffuse intrinsic pontine glioma, important studies are under way.

[Ian Murray]

I am grateful to the Minister for giving us a fairly comprehensive answer, and indeed some hope that progress is being made on this issue. Will she pick up on the issue raised by Luke’s parents? They would like to meet her to discuss not just their experience but how Luke could perhaps help with some of that research. It would be great for her to hear directly from the parents so that she can get a full picture. It is not just about research and development; it is about their whole experience of being parents of a child with the disease.

[Jackie Doyle-Price]

I would be more than happy to meet Luke and his parents. As well as researching the symptoms and the possible treatments for this disease, we need to understand the experience that families go through, because support for families has to be part and parcel of the treatment. I would be delighted to hear from Luke’s parents to learn from their experiences.

We often look at these things in a very clinical way—it is clinical practice—but we are talking about human beings and we are talking about lives. There is no substitute for bringing home exactly what we are talking about when young children are suffering with such a pernicious disease.

We will build on the studies I have outlined, and we will ensure that the funding provided for research results in better outcomes for those who are suffering, particularly where they are children, but we should remember there is hope. We heard Luke’s story, and we heard that he is at school. He has lived longer than his initial prognosis, so we wish him well. We have much hope.

Here on the Front Bench next to the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Hexham (Guy Opperman), and looking at the hon. Member for Sheffield Central (Paul Blomfield), I am struck by the fact that both have lived through brain tumours and come out the other side. They are an inspiration, and they show that, with the right treatment, people can live despite having a potentially killer disease.

It is my job as a Minister, and it is the job of the Department of Health, to ensure that we leave no stone unturned in making sure that we get the best possible treatment for anyone who suffers from these conditions.

National Health Service (Amended Duties and Powers) Bill

Ian Murray Excerpts

Friday 21st November 2014 Commons Chamber

[Ian Murray (Edinburgh South) (Lab)]

My hon. Friend is making one of the best speeches we have heard in this Parliament about protecting our national health service. Does he agree that another way we could prevent private providers from competing in the national health service would be by persuading this Tory Government to exclude the national health service and other public services from the transatlantic trade and investment partnership negotiations?

[Clive Efford]

My hon. Friend has guessed the next part of my speech. Part 4 of the Bill deals with TTIP. I have heard some criticisms that the Bill does not protect the NHS from TTIP. Clause 14 reads:

“No ratification… of the proposed Transatlantic Trade and Investment Partnership Treaty shall cause any legally enforceable procurement or competition obligations to be imposed on any NHS body entering into any arrangement for the provision of health services in any part of the health service.”

There are differing legal views on whether the proposed TTIP will or will not impose legally enforceable procurement or competition obligations on the NHS. However, without this clause the question of which set of highly paid lawyers is right will be decided only after the treaty is signed and will be a decision for the courts, not the elected Government. I am sure that is music to the ears of Government Members.