Oral Answers to Questions

Marion Fellows Excerpts

Tuesday 29th October 2019 Commons Chamber

[Kerry McCarthy (Bristol East) (Lab)]

4. What progress has been made in enabling the provision of Orkambi on the NHS.

[Marion Fellows (Motherwell and Wishaw) (SNP)]

18. What progress he has made on increasing access to drugs to treat cystic fibrosis.

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

I am delighted that a deal has been agreed to provide Orkambi and other cystic fibrosis drugs on the NHS. This deal is great value for the NHS and backed by the National Institute for Health and Care Excellence, but crucially it will improve thousands of lives. My heartfelt thanks go out to many campaigners from right across the House who have pushed this agenda but especially to the Cystic Fibrosis Trust and the patients who, along with their families, have bravely campaigned against this devastating disease. I am thrilled that we can make this progress.

--- Later in debate ---

[Matt Hancock]

Absolutely. I pay tribute to the hon. Lady, who raised that case with me last night and gave me advance warning that she would raise it in the House today. I shall be happy to ensure that the relevant member of the team meets her with her constituent, if appropriate, so that we can get to the bottom of this.

[Marion Fellows (Motherwell and Wishaw) (SNP)]

I want to associate myself with the thanks to all the campaigners who worked so hard to ensure that these drugs would be available in England as well as Scotland. I never doubted that my Government would press and press, and I am delighted that the Secretary of State’s Government have followed suit. However, there are still great Brexit uncertainties. Given that people fought for so long, what reassurances can the Secretary of State give those who will obtain these life-saving drugs that they will be possible, affordable and sustainable?

[Matt Hancock]

The agreement that the hon. Lady’s Government—the UK Government—reached with Vertex means that this drug will be available in Wales and Northern Ireland as well. It is true that Scotland chose to go it alone and as a result has not received such good value for money, but what really matters is that the drug is now available throughout the United Kingdom.

Community Pharmacies

Marion Fellows Excerpts

Wednesday 2nd October 2019 Westminster Hall

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a pleasure to serve under your chairmanship, Sir David, and I congratulate the hon. Member for Halifax (Holly Lynch) on bringing forward this important debate. I do not want to spend too much time summing up and repeating what has already been said by other Members—I have a list of them here—because I want to leave time for the hon. Member for Washington and Sunderland West (Mrs Hodgson) to make her case and for the Minister to answer the many questions that have been asked—I know she will appreciate that.

As everyone here should know, the NHS operates differently in Scotland. There are many plus points to being a patient and a user of community pharmacies in Scotland, not least of which are free prescriptions for all and the way the Scottish Government value and support local pharmacies. As we are all aware, pharmacists are in a unique position to improve medication safety. They have the time and clinical expertise to make a difference to how patients manage chronic conditions, for which they might be taking multiple medications.

For many patients, it is probably much easier to consult a pharmacist than a GP. The community pharmacy often becomes the de facto community health centre, and most of us know the value of what those centres do. They can be the first point of care, and how many of us here have just popped into the chemist for a bit of advice when we did not feel well, taking some strain off our GPs?

I pay tribute to my local pharmacy, because I could not have managed the last year and a half of my husband’s life without the help and support of its staff. They provided help, advice and reassurance in equal measure and took a real interest in how I was doing. I saw them do exactly the same for other people who visited what is an invaluable point of help.

In Scotland, pharmacists already play an active role in coaching patients on the potential side effects of medication, going out of their way to say why it is important to take medicines exactly as prescribed. Unfortunately, due to this Tory Government’s disastrous handling of Brexit, there is a real possibility that community pharmacies and their customers will be left without an adequate supply of medicines. The Operation Yellowhammer documents gave us a real insight into how that will affect our communities. The threat remains significant and, with just 30 days to go until the Brexit deadline, information about medicine supplies and stockpiling is lacking. Pharmaceutical companies tried to stockpile for the 29 March deadline, but warehousing space is much reduced at this time of year, especially as warehouses fill up with Christmas goods.

Of the 12,300 medicines licensed for use in the UK, around 7,000 come to Britain either from or through the EU. According to the Government’s reasonable worst- case scenario, the flow of goods could be cut by 40% to 60% on day one following a no-deal break, taking a year to recover. As we have already heard, that would play havoc with our local community pharmacies, because they are very much on the frontline. They are where our communities turn when they need help with medication.

[Jim Shannon]

I declare an interest as a type 2 diabetic who is on tablet medication. Over the past few weeks, I have been contacted by type 1 diabetics who depend on insulin. The hon. Lady refers to the need to ensure that medication such as insulin is available after Brexit. I understand from my discussions with the Government that they have assured us that it will be. Does she agree that it is important for the public record that we say that in this Chamber today?

[Marion Fellows]

I thank the hon. Gentleman for his intervention. I am not standing here to cause panic; I have spent a long time not trying to cause panic, but I have been wondering what will happen if the medications that people rely on do not arrive, because that really is a critical concern for lots of people. I know that community pharmacies and pharmaceutical companies are doing their very best to make sure that it does not happen.

Because the NHS in Scotland is different, I have had my eyes opened to a number of things that I did not realise were happening. I had assumed that what happens in my own country would happen in England, but it very much does not; I have had that experience in my dealings with Vertex Pharmaceuticals with respect to cystic fibrosis drugs as well.

I have to say that the SNP Scottish Government really do recognise the importance of community pharmacies and are taking action to ensure that they remain properly resourced. In April, the Scottish Government announced that community pharmacies will receive an extra £2.6 million in funding this financial year. We must compare that with the cuts in spending that this UK Tory Government have made to community pharmacies’ funding over a number of years, with absolutely no provision being made for inflation, as we have heard.

The package announced by the Scottish Government includes confirmation that the Pharmacy First scheme has been integrated with the national Minor Ailment Service, so there is a real drive for people to consult their pharmacist first. People who can register with the Minor Ailment Service, such as those who are over 60 or in full-time education up to the age of 19, can see a pharmacist and be given medication there and then without having to see their GP. The scheme has recently been extended; it now covers not just things such as diarrhoea, but treatment for uncomplicated urinary tract infections and impetigo. All those things reduce the strain on GP services—we know that across the country, with its ageing population, they are under strain.

The increases in funding have been welcomed by the Royal Pharmaceutical Society in Scotland, which states:

“The RPS supports the Scottish government’s vision for more people to use their community pharmacy as a first port of call.”

The Scottish Government have reviewed pharmaceutical care of patients, and they really want to understand how community pharmacies can be better supported. They are putting their money where their mouth is.

I do not always get to stand here and tell an even better story, but in Scotland we care about how our communities can be better treated and have better health outcomes. To my knowledge—I need to verify this—a local pharmacy in Scotland does not charge for delivery to patients because, as the hon. Member for Heywood and Middleton (Liz McInnes) pointed out, people who qualify for a free prescription service are really hammered if they then have to pay for the delivery of their drugs. I ask the Minister to look at that. As hon. Members all know, I frequently stand here and say, “Can you look at how things are done in Scotland and see whether that can be adapted for better use here?” I plead with the Minister to look at that again.

The Scottish Government really do recognise the vital role that community pharmacies play in Scotland, in rural and in urban areas. I will sit down now and leave the hon. Member for Washington and Sunderland West to sum up for the Opposition.

Oral Answers to Questions

Marion Fellows Excerpts

Tuesday 18th June 2019 Commons Chamber

[Mr Speaker]

Order. I am very sorry, but, as in the national health service—under Governments of both colours, I emphasise—demand invariably exceeds supply. I will take the remaining questioners whose names are on the Order Paper and who wished to ask substantive questions but did not manage to get in. That seems only fair, as they have been bobbing up and down for the duration. Let us hear them.

[Marion Fellows (Motherwell and Wishaw) (SNP)]

Regardless of which type of Brexit we face this autumn, bureaucracy, customs charges and stockpiling costs will inevitably drive up the price of imported drugs and medical devices. Will the Secretary of State undertake to provide additional funds for NHS England and the devolved nations to cover those Brexit-induced costs and to avoid cuts in clinical services?

[Matt Hancock]

Additional funds have already been provided to ensure that medicines are available throughout the country, whatever the Brexit scenario.

Cystic Fibrosis Drugs: Orkambi

Marion Fellows Excerpts

Monday 10th June 2019 Westminster Hall

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Hanson. I thank the hon. Member for Sutton and Cheam (Paul Scully) for setting out in his opening speech facts that a lot of us did not know and facts that some of us did. It was a very useful start to this wide-ranging and well attended debate. I will just ask this question, though: how many times do we have to debate this very serious subject?

Again, I have to declare a personal interest. I am a cystic fibrosis carrier. My late husband was, too. My children are carriers, and my granddaughter, Saoirse Grace, has cystic fibrosis—mutations F508del and D1152H. I do not understand to any great degree what the last part of that actually means, but I do know that she is not the worst sufferer of cystic fibrosis. She has the best kind, if you like. She is pancreatic sufficient, and for that we are always grateful. Saoirse will not directly benefit from Orkambi, but along with 90% of people with cystic fibrosis in the UK, she will benefit from the triple therapy coming down the line. Those therapies will deliver unprecedented improvements in acute lung health and reductions in pulmonary exacerbations—a key driver of decline.

Approximately 900 people in Scotland live with cystic fibrosis. NHS Scotland estimates that one in 24 Scots has a CFTR mutation, which, if carried by both parents, would lead to a child being born with cystic fibrosis. England has the highest prevalence of cystic fibrosis in the world, with 1% of the world’s population but 12% of the world’s CF population.

There should be no postcode lottery for treatment. The UK Government should follow the Scottish Government’s lead on cystic fibrosis treatment. For people in England to receive Orkambi, NHS England would need to pay Vertex £500 million over five years and £l billion over the next 10 years. However, in a debate on CF and Orkambi last year, it was stated that the costs of Orkambi can be offset by reduced hospital admissions, and other benefits should also offset the cost, as has been stated in the Chamber today. Vertex has stated that its offer to NHS England for the provision of its CF drugs represents the lowest price for Vertex’s portfolio of CF drugs in any country in the world. I point out that I am not here to make a case for Vertex; I am here to make a case for people with CF who need this drug.

The Scottish Government recently announced that NHS Scotland and Vertex Pharmaceuticals had reached a deal to provide interim access to Orkambi and Symkevi, through a system known as peer approved clinical system tier 2, while the Scottish Medicines Consortium reviews the relevant evidence for Orkambi. PACS tier 2, introduced by the Scottish Government in June 2018, involves an individual application for patient access to drugs not recommended by the SMC and not routinely available on the NHS.

The Scottish National party believes that the UK Government need to do more to facilitate interim access to Orkambi and other drugs to treat cystic fibrosis and to get NICE to re-evaluate making the drug more widely available for people living with the illness. In England, NICE said Orkambi was too expensive for the NHS in 2016, and since then Vertex and NICE have been unable to reach an agreement that will bring these drugs to patients. The UK Government are showing a lack of flexibility by only urging Vertex Pharmaceuticals to fully re-engage with the NICE appraisal process and to accept the offer that the NHS made in July 2018. Vertex has said that the methods used by the Scottish Government to obtain the drugs reflect the innovative nature of medicines that have the potential to extend life for patients with rare diseases such as cystic fibrosis, and that it is hopeful that, through that process, all eligible patients in Scotland could have access to its medicines soon. If Orkambi and Symkevi are accepted by the SMC, which makes decisions independently of the Scottish Government, eligible patients in Scotland could have access to these precision CF medicines in 2019.

In the interim, Vertex and the Scottish Government have agreed a confidential discount that would be applied to approved PACS tier 2 applications. The Scottish Government also asked Vertex to provide access to the medicines at a discounted price to the list price while they finished the contract negotiations, and Vertex said, “Of course.” Vertex stated that it would be willing to do exactly the same thing in England.

There is agreement across the Chamber that Orkambi, Symkevi and Vertex’s triple therapy should be available UK-wide. I have no desire to get into the argument between NICE and Vertex in England. I want England to do what Scotland has done. I want children across the UK to get the benefits of these drugs. As has been said, this problem will exist whatever view we hold of Government at the UK level. However, political will must be exercised in the process of getting those with cystic fibrosis the drugs that will improve their lives and futures.

Finally—I will not take too long, Mr Hanson—I give my heartfelt thanks to all the parents and guardians of CF sufferers, and to those affected by cystic fibrosis, for their continuous campaigning and awareness-raising. It is awful that they have to keep doing that. I ask the Minister, please do not let their work be in vain.

Clinical Trials and Clinical Research Capability

Marion Fellows Excerpts

Thursday 23rd May 2019 Westminster Hall

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Hanson. I congratulate the hon. Member for Bolton West (Chris Green) on securing this important debate. I particularly enjoyed his opening remarks on scurvy, and I thank him for reminding me about where the term “limeys” came from. He is obviously passionate and knowledgeable about this subject. I have quickly skimmed through some of the things he spoke about and, I have to say, I found very little to disagree with in his speech.

The hon. Gentleman said that Brexit will be challenging for many reasons, especially getting clinical trials properly conducted post-Brexit, particularly when, at the moment, no one knows what is happening. He pointed out something that had not crossed my mind: if we do not get those relationships right post-Brexit, the UK is too small a country to conduct positive and technically feasible trials in new and important areas.

The hon. Gentleman talked about the importance of harmonisation across Europe, and about something especially important to Scotland and to my party: the ability of people to move freely. We must take a European and a broader, transnational view at how much people working in the sector can bring to this country, and what UK nationals can bring back when they return from working abroad.

The hon. Gentleman also mentioned visa costs, another highly important issue for Scotland and the Scottish Government. Astonishingly, a visa for a researcher and their family can cost 11 times as much in this country as it would in France. That would be a no-brainer for a clinical researcher looking at where to go to further his or her career.

Clinical trials are essential for bringing new medicines to people. They test whether new treatments are safe and effective, and allow patients to access new medicines earlier. The UK regulatory environment for clinical trials is led by the Health Research Authority and the Medicines and Healthcare products Regulatory Agency. Wellcome, whose report I will mention later, found that more than 4,800 UK-EU clinical trials took place between 2004 and 2016. Around 40% of the trials currently run in the UK are being run with other member states. Clinical research supported by the National Institute for Health Research clinical research network has generated an estimated £2.4 billion and nearly 40,000 jobs. This is not an insignificant sector.

New legislation—the EU clinical trial regulation—will replace the EU clinical trials directive in 2020. Under the CTR, all trial applications, data and co-ordinated decisions from member states will be communicated through a single portal. Streamlined systems and communications will help to simplify compliance with the CTR, potentially saving researchers in the EU £600 million a year, as well as offering savings of £60 million a year to UK researchers.

Clinical trials are managed nationally in the UK by the MHRA, although some aspects of clinical trials are shared across the EU medicines regulatory network. For example, a clinical trial sponsor or legal representative for clinical trials in the EU should be based in the EU or European economic area. Currently, 40% of UK-based trials also have a site in the EU.

Wellcome’s report “Brexit and Beyond: Clinical trials” stated that the best option for trials is

“full UK participation in the EU clinical trials system”.

Wellcome found alternative options, but posited that all

“involve significant trade-offs that would have an impact on UK–EU clinical trials.”

The Scottish National party advocates a second EU vote. However, failing that, and failing full participation, the UK should meet its commitment to put the EU clinical trial regulation into law, and should remain aligned to the EU framework.

The UK Government stipulate that in the case of no deal, the MHRA would take on responsibilities currently undertaken through the EU system. However, Wellcome found that, even if the withdrawal agreement is voted through, which after the last few days seems impossible,

“the MHRA would not be able to lead on reviewing applications, a role known as being a ‘reporting Member State’.”

No deal would likely lead to significant uncertainty over the legal arrangements for clinical trials.

Brexit is already having a negative effect, with Reuters finding that the

“number of new clinical trials started in Britain last year was 25 percent lower than the average for 2009-16”.

It highlights Brexit as the reason for the fall in numbers. A total of 597 trials were initiated in Britain in 2017, against an average of 806 over the previous eight years. The UK Government have committed to exploring the option of full association to research and innovation programmes, but there are no guarantees of success.

[Chris Green]

As we were discussing before the debate, the United Kingdom is a world leader in research and development and, because of the excellence in the UK, we receive disproportionate funding from the European Union. Does the hon. Lady share my concern, and agree that, post Brexit, the UK Government need to maintain that enhanced level of funding?

[Marion Fellows]

I thank the hon. Gentleman for his intervention, and I agree. As we were discussing, Scotland punches above its weight per head of population. From memory, we receive 11% of Erasmus+ funding, which is more than we should. Again, that is because of the excellence of the research in Scottish universities, in conjunction with EU nationals and other universities across Europe.

Where are the UK Government currently in exploring the option of full association to research and innovation programmes with the EU? The Department of Health and Social Care wrote in August 2018:

“A scenario in which the UK leaves the EU without agreement (a ‘no deal’ scenario) remains unlikely”.

Again,

“facts are chiels that winna ding”—

I will spell that for Hansard later. The ground is moving beneath our feet as we speak, just before the recess. It is vital that we do not leave without a deal, but—although we can all hope—a no deal is becoming more likely. We need to think very carefully. Can the Minister give us any reassurance that there will not be a no-deal Brexit? That is asking a lot, I know, but it has to be asked. The quote that I have been given is:

“Negotiations are progressing well and both we and the EU continue to work hard to seek a positive deal.”

Can the Minister provide an update on all negotiations taking place?

The Brexit Health Alliance brings together a range of health professional, patient, and health and care organisations. The highly influential group has called for a deal that delivers the closest possible alignment and regulatory co-operation between the UK and the EU with respect to medicines and medical devices, to guarantee patient safety and public health. I do not think that anyone in the Chamber would disagree with that. We really need to ensure that it happens.

We believe in Scotland that, at least in the short term, the best way to protect clinical trials in the UK and their future is to vote for the SNP today in the EU elections. The Government’s handling of Brexit could severely damage, if not ruin, the UK’s reputation as a world leader in medical research, having produced around 25 of the top 100 prescription treatments. The UK currently benefits from access to research funding from EU funding programmes such as Horizon 2020 and the Innovative Medicines Initiative.

Innovation and progress are impossible without funding, and it can take many years to get from funding to outcome. Reducing funding now therefore has a negative effect for the future. The UK Government confirmed that Horizon 2020 provides about €80 billion of funding, available over seven years—that is, until 2020—of which the UK has secured €5.1 billion of funding to date, which is 14.3% of the total. Europe is therefore really important to us. Although it has been confirmed that the UK will participate for the remainder of the programme, what will happen in any future programmes remains undetermined.

