Meeting of the Parliament

Meeting date: Wednesday, September 26, 2018

Official Report 1223KB pdf

---

European Atomic Energy Community (Impacts of Leaving)

The final item of business is a members’ business debate on motion S5M-11849, in the name of David Stewart, on the impact of leaving the European Atomic Energy Community. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes what it sees as the importance of the medical isotopes that are used in radiotherapy for the treatment of cancer, diagnostic work and therapy throughout Scotland and the rest of the UK; understands that, because of Brexit, the UK will be leaving EURATOM, which is an international body that is legally joined with the EU to regulate nuclear material; believes that the UK does not produce any of these isotopes and that two-thirds of the countries that it imports them from are EU member states; understands that transporting them can be difficult, as radioisotopes have a very short half-life and cannot be stored for long periods of time; believes that any delay can lead to a decrease in useable material and, subsequently, the cancellation of appointments; understands with concern that leaving EURATOM could result in shortages of medical isotopes, increases in cost, and more medical operations in place of radiotherapy; believes that this would have a negative affect for people in the Highlands and Islands and across Scotland who rely on such treatment, and, in order to continue the necessary trade arrangements around the isotopes, notes the calls for the UK Government to come to an agreement that allows the country to remain a part of EURATOM.

17:09  

I thank all members who have stayed behind tonight to support this motion and all those members who signed my motion. For those who have not yet signed the motion, I of course always welcome sinners who repent.

On the surface, the debate may seem to be a surrogate for another round of Brexit speeches plus a seminar on an arcane institution—Euratom—or a poor man’s lecture on nuclear physics. However, I am sorry if any member is here under false pretences. The issue is very simple: the future treatment and care of cancer patients and the security of supply of radioisotopes.

Notwithstanding my opening statement, I will attempt to set the context of the problem. The United Kingdom joined the European Atomic Energy Community, which is better known as Euratom, on 1 January 1973. The UK gave notice to leave Euratom as part of the article 50 process, and the European Commission is clear that

“the Euratom Treaty will cease to apply to the UK on 30 March 2019”.

Why is that a problem for health services and cancer patients? Euratom is a crucial and essential vehicle for the management of radioisotopes. As the Euratom Supply Agency mission statement makes clear, its job is to support

“secure and safe supply and use of medical radioisotopes.”

Members will be aware that medical radioisotopes are used in radiotherapy for treatment of cancer and in nuclear medicine for both diagnostic work and therapy. The principal radioisotope used worldwide is technetium, which is derived from a parent element that has a half-life of 66 hours. The element is obtained from a small number of research nuclear reactors, none of which is located in the UK. The Hinkley Point nuclear research facility, which is planned for 2027, could produce medical isotopes, but the jury is out as to when that facility will be completed. The bulk of the UK’s supply is from the European Union and is facilitated by the Euratom supply operation. For example, the High Flux reactor in the Netherlands supplies the UK and has capacity for a third of global demand. However, it is estimated that it will cease operations in 2024.

Therefore, the context is that we have a world shortage of medical isotopes. A key provider, Canada, has just ceased production, so the EU is home to four of the top six global producers. The distances to Australia and South Africa, which are also significant players, mean that they are problematic providers, because supply would be limited by the decay of medical isotopes during transportation.

The key issue is that isotopes have short half-lives, which means that they decay rapidly and cannot be stored. That creates an urgent need for a constant, reliable and predictable supply, but that has failed in the past and created global shortages. Euratom has a central and crucial leadership role, because it supervises the supply chains. There was a crisis in 2008, with the closure of the Channel tunnel, and a crisis again in 2015, when industrial action in Calais caused chaos in the transportation of isotopes and the cancellation of treatment across the UK.

I argue today that there is a clear and present danger to the national health service in Scotland and beyond. The loss of frictionless borders post-Brexit could result in a traumatic failure to deliver medical isotopes on time to cancer patients. As the Royal College of Radiologists has said,

“Navigating Brexit is undoubtedly a huge task for ministers, but our access to these vital materials for diagnosing and treating cancer must not be left to slip down the negotiations list.”

Radioisotopes are essential tools for nuclear medicine that combine with a drug that guides isotopes to a particular part of the body. The scale of use is immense and invaluable. In the UK, about 700,000 nuclear medicine procedures are carried out each year, of which around 70,000 are in Scotland. They are essential in diagnosing coronary disease, detecting the spread of cancer to the bones and biomedical research. As the British Nuclear Medicine Society has said,

“patients will be poorly served by not having a cheap, plentiful supply of”

technetium, which is the most commonly used medical isotope.

What are our options? On a simplistic level, if it ain’t broke, why fix it? We could stay in Euratom. However, with the current UK Administration that decision is unlikely.

Secondly, we could look at having associate status of Euratom under article 206 of the Euratom treaty, which sets that out with reciprocal rights and special procedures. The best example is Switzerland, which joined in 2014. That status gives access to funding for nuclear research.

Thirdly, we could join the USA, Australia and Canada in having third-country status under article 101 of the treaty. The advantage of that is that we would have common research on a shared-cost basis.

I apologise for the technology, but we could create more cyclotrons in Scotland. That is not from a recent episode of “Dr Who”; a cyclotron is a linear accelerator that produces radioisotopes for positron emission tomography and computerised tomography scanners, better known as PET and CT scanners. There are three in Scotland—in Glasgow, Edinburgh and Aberdeen—but there is no spare capacity for the PET scanner in Dundee. While I am on my feet, I must campaign for a PET scanner in the Highlands, which spends £300,000 on scans alone. However, in my view, a large-scale switch is expensive and probably unlikely.

Fifthly, what about waiting for Hinkley Point C to be up and running in 2027? As I said earlier, the big question is whether it will be on time. Further, what will its capacity be? We still need to organise the supply chain management.

During the debates in the House of Commons on the European Union (Withdrawal) Bill, many MPs made telling contributions saying that, if we withdraw from the club—the Euratom Supply Agency—during a global shortage of medical isotopes, why should the club care for us? As the old saying from Capitol Hill goes, if you are not at the table, you are on the menu.

One does not need the predictive powers of the Brahan seer—who, incidentally, in the 17th century, predicted the second world war—to divine the future in this area. We have a global shortage of radioisotopes; we produce none of our own; and we are leaving the market that produces the majority of the world’s supply. This is not an obscure academic debate but something that will influence the quality and quantity of life for cancer patients in the UK now and in the future. As Jimmy Dean once said,

“I can’t change the direction of the wind but I can adjust my sails to always reach my destination.”

17:16  

I congratulate David Stewart on bringing this extremely important debate to the chamber. In his opening remarks, he clearly outlined the purpose of Euratom, which was created in 1957, and its importance. The Euratom framework has enshrined the regulation of and safeguards for the transportation and use of radioactive materials. It is worth repeating that the agency has been established for more than 60 years.

Brexit poses a threat to Scotland’s access to the international pool of research knowledge, skills and expertise on the subject of nuclear energy and medicine. For our nuclear industry, rapid withdrawal from Euratom spells disaster. Many experts in the field of nuclear energy, including the British Nuclear Energy Society, have suggested that, following the UK’s departure from Euratom, many power stations across the country might not be able to source nuclear fuel such as uranium 235 or plutonium 239. If the UK does not have an agreement, we will not have the necessary isotope material to provide services for our patients.

Given my health background, I will focus my speech on the health implications of leaving Euratom. David Stewart mentioned the shipment and stock of radioactive medical isotopes that are used for X-rays, magnetic resonance imaging scans and PET scans; they are essential in the provision of cancer treatment for some of the patient population, but that is under threat. That means that there might be significant delays for patients who are looking to access life-saving medical treatments in a timely manner, which might lead to premature and unnecessary deaths.

Earlier this year, my colleague Dr Philippa Whitford spoke on this subject in a debate in the House of Commons. She has first-hand knowledge of medical isotopes as she is a breast surgeon. I echo her saying that the Royal College of Radiologists is concerned that

“an inability easily to bring isotopes into the country could affect half a million scans and 10,000 cancer treatments. Isotopes cannot be stored, because they have a short half-life, so we need Euratom.”—[Official Report, House of Commons, 12 July 2017; Vol 627, c86WH.]

These are not pharmaceutical medicines that can be stockpiled, as has been suggested of other medicines. The scans and treatments to which Dr Whitford referred will in many cases have saved lives.

As many will be aware, medical isotopes are very particular products and their transportation must be carried out safely and in line with international guidelines—alternatives to them are limited. In a letter dated 6 September 2018, the president of the British Nuclear Medicine Society, John Buscombe, indicated that in addition to the potential logistical issues with transportation and supply of radiopharmaceutical products, including medical isotopes, the cost of importation and customs clearance is likely to increase significantly. In the same letter, President Buscombe urged local health boards across the UK to make preparations for that increase in cost, which I find extremely concerning.

What can the Scottish Government do to support our NHS boards to address the challenges of leaving Euratom? The 60-year-old treaty supports the safe supply of much-needed medical isotopes that save lives. It is really important that we bring the matter to the Parliament’s attention today.

17:20  

I, too, welcome the opportunity to debate this important subject, and I thank David Stewart for allowing us to have this discussion tonight. I cannot pretend to match his scientific expertise, but I am told that Brian Whittle has a chemistry degree, so I ask members to save their questions for him.

I promise not to do a standard Brexit speech, not least given the very serious implications that the matter has for cancer patients. I do not represent the UK Government, but I feel it is only fair to put its position to the Parliament.

A significant amount of discussion has already taken place at UK level on our membership of Euratom. I believe that, on all sides, whether people voted to leave or to remain, there is some consensus. The Prime Minister stated in a speech in May that she wants

“the UK to have a deep science partnership with the European Union”

and that the UK

“would like the option to fully associate ourselves with the excellence-based European science and innovation programmes—including the successor to Horizon 2020 and Euratom R&T.”

Last year, the Secretary of State for Business, Energy and Industrial Strategy, Greg Clark, said:

“The Government’s ambition is to maintain as many ... benefits as possible through a close ... association with Euratom in the future”.—[Official Report, House of Commons, 11 January 2018; HCWS399.]

There has been recognition of the need to protect the significant progress that has been made over the years between the UK and the EU in respect of nuclear research and nuclear decommissioning expertise, for example, and Brexit must not hinder that in the future. The Chequers proposal includes continued

“cooperation and information-sharing with the European Observatory on the Supply of Medical Radioisotopes.”

The UK Government has prioritised ensuring that a close relationship with Euratom exists after we leave the EU.

Although I recognise that much of David Stewart’s motion is on radioisotopes, there are some important points to make about the Nuclear Safeguards Act 2018, which is an important aspect, for several reasons. First, it allows the UK Government to make regulations for and to implement international agreements in relation to nuclear safeguarding, which will be required once the UK leaves Euratom. Secondly, it allows existing legislation to be amended by regulation in relation to withdrawal. Thirdly, it extends to the whole of the UK. Ultimately, I believe that it will allow for continuity.

On the main issue of medical radioisotopes, there have been assurances that leaving Euratom will not affect the UK’s ability to import medical radioisotopes. A paper that was published by the Department for Business, Energy and Industrial Strategy notes that

“The Euratom Treaty refers to medical radioisotopes ... and prohibition of customs duties”

et cetera, and that

“These references do not set any restrictions or limitations on trade in such materials with countries outside the EU.”

I submit that nothing in the Euratom treaty will impede the UK’s ability to continue to access medical radioisotopes from the EU when the UK is no longer a member state. The UK’s ability to import medical radioisotopes will not be affected by our withdrawal from Euratom.

There are issues around the Euratom treaty, which means that there is a free flow and movement of scientists. Is that part of Theresa May’s red line whereby we are not going to allow migration of workers? That would impede the ability to continue with research in Euratom.

I do not accept that. I am not going to get stuck into a debate about migration, but there has been a very clear commitment to EU citizens even in the event of a no-deal Brexit. The UK Government has made its position more than clear.

As I said, I welcome this opportunity to have the debate. Leaving the EU is clearly the most important political moment of our lifetimes and it is right that we have a frank debate about it. However, it is in the interests of the UK and the EU to ensure that the trade in medical radioisotopes is as frictionless as possible for the benefit of patients here in Scotland—and, after all, they are the people who we must keep in mind more than anyone. I hope that, given that significant forward planning has taken place, that will be realised in the months and years ahead.

17:25  

I, too, congratulate David Stewart on securing this debate on an important topic that was highlighted in a report by the Health and Sport Committee earlier this year. I am pleased to support the debate, both as the convener of the committee and because of the important role that my home city of Aberdeen has played in the field of medical physics. Members will know that credit for the invention and development of MRI and of PET scanners belongs to pioneers such as the late Jim Hutchison and John Mallard at Foresterhill.

Aberdeen royal infirmary is also one of several centres of nuclear medicine in Scotland’s cities that provide vital diagnostic and treatment tools for cancer patients in particular. The delivery of those services depends on nuclear physicists, radiologists and radiographers, all of whom are highly skilled, high-value staff; some of them, sadly, are in short supply, not just in Aberdeen but across the Scottish NHS.

Hospitals such as ARI also have radiopharmacies, whose staff are responsible for procuring the isotopes and managing the radioactive material that are essential to those medical uses. Those pharmacy specialists are also much to be commended for their essential contribution, and the good relationships that they have built up with the manufacturers of the isotopes in Europe have played an important role in ensuring the reliability of supply, on which patients depend. That said, that is, by definition, not a perfect market, or even a medically focused business model. The suppliers of radioisotopes did not go into business to meet medical need; their core business is typically military or involves civil nuclear power generation or related research. It is therefore a credit to all concerned that what is essentially a sideline to other much larger business activities has become so valuable in its own right, to the point where Britain leaving Euratom carries such significant risk for medical treatments.

The reason for the British Government giving separate notice of the UK’s intention to leave Euratom, as part of the Brexit process, is simply that the members of the European Union are signatories to the relevant treaty but—as David Stewart and Emma Harper mentioned—Euratom is technically separate from the EU itself. There is, therefore, nothing to prevent UK ministers from seeking to protect the many benefits of Euratom membership, including access to radioisotopes, as part of the wider negotiations on our future relationship with the European Union. Of course, that depends on ministers putting forward serious and credible proposals across the board, in particular around the terms of trade, in order to avoid tariff and other barriers between the United Kingdom and the EU. The prospects of that happening remain to be seen.

As has been said, the building of Hinkley Point C, perhaps in 2027, will resolve those critical supply issues, but that is no consolation to those who will need access to radioisotopes in the next few years. Supply from EU countries such as France, Belgium and the Netherlands remains essential, and securing that supply well into the 2020s must be a high priority for the UK Government.

If UK ministers are able to address those issues in the next few weeks or months, their negotiating position will be strengthened by the fact that EU countries rely on being able to import radioligands, which are manufactured in the UK by GE Healthcare. However, if ministers do not solve the problem, not only will patients here lose out, but there is a risk that GE Healthcare will ultimately choose to relocate that high-value, high-technology business to somewhere else in the EU.

A lot is at stake, in economic and health terms, and the UK Government must do everything that it can to resolve the issue as early as possible, for all our sakes.

17:29  

I thank David Stewart for bringing the debate to the chamber.

In the maelstrom that currently consumes British and Scottish politics, with Brexit and the continued constitutional bunfight, today’s debate should allow us the opportunity to have a much-needed balanced and informed debate on the potential fall-out—excuse the pun—from Brexit. It also serves to highlight the importance of the negotiations that are currently under way and what our role could and should be in ensuring that important issues such as the impact of leaving Euratom are not allowed to fall through the cracks.

I was going to make interventions in a couple of speeches. I do not underestimate the need to establish the movement of isotopes across our borders. However, I wanted to note that, although there are isotopes that have a very short half-life, which David Stewart mentioned, we also use isotopes that have a very long half-life. I have scribbled down strontium-90, which has a half-life of 30 years, cobalt-60, which has a half-life of five years, and iridium, which has a half-life of 74 days. They are also used in the process. It is important that we are having the debate to ensure that we stay factual, but I say that without underestimating the need for isotopes with a very short half-life.

Euratom has responsibility for establishing a single market for trade in nuclear materials and technology across the EU. It provides a key role in facilitating a secure and constant supply of radioisotopes, which are used across a range of sectors, including the medical, industrial and scientific fields.

My colleague Donald Cameron looked at the response from the UK Government. It is welcome that it seeks to continue to support the organisation and that it seeks continuity of co-operation and standards. I think that that includes the wish to maintain the UK’s mutually successful civil nuclear co-operation in the European Union. That is good news, and the intention has been very clearly outlined in the industrial strategy in order to support the scientific community and build as much support for it as we can after we leave the European Union.

We have discussed medical isotopes. Contrary to what has been said in some reports, medical radioisotopes are not classed as special fissile material and therefore are not subject to the same nuclear safeguards. Therefore, the UK’s ability to import medical isotopes from Europe and the rest of the world should not be affected.

I am very reluctant to argue with people who have degrees in industrial chemistry, but I knew that that issue would come up, and I have a letter from the European Commission, which has made it quite clear that radioisotopes, as in the case of other goods, are covered by the Treaty on the Functioning of the European Union concerning the single market. That means that their import or export is still subject to customs procedures or regulatory checks. Therefore, irrespective of the issue involving Euratom, which is the main supply agency, the European Commission has a vital import and export role, and a locus, in the area.

I will not argue with that; I merely pointed out that medical radioisotopes are not classed as special fissile material, so I think that they can be imported from around the world, including Europe.

The British Medical Association has suggested that the UK Government should negotiate a formal agreement with Euratom that is similar to agreements that are in place with non-EU countries, such as Switzerland. A precedent has already been set for collaborative working with countries outside the EU.

For the UK, negotiating a formal agreement with Euratom would ensure consistent and timely access to radioisotopes for medical purposes and facilitate close collaboration on radiation research and support. From the EU’s perspective, negotiating a formal agreement with the UK would underpin continued collaboration with UK nuclear research institutions and facilitate continued access to UK data that supports EU involvement in research projects. Should there be a failure to agree a withdrawal agreement by March 2019, the UK would have to operate outside Euratom and source radioisotopes from outside that framework. I agree that that would be problematic, but we must also remember that that would close off a market for countries that supply such products, and the UK market is a major one. In the longer term, it would also restrict the ability of the UK and the EU to benefit from sharing expertise in radiation research, radiation protection and the disposal of radioactive waste.

In the blizzard of political posturing that surrounds Brexit, we have a responsibility to ensure that issues such as our relationship with Euratom remain high on the agenda in the Brexit negotiations. I would prefer us to do that in a public forum, so that we can inform the public of the work that is being done, but I understand why political parties might be reluctant to act on such issues in public. Therefore, I ask that, at the very least, we, as a Parliament, do so behind closed doors.

I again thank Dave Stewart for giving us the opportunity to keep Euratom on the agenda.

17:35  

I join members in congratulating Dave Stewart on securing this important debate.

In 2016, 62 per cent of voters in Scotland indicated their wish to remain in the European Union. Despite the clear and decisive wishes of the Scottish people, the UK Government has pressed ahead regardless with its intention to take the whole UK out of the EU.

In our analysis, “Scotland’s Place in Europe”, the Scottish Government demonstrates that staying in the EU is the best option for Scotland’s future. Our analysis also shows that, failing that, continued membership of the European single market and the customs union is essential for our economy, our society and our people. It was good that Lewis Macdonald brought the economy into the discussion.

The potential consequences of leaving the EU are far reaching and damaging. It is only as the negotiations have progressed and become more complex that everyone can see just what is at stake. We must ensure that the Scottish voice is heard throughout the negotiations, and that we continue to push to be given meaningful input to them.

Last week, the First Minister called on the UK Government to seek an extension to the article 50 negotiations, and to reconsider our proposal to remain in the single market and the customs union in order to mitigate the worst damage of Brexit.

It is crucial that the UK Government ensures that there are robust contingency plans in place to safeguard an uninterrupted supply of medicines and medical products, including medical isotopes, that are sourced from the EU. Many of the practical issues related to the supply of medical isotopes, such as entry and customs controls, are outside the Scottish Government’s control, but we will continue to press the Department of Health and Social Care to co-operate and to engage fully with us on the Brexit preparation plans.

Members can be assured that we are preparing for all eventualities related to EU withdrawal. Officials have been working closely with NHS Scotland boards over recent months to mitigate the risks and potential implications, where possible. NHS boards are also doing their own planning for Brexit: I assure Emma Harper that we are supporting them in that work, in the context of what is a fluid and rapidly developing situation. All boards have consistently identified concerns relating to the obvious workforce issues. They have also identified issues to do with medicines, medical isotopes, medical devices, clinical trials, access to future EU funding and the right of Scottish citizens to access state-provided healthcare across the EU.

In August this year, the UK Government announced plans to secure supplies of medicines, medical devices and clinical consumables in the event of a no-deal Brexit. Those plans include its intention, in order to ensure that there is an additional six-week supply, to stockpile medicines that might be impacted by delays at the UK border. Officials are working with the Department of Health and Social Care on that issue and are discussing preparedness plans with NHS Scotland.

Emma Harper outlined the medical uses of medical isotopes. Those that are used for diagnosis and treatment of diseases including cancer are all made outwith the UK. As Dave Stewart said, those products cannot be stockpiled, because they decay rapidly. With the benefit of his industry experience, Mr Whittle was able to highlight one or two medical isotopes that do not decay rapidly; however, many have short half-lives and do decay rapidly. Therefore, it is critical that they reach hospitals as soon as possible and are not held up by customs delays.

The UK’s membership of the European Union is inextricably linked to its membership of Euratom—the European Atomic Energy Community. Although it might be possible to have some other arrangement, it is clearly better for the UK to be part of that community than for it to be a bystander. By leaving the EU and, by extension, Euratom, the UK Government risks future production and supply of medical isotopes for the whole of the UK.

This is probably the first time that I can say that I agree with every word that the minister has said. Does the Scottish Government have a contingency plan in case of shortages? Has it considered asking, for example, Healthcare Improvement Scotland to carry out an analysis?

Cyclotrons are important, and we have control over them. However, the minister’s city of Dundee does not have the raw material that is needed. I make a plea for decentralisation, because the need is real, in particular in Raigmore hospital in Inverness.

As the implications of Brexit become clearer, we need to look at all the options, to make sure that we try to mitigate what is a really bad situation.

In contrast to the rosy picture that was painted by Donald Cameron and Brian Whittