My Lords, I am very grateful to the noble Lord, Lord Lansley, for stating in very clear terms the benefit of putting into statue some of the restrictions on some of the activities of our political leaders, so that we do not need to trust
them, because these are in the law. I hope that when it comes to future groups in this debate, the noble Baroness, Lady Noakes, and others will remember those very wise words of counsel that it is important to have things in writing in our statutes to protect our valued principles and institutions. I am grateful to the noble Lord for doing that.
As my noble friend Lord Fox pointed out—this is at the heart of the debate on this group—the NHS is not just a greatly valued health and social service for our nation but is seen by many as a great economic asset. The noble Lord, Lord Lansley, is right that, when it comes to procurement and the provision of services, there is a great deal that is provided by the private sector. In the debate on the first group, I highlighted that about half the public procurement of the entire UK Government relates to health and that around one-quarter of the beds in the mental health service in the north-west of England are operated by an American health operator. I made no judgment about the good or bad side of that, but simply stated it as a fact. And it is a fact that the United States wants to expand market access to the provision. The question that then comes is: what is the limit and, as my noble friend Lord Fox indicated, what is the right balance? That is a question for the Government.
The Government have stated, as they would say, “categorically”, that the NHS is not for sale. Michael Gove was in the Scottish Parliament just this week, and he said to MSPs:
“The NHS is not for sale under any circumstances.”
My question is: what does he mean by the NHS? For many people, intellectual property and pharmaceuticals, the access to and price of medicines, the delivery of services, the buildings that people are in, and the employers of the people providing those services, are the NHS. We can outline concerns about some of the risks of a trade agreement facilitating greater market access for the provision of the private service situation from America, but what is the Government’s view about the limits of that? This is a genuine and legitimate question that Members speaking on this group have asked.
Before I move on to Amendment 75, in the name of my noble friend Lady Sheehan, reference was given to the potential American deal. The noble Lord, Lord Lansley, is absolutely correct that much of the Bill is about how the continuity agreements are in operation; he cited the existing agreements that we have and he cited CETA. On IP and ISDS, which we will come to later, there is a different approach, which we want to explore further.
One of the things that gave us a degree of reassurance —there was of course debate on CETA and the health service; I remember that very clearly—and one of the differences was that British parliamentarians were able to take part in discussions agreeing the mandate for CETA when it came to the remit and extent to which health and pharmaceuticals and intellectual property would be within the agreement. The INTA committee in the European Parliament would have seen the text of the mandate and the negotiation position, the offer from the European Union and a draft text before it was signed, and it would have seen the final text before
it went for a final review. None of us in this Committee will have any opportunity to have any of the equivalent for the American deal. It is therefore right to ask probing questions, especially since the question asked—I think by the noble Baroness, Lady McIntosh—was: what do the Americans want? I agree with the noble Baroness, Lady Noakes, that wanting something is not getting it. However, knowing what they want, and asking the Government what their position is on whether we are offering it, is correct scrutiny.
What do the Americans want? As we have heard, on intellectual property they refer to TRIPS, and page 8 of its negotiating mandate says it wants to
“ensure that the Agreement fosters innovation and promotes access to medicines, reflecting a standard similar to that found in U.S. law”.
When it comes to procedural fairness for pharmaceutical and medical devices, it wants to:
“Seek standards to ensure that government regulatory reimbursement regimes are transparent, provide procedural fairness, are nondiscriminatory, and provide full market access for U.S. products.”
We know what the American request is. We have not seen any of the negotiating offer from the UK—any counter-offer or any draft text—and the committee of the noble Lord, Lord Lansley, has not been provided with any draft text, as far as I am aware. Therefore, it is right to have in this Bill, at this time, proper questions along those lines. If the Government do not say what they mean by the NHS and the extent to which market access is open to new American providers then we must have the continuation of scrutiny.
On Amendment 75, I think my noble friend did the Committee a great service in bringing this amendment forward. My noble friend Baroness Northover has given the international context, as part of the debate on this group is around the international considerations. I am a member of the International Relations and Defence Select Committee, and we published a report in July this year which highlighted some of the truly drastic impacts of Covid-19 on Africa. We looked not just purely at the health elements but at the economic impacts. Of course, any economic impacts on the continent of Africa are also trade impacts for the United Kingdom’s relationship with those countries.
The African Trade Policy Centre of the UN Economic Commission for Africa has seen a 40% fall in African exports and GDP has effectively halved. The worst-case scenario looks like GDP falling by $120 billion, and UN ECA estimates point to Covid-19 pushing 27 million people into extreme poverty while imposing £44 billion to £46 billion in additional health costs. We know that those additional health costs will also incorporate what is likely to be a huge burden on many countries to provide vaccines and other medical support for a long-term, sustainable recovery from Covid-19.
It is right that my noble friend has raised the issue of the TRIPS Agreement and the Doha Declaration and whether the United Kingdom should activate, under that TRIPS Agreement, the ability of taking products over patents and then making them accessible. They would be accessible not just here in the United Kingdom but through a trading relationship. It is absolutely right that she has made that case. The noble Lord, Lord Lansley,
has pointed to the Government’s capability to do that. My question to the Minister is: is it the Government’s intention to do it?
Canada did it in March. Canada Bill C-13—
“An Act respecting certain measures in response to COVID-19”—
authorised the Government of Canada to supply
“a patented invention to the extent necessary to respond to a public health emergency that is a matter of national concern.”
The Prime Minister indicated that Canada’s role within that is not just at home but abroad. If Canada was able to do that in March, knowing what the likely global impact would be not only on Canada but on the least-developed countries in the world, what is the UK’s position? If we have not activated that agreement, why not? If it is the Government’s intention to do it, how will they implement it?