The Innovative Medicines Initiative has committed more than £5 billion to support large-scale, ambitious research. IMI-supported projects have generated more than 4,000 peer-reviewed projects. From 2008 to 2016, the UK received 28% of total IMI funding from the EU Commission—the largest amount for any country, totalling €302.8 million. UK academic institutions and small and medium-sized enterprises receive the highest levels of IMI funding of any country.

The UK is very successful at conducting clinical trials. It sponsors approximately around 1,500 trials that include other EU countries. Half of those trials will still be occurring in 2019. It is important to collaborate internationally, particularly for rare disease trials, because there are not enough patients in one country alone. Without large-scale drug or medical device approval processes, the approval of drugs and devices could be delayed, resulting in slower access to new treatments for patients. None of us wants that.

I congratulate the hon. Member for Bolton West on recognising the work of charitable institutions such as Cancer Research UK. It is really important to people throughout the UK that funding and collaboration does not cease, because people are waiting for answers to diseases, some of which have not yet been named. The idea of UK Research and Innovation has not been dealt with; the delegated legislation to deal with it has yet to come to the Floor of the House. We wait with bated breath to see whether the Minister can answer any of my questions to her today.

--- Later in debate ---

[Jonathan Ashworth]

I have not yet decided whether to run next year’s marathon, but should we decide to run, it would be great to have you running with us, Mr Hanson—or indeed the Minister.

[Marion Fellows]

As a fellow Front-Bench spokesperson, may I withdraw from any suggestion that I might run the marathon next year?

[Jonathan Ashworth]

That is disappointing, but several SNP colleagues ran it this year. Anyway, today’s debate is not about the London marathon—important though it is.

The hon. Member for Bolton West made an excellent speech. I understand that a reshuffle of junior Ministers is going on; based on the quality of his speech, he is very deserving of elevation to the Government Front Bench. He might not want to join it at the moment, but that is a different issue. He well deserves a call from Downing Street.

The hon. Gentleman made some points that muster consensus across the House, as we heard from the hon. Member for Motherwell and Wishaw (Marion Fellows). We agree with what the hon. Gentleman said about R&D investment and the implications for medical research and trials post Brexit. If I may gently tease him, I think that he and I were on different sides of the debate in the Brexit referendum. I believe that some of the issues that he raised today were not given the prominence that they deserved in the referendum campaign the first time round. He may disagree, but I think that many of the concerns that he rightly raised will come to the fore and prove particularly damaging for our clinical research if we leave the European Union on World Trade Organisation terms. If that is the prospect that the country faces, I believe that we should have another opportunity to ask the British people whether that is what they want—but, again, I digress.

The hon. Gentleman made an interesting observation about the history of clinical trials. I did not know where the term “limey” came from, so I am pleased that he has educated me on that front. He could also have mentioned Edward Jenner, who was born 270 years ago and who discovered a vaccine for smallpox through a clinical trial. Because of Edward Jenner’s work, the world was rid of smallpox; the World Health Organisation declared the world free of smallpox in 1980, its first and only such declaration about any human disease.

That example brings home the importance not only of clinical trials, but of understanding and being guided by the science, especially in an age when more and more anti-vaccination propaganda and disinformation is spreading far too rapidly on social media—typing in “anti-vax” on Facebook or Instagram brings up all kinds of disturbing, poisonous nonsense. Sadly, while more and more measles outbreaks are happening throughout Europe and in parts of the United Kingdom, our measles, mumps and rubella vaccination rates are falling. I put on record the importance of being guided by science and understanding the impact and outcomes of clinical trials, which can make a huge difference to saving lives and improving health.

I entirely endorse the hon. Gentleman’s well-made point about the £30,000 visa cap. It is not just that the cap will affect the country’s science base and our ability to attract the best scientists, research technicians and so on to our shores; at a time when we have 100,000 vacancies across the national health service, including 40,000 for nurses and thousands for midwives and paramedics, and when hospital trusts are struggling to recruit, it is completely counterproductive for the Government to propose a £30,000 visa cap.

This country has a proud history of the national health service attracting people from across the world, including clinicians, nurses and technicians. Of course our international recruitment should always be ethical, but to hinder the NHS in this way will do huge damage to our ability to attract the staff we need in the future. We are told that the Dido Harding review of the workforce will propose that the NHS should recruit 5,000 international nurses a year. I presume that the Government would endorse that, but it suggests that one hand of Government does not know what the other is doing. I appreciate that this is a Home Office matter and not necessarily within the Minister’s remit, but I urge Health Ministers to pressure the Home Office on it, because it is not remotely in the interests of our science community or of our NHS generally.

Throughout the 70-year history of the national health service, scientific research and innovation, of which clinical trials have been a part, has made great advances. Sixty years ago, the first mass immunisation programmes offered polio and diphtheria vaccines to under-15s. I think back to the hospital wards full of iron lungs for people suffering from polio; I was not born then, of course, but we have all seen them in grainy black and white photos. What was once an everyday occurrence for too many children in this country is no longer a feature of our national health service—a striking example of the importance of vaccines, research and clinical trials. An everyday aspect of doctors’ and nurses’ care—tending to people in iron lungs in hospital wards—has been completely transformed because of our research and clinical trials.

There have been all kinds of remarkable innovations in the NHS over the past 70 years. We pioneered the first heart transplants here. Forty years ago, we pioneered in vitro fertilisation. We developed CT scanners, MRI scanners and clinical thermometers. We made great advances with DNA. Seminal trials funded by the British Heart Foundation found that aspirin and clot-busting drugs can save lives after a heart attack. Extraordinary, amazing innovations have taken place in the United Kingdom because of the strength of our science base. We must celebrate that, build on it and give it all the support we can.

As the hon. Member for Bolton West rightly said, the issue has become ever more important in the context of an ageing population. In 1948, at the birth of the NHS, 11% of the UK population were 65 or over. Life expectancy was 71 for women and 66 for men. Today, those figures stand at 82 and 79 respectively, and the so-called “oldest old”—those with a substantial risk of requiring long-term care—are now the fastest-growing age group in the UK. It is projected that by 2040 nearly one person in seven will be over 75; the number of over-85s is set to double over the next 20 years. The changing demographic profile of our society will demand greater investment in science to deliver medical advances.

NICE Appraisals: Rare Diseases Treatments

Marion Fellows Excerpts

Thursday 21st March 2019 Commons Chamber

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a pleasure to follow the hon. Member for Strangford (Jim Shannon), and I congratulate the hon. Members for Blaydon (Liz Twist) and for North Tyneside (Mary Glindon), and the Backbench Business Committee, on securing this debate.

This is not the first time that I have spoken in such a debate, and I declare an interest because my two-year-old granddaughter, Saoirse Fellows, has cystic fibrosis. We are very fortunate because she is pancreatic sufficient, but it is a real worry for our family. I should also say that I am waiting for granddaughter No. 4 as we speak, so if I am a bit lightheaded that is why. I have never listened to a debate in either Westminster Hall or the Chamber in which so many people have cited Scotland as a great example of how to do things. That is normally my job in these debates, so I am grateful to hon. Members who have already done part of that job for me.

An estimated 7,000 rare diseases affect about 3.5 million people in the UK, and around 80% of those are genetic. It has been reported that 95% of rare diseases have no approved treatments available. The default NICE referral route for the majority of orphan medicines is the single technology appraisal, but many will be close to meeting the selection criteria for NICE’s highly specialised technology programme, which has already been mentioned. Stakeholders are frequently sought to make the case for an HST referral, which is a more appropriate route for orphan medicines.

The Government have maintained the position that it is appropriate for orphan medicines to be considered under NICE’s standard STA and that orphan medicines have been successfully reviewed under the STA programme. However, many Members have said how that is not working for their constituents. The Scottish Medicines Consortium has adapted its processes to increase the input of clinicians and patient group experts in decisions for certain orphan medicines.

Mr Deputy Speaker, I am cutting my speech because I want to allow more time for both the Opposition spokesperson and the Minister. Scotland and the SMC has led from the front, and NICE has adopted many of its methods in the past. I encourage the Minister to look again at what Scotland is doing. We are a small country and a devolved nation, but we can do it, so I can see no reason why the England NHS should not be getting the same medicines as we do. We have a higher approval rate: 69% in Scotland to 55% in England. We have a new medicines fund specifically for orphan drugs, which is instrumental in helping to secure access to medicines for rare diseases. That does not exist in the other devolved nations. Both Scotland and Wales have taken a proactive approach to addressing concerns about the applicability of the standard processes for orphan treatments.

The new medicines fund has really helped to deliver better medicines more quickly to Scotland. The fund has covered the cost of orphaned drugs for individual patients where the condition affects fewer than one in 2,000 people. A total of £21 million was made available for the fund by the SNP Scottish Government. The Scottish Government have since made further improvements, reforming access to new medicines by creating the peer approved clinical system tier 2. The system allows clinicians, on behalf of their patients, to ask a PACS panel whether they can access a medicine that has not yet been recommended by the Scottish Medicines Consortium. That is exactly why Orkambi and Symkevi can be used in Scotland. I would suggest it is absolutely imperative that this is looked at in England. Spinraza, which has been mentioned in the debate, is already being used in Scotland. I ask the Minister this: why is it not possible for NHS England to use those drugs in England to the same extent that they are in my own country?

I do not want to bring too sour a note to the end of this debate—there is real consensus across the House, and Members have spoken sincerely and passionately on behalf of their constituents and others across the country—but I worry, and I think many other Members across the Chamber will be worried, that we are heading towards Brexit. No one knows where it is going or the impact it will have on the availability of medicines generally, and, more importantly for this debate, medicines that are not yet even available in England as they are in Scotland.

DRAFT GENERAL FOOD HYGIENE (AMENDMENT) (EU EXIT) REGULATIONS 2019 DRAFT CONTAMINANTS IN FOOD (AMENDMENT) (EU EXIT) REGULATIONS 2019 DRAFT SPECIFIC FOOD HYGIENE (AMENDMENT ETC.) (EU EXIT) REGULATIONS 2019 DRAFT GENERAL FOOD LAW (AMENDMENT ETC.) (EU EXIT) REGULATIONS 2019

Marion Fellows Excerpts

Tuesday 5th March 2019 General Committees

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a pleasure to serve under your chairmanship, Ms McDonagh.

I will be brief. Regardless of the SNP’s opposition, in principle and in its entirety, to the UK’s withdrawal from the EU, we recognise and understand how important it is that these statutory instruments are established and that we preserve the framework around the status quo. Food standards post-Brexit will be a critical issue. It is crucial that neither food safety nor standards are diluted or diminished. Scotland has a great record in food exports, and our great Scottish food is recognised across the world as being of a particularly high standard. We all want that to continue.

The stockpiling of food in preparation for Brexit demonstrates the drastic effect that the Brexit process has had on the most basic of human requirements. It is important to emphasise that the review of these instruments should ensure the retention of the highest standard of food safety. The Government could avoid all this administrative burden if they simply ruled out a no-deal Brexit. It is especially important to small businesses that any additional requirement placed on them, or any financial burden, no matter how small, is recompensed by the Government.

It is a pleasure to follow the hon. Member for Washington and Sunderland West. I cannot compete with all her questions to the Minister and will not repeat them. I will simply say to the Minister, please answer them, because we are interested in these matters too. Given that no policy change is being enacted and these instruments are required to ensure food standards, I will abstain if they are put to a vote.

Nursing: Higher Education Investment

Marion Fellows Excerpts

Wednesday 21st November 2018 Westminster Hall

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Wolverhampton South West (Eleanor Smith) for securing this important debate, to which I have listened with great interest. I will not summarise what everyone said, but cut to my speech, as there are a few other important things I want to say. We have heard questions to the Minister from both sides of the Chamber about the state of nursing and applications to study nursing in England. It seems passing strange to me that the Government have chosen to abolish bursaries at a time when nurses from the EU are leaving NHS England, causing even further shortages. I was particularly struck by the hair-raising stories that the hon. Member for Mitcham and Morden (Siobhain McDonagh) gave us about patient safety and nurse safety—I hope the Minister addresses that.

As has been mentioned, the situation in Scotland is quite different. In case the Minister is not aware, I shall give him some ideas about how we do things in Scotland, to see whether that will help. I do so in a spirit of help, to see whether we can improve things in NHS England. In Scotland, the First Minister has just announced an increase in nursing and midwifery bursaries—the bursary will go up to £10,000 in 2021. That is part of a drive to continue the increase in numbers of student nurses we have had over the past few years. The Scottish Government also have discretionary funds for those nursing and midwifery students who are most in need, and are upping the number of places for students of nursing and midwifery in the academic year 2019-20. We recognise the importance of those nurses.

On a personal note, after what I have been through over the past year, I would not be able to stand here were it not for the support of nurses throughout the entire stage of my late husband’s treatment and the end-of-life care that he received, and I appreciate the opportunity to put on record my thanks to St Andrew’s Hospice in Airdrie, of which I am a patron.

The Scottish Government’s discretionary fund will give more money to mature nursing students—that cause has been mentioned—if we use the word “mature” to apply only to those who have children. Those people need extra support and are given it. As most previous speakers have said, it is important that we attract mature students into nursing, as well as those who come straight from school. From personal experience, I think that mature students bring an extra level of care and understanding that we do not always get right away from young entrants into the profession.

Student nursing and midwifery places in Scotland will increase for the seventh consecutive year, reaching record levels with the intake rising by 7.6% to more than 4,000. Upping intake for the 2019-20 academic year is one of a number of measures to support the sustained recruitment and retention of NHS staff, but it is also important to retain our existing staff. We have heard stories about the pressures that nurses are currently under, and they must be alleviated. In addition to increased student places, almost 460 former nurses and midwives have signed up to retrain through the Return to Practice programme since 2015. The Scottish Government are funding the Open University to deliver a pre-registration programme, which currently supports around 116 nursing students. In October 2016, 10,239 students were in education—an increase from 9,936 the year before—and we will get the 2017 data next month.

I often find myself standing in this place, especially in Westminster Hall, and asking Ministers whether they have looked at the situation in Scotland, because sometimes we are more progressive. Sometimes it is easier, because Scotland has a smaller national health service, but we also value the NHS in Scotland. Earlier this decade, the First Minister announced that, in all hospitals in Scotland apart from those built under private finance initiative contracts, parking charges would be withdrawn. That has been carried out. That simple measure can help nurses, and I urge the Minister most sincerely to consider it, as well as some of the other practices that we have taken on board to increase nursing numbers in Scotland.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies, and I congratulate my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) on securing this important debate. The level of interest from Members shows how important this subject is. My hon. Friend spoke from great personal experience, and I thank her and everyone else who has worked in the NHS for their contribution over many years to make it an institution of which we are all rightly proud.

My hon. Friend comprehensively dismantled the Government’s arguments on the merits of removing the bursary. As she said, it is indisputable that the number of applications and the numbers of people starting courses have fallen, and that the age profile of students has changed. She was right to say that the decision to abolish the bursary was a political choice, and not one that the Labour party would have made. Along with other Members, she highlighted areas that have fewer nurses in community and district hospitals and in settings that treat those with learning disabilities or mental health problems. Given that the pipeline for delivering nurses is not working as it should, those shortages may worsen. My hon. Friend was right to say that higher education is the best way to train enough highly skilled nurses to meet the needs of patients.

[Marion Fellows]

I wonder how many Members are aware that the Select Committee on Education will shortly publish the results of its inquiry into nursing apprenticeships.

[Justin Madders]

I thank the hon. Lady for her public service announcement. Let me now refer to some other contributions.

The hon. Member for Henley (John Howell) made a fair point about how the price of housing exacerbates the shortage of nurses in some areas, and all Members will be aware that earlier this year more than 1,900 nursing vacancies were advertised in the Thames Valley area, although only five were filled.

My hon. Friend the Member for Lewisham East (Janet Daby) gave a thoughtful and persuasive speech that highlighted the fact that the number of applicants over 25 has fallen by 40%, and she mentioned the impact of that in specialist areas. She was right to say that the nature of the nursing degree limits the opportunities for students to earn income outside their course demands.

The hon. Member for Sleaford and North Hykeham (Dr Johnson) made a considered contribution about her criteria for what would make a successful training course, and I will reflect on that good piece of advice.

As always, it was a pleasure to hear from my hon. Friend the Member for Sheffield Central (Paul Blomfield), who has great experience in this area. He referred back to a debate in 2016, and was right to say that this policy has damaged mature students and social mobility. Many concerns that were raised back in 2016—including by Government Members—have been ignored, or indeed come to pass.

The hon. Member for Chelmsford (Vicky Ford) gave us the benefit of the thoughts of nurses in her constituency. It is always a good idea to hear directly from those on the frontline, and she came up with some interesting practical suggestions about what could be done to make the lives of nurses easier. Along with other Members, she mentioned the impact of this policy on the number of mature students applying, and the impact that that has on particular specialisms.

My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) set out why, due to a combination of factors, now is not the time to experiment with a flawed and unproven model. She mentioned the challenge of retention, and related some graphic and moving stories from her constituents. She was right to say that if we do not fix this issue now, we will pay the consequences for decades to come.

Finally, my hon. Friend the Member for Lincoln (Karen Lee) spoke of her own frontline experience, and mentioned the expense and risk of over-reliance on agency staff. No doubt the challenges that we face and have discussed today will be exacerbated, which will place even more reliance on temporary and agency staff.

We have had a broad and wide-ranging debate. This is the Minister’s first outing in his role, and I welcome him to his place and congratulate him on his appointment. I was trying to work out whether he is the fourth or fifth Minister I have shadowed since I was appointed to my role just over three years ago, which shows that it is not just the NHS that has problems with retention.

The NHS faces a significant workforce challenge, and nowhere is that more pronounced than in nursing. England is missing about 42,000 nurses and, according to conservative estimates, without significant intervention that figure may rise to more than 48,000 by 2023. The situation is serious—other Members have described it as a “crisis”, which is absolutely right, but this crisis could have been avoided.

As Members have said, we are facing a perfect storm, with recent trends showing that more nurses are leaving the profession than joining it, the ongoing uncertainty over Brexit, the fact that one in three nurses is due to retire within the decade, and the catastrophic decision to scrap bursaries for nurses, midwives and allied health professionals. According to the Royal College of Nursing,

“without enough nurses, care is fundamentally unsafe, frontline staff are compromised and people seeking access to health and care services are not able to receive the care that they need.”

The RCN also reports that services are sometimes so short-staffed that nursing students are inappropriately used to plug gaps in the workforce and have to look after patients before they are qualified to do so. That is an extremely worrying development.

This is a crisis of the Government’s own making. Before I come on to the current policy context of higher education funding, I will say a little about the circumstances leading to the decision to undertake the reforms back in 2015. As my hon. Friend the Member for Wolverhampton South West said, workforce planning has not traditionally been a great strength of the NHS.

One of the first decisions of the coalition Government back in 2010 was to cut the number of nurse training places at university. In 2010-11, 20,092 places were funded, but that fell sharply to 17,741 in 2011-12 and dropped again to 17,546 in 2012-13. At that stage, David Green, vice-chancellor of the University of Worcester and a former chair of the west midlands group of universities said:

“We are heading straight for a national disaster in two to three years’ time.”

The RCN also warned that the cuts would cause

“serious issues in undersupply for years to come.”

Those warnings were not heeded by the Secretary of State at the time, and a completely predictable and preventable crisis in the nursing workforce was created. Had the coalition Government only maintained the levels set by the last Labour Government, 8,000 additional nurses would have been trained in the last Parliament alone.

In the midst of this completely manufactured crisis, the abolition of undergraduate nurse bursaries was announced. I ask the Minister to consider whether that response to the crisis was the correct move. In just two lines in the 2015 autumn statement, with no consultation and no evidence base, the Government committed themselves to a huge gamble with the future of the NHS workforce and with patient safety. The then Minister described the proposal as

“potentially one of the most exciting things that we will do in the NHS in the next five years to increase opportunity and quality, and the presence of nursing staff on wards.”—[Official Report, 4 May 2016; Vol. 609, c. 196.]

We were told at the time that our many concerns were misguided, and that the changes would lead to an additional 10,000 training places being provided. However, as we have heard, the opposite has happened. As of September 2018, almost 1,800 fewer people are due to start nursing university courses in England. The number of mature students has plummeted by some 15%, which as we have heard has had a particular impact on specialist areas. There has been a 12.9% reduction in the number of mental health nurses since 2010.

As my hon. Friend the Member for Stroud (Dr Drew) said, there has been a shocking 40% reduction in learning disability nurses. Learning disability nursing celebrates its 100th anniversary in 2019. It will be an astonishing failure of the Government’s if they allow it to disappear altogether. That reduction comes at a time when the needs of people with learning disabilities have never been more paramount, with premature mortality resulting from complex health conditions and people being detained in assessment and treatment units for far longer than necessary.

We warned at the time that this policy would have precisely the effect that is has. After meeting representatives from the profession and looking at the evidence, the Government carried on. On the other hand, they did not formally consult the Royal Colleges before announcing their plans. I know that there has been some dialogue since then, and I will be grateful if the Minister will set out his recent discussions with the sector about the impact of the bursary cut and what steps the Government are taking to deal specifically with the crisis in learning disability and mental health nursing, which have been particularly hard-hit by the changes.

As various Members have said, the new Secretary of State recognised the crisis by saying

“simply put: we need more”

nurses, and that:

“That is something we will specifically address in the long-term plan for the NHS”.

That plan is due to be published any time now, and we will examine it very closely. However, if the Secretary of State is serious about tackling the workforce crisis and increasing the nursing workforce, he needs to make a key element of the strategy the reintroduction of NHS bursaries. It remains our policy to do so, and there has not been a single jot of evidence since they were removed to dissuade us from our initial view that their abolition was short-sighted, damaging and, ultimately, self-defeating. In a written answer on 19 April this year, the former Minister indicated that the Department would publish an update on the effect of the plans later this year. Will the Minister advise us of where that is up to?

Although I have referred to a lot of large numbers to highlight the overall impact of the policy, it is important to hear, as we have from some Members, about the impact on individuals. I do not know if the Minister had the opportunity to attend the RCN drop-in earlier today. If he did not, I convey to him how well the students I spoke to conveyed how difficult it is to work what they and I consider to be unsafe hours to make ends meet; how the inclusion of the student loan in income for benefits calculations leaves families worse off; and how the students notice that, each time they return to the lecture theatre, there are fewer and fewer of them. What assessment has the Department made of the attrition rate of university courses since the abolition of the bursary?

In conclusion, the uncertainty created by Brexit means that the reliance on recruitment from the EU that we have seen in recent years is no longer an option to shore up nursing numbers. Our NHS staff cannot keep giving more at the same time as we give them less. The Government need to fund our future and invest in nursing higher education. They simply cannot afford not to.

Access to Orkambi

Marion Fellows Excerpts

Tuesday 17th July 2018 Commons Chamber

[Mr Lewis]

I agree entirely with the hon. Gentleman. It is absolutely vital that we see an engagement process that leads to action. I will develop that argument as I make my contribution here this evening.

[Marion Fellows (Motherwell and Wishaw) (SNP)]

The hon. Gentleman mentioned many organisations. I wish to pay tribute to Scotland Parents CF Support Group, which has been very generous in helping me to understand and bring this matter to people’s notice. This is a UK-wide issue. I know that we are discussing NHS England, but this is also an issue in Scotland. Hopefully, if we can get those in England to get this drug, it will have a domino effect in Scotland, thereby saving and improving the lives of people with CF.

[Mr Lewis]

I think that, in this context, we can all unite behind the concept that we want a resolution that is UK-wide if at all possible. Clearly, that would require different organisations to be involved, but if we can set a precedent here, we could make rapid progress, and that can only help all parts of the United Kingdom. May I make some progress, and then I will give way to other hon. Members?

All of us who have the privilege of serving in this House are mothers or fathers, brothers or sisters, grandparents, uncles or aunts, godparents, friends or neighbours. It could very easily be one of our family members or friends who is diagnosed with cystic fibrosis at birth and who struggles with a life of perpetual illness, frequent hospitalisation and a daily multitude of drugs. Worse still, they could be living with the fear of premature death at an age when many young people are getting married, starting a family or taking their career to a new level.

I ask hon. Members to imagine that their family member or friend was denied access to a drug that could improve their quality of life and prolong their life for many years—a drug that was readily available in 12 other countries. No one in this Chamber today would accept no for an answer, or remain silent as the NHS and a major drugs company traded increasingly public blows as to who is to blame for unnecessary suffering and potential loss of life. If the situation is not good enough for our loved ones, it should not be good enough for anybody else’s.

I first became aware of Orkambi when a young constituent from Prestwich attended my constituency surgery with her mother. Many Members will have met constituents in a similar situation. Alex Darkin is 10 years old and suffers from cystic fibrosis. She is a remarkable girl, whose courage and positivity are truly inspirational. Alex started this year with 80% lung function—a number that scared her mother, Emma, because Alex’s lung function was over 100% a few months previously. These days, Emma would give anything to see the number 80 again. Alex’s lung function continues to drop and is now around the 54% to 56% mark.

Alex has physio and takes a large amount of medication just to manage her condition. She brought all that medication to my surgery and I found myself looking at a young person who has to go through the routine of taking that medication every day; that, in itself, is a massive challenge. Alex has intravenous antibiotics every three months, and her daily life is inevitably dominated by her drug and physiotherapy regime. Very sadly, she now has irreparable lung damage. A consultant recently advised that doctors are running out of options with regard to medication, and explained that if Alex were a year older her parents would be able to apply for Orkambi on compassionate grounds, as her lung function had deteriorated more than 25% in less than three months. Emma and Alex contacted me because they could not afford to wait another year to get this drug on compassionate grounds. Surely a truly compassionate society would ensure that this drug was available to all who needed it.

Leaving the EU: NHS

Marion Fellows Excerpts

Thursday 22nd March 2018 Westminster Hall

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Davies. I want to associate myself with the remarks made by colleagues about the tragic anniversary we are observing today.

If this Government deliver Brexit, we must negotiate a good deal for our healthcare institutions, our outstanding staff and us—the patients. I understand that we all have good intentions—no one here wants a bad Brexit deal—but I would like to hear from the Minister today how the Government’s stated intention to do no harm to the health service in each part of the UK is going to be delivered in practice.

We know already that the Government’s negotiating record in the talks is poor. After stating that we were going to take back control of our fishing industry, they have managed to deliver a deal for the transition period that no one—not one fisherman nor any MP—believes is in the best short-term interests of the industry. How will the Government ensure that we get a healthy Brexit deal for today, tomorrow and the future?

I am proud to have University Hospital Wishaw in my constituency. It is a large employer and provides healthcare across neighbouring constituencies as well. When patients use the facilities there, they want to know that they are getting the best healthcare possible. That is far more important to them than where their healthcare professional originally came from.

In preparing for the debate, I read reams of statistics and briefings from organisations representing medical professionals, such as More United, Healthier IN the EU, Scientists for EU, the Royal College of Nursing, the Royal College of Midwives, and the Royal College of Physicians and Surgeons of Glasgow, to name a few. All their research paints the same gloomy picture: EU and EEA doctors, nurses and other healthcare professionals who have left, and those who are considering leaving the UK, are leaving gaps in healthcare provision. There is also likely to be a crisis in social care as regulations tighten and people stop seeking work in the UK after Brexit.

It is incumbent on the UK Government, to which immigration is reserved, to ensure that healthcare professionals and social care workers from EU countries are encouraged and welcomed here, or there will be a serious drop in the high standards that patients expect from their NHS. The Scottish Government estimate that non-UK citizens account for approximately 5% of the NHS workforce in Scotland and around 6.8% of Scotland’s doctors. They have to estimate, as that data is held only at UK level because immigration is a UK matter. That seriously affects effective workplace planning by NHS Scotland. This issue needs to be addressed by the UK Government as a matter of priority.

Those EU nationals who want to stay and work in our NHS, and who want settled status, should be prioritised. It would be a real acknowledgement of what they do for our most vulnerable citizens if the costs of that process were met by the UK Government. The UK Government also need to ensure that there are regular reviews of the tier 2 shortage occupation list, so that specific staff shortages can be addressed. That should include medical research and the pharmaceuticals sector. We need to retain access to the best staff available, no matter where they come from.

Once Britain leaves the EU, we must retain frameworks and regulations that allow us to co-operate fully with the Medicines and Healthcare Products Regulatory Agency and the European Medicines Agency. That would allow for the smoothest transition, in terms of the authorisation of medicines for use in the UK, safety and pharmacovigilance. That is what patients and clinicians need. We also need a sufficient transitional period following the current negotiation process to allow for the development of robust, deliverable regulatory processes that do not disadvantage the UK and its citizens.

As has already been referred to, the Scottish life sciences sector is important. It employs 37,000 people, contributes more than £4 billion of turnover and £2 billion of gross value added to the Scottish economy, and is growing at around 6%. The life sciences sector in Scotland is distinct from the UK sector, in that med-tech and diagnostics companies comprise nearly half of it, with pharmaceuticals at 5%. The Government must take that into account in any future negotiations.

It is comforting to UK nationals who live in another EU country that, on the day the UK leaves the EU, they will still be eligible for the same healthcare as citizens there and will still be able to use the European health insurance card scheme when visiting another EU country. But what about UK citizens who, for example, require regular dialysis? Will leaving the EU mean that they will never be able to travel abroad?

We need to retain close links with the European Centre for Disease Prevention and Control. Potential pandemics will require the sharing of information. Notification of communicable diseases must not stop, and there has to be cross-border co-operation on those and other serious health threats.

Future trade agreements must not be allowed to impact on health and social care in Scotland. The Scottish Parliament’s European and External Relations Committee inquiry into the Transatlantic Trade and Investment Partnership, TTIP, stated:

“The protection of public services in Scotland, particularly NHS Scotland, was a key concern of those giving evidence to the Committee.”

Despite reassurances from the European Commission and the UK Government, the Committee remained

“concerned about the definitions of public services and whether the reservations contained in the final agreement would protect the full range of public services that are delivered in Scotland.”

We need to be clear that any future trade deals by the UK Government should explicitly address issues in order to protect the NHS from unintended consequences.

Out of a group of 60 or so proponents of the hardest of Brexits, not one is present to set out the pro-Brexit case for the NHS. They are not here, because they have no positive case to make. At its core, leaving the EU will damage the NHS and provide a worse service for patients.

Every step must be taken to protect the NHS across the UK from being hampered in its life-saving work. Patients deserve the best, and physicians, nurses, clinicians and those requiring social care should also get the best deal possible. Our life sciences, med-tech and diagnostic sector should be protected. We need to work with the EU on regulatory processes and disease prevention control. We must protect our most vulnerable citizens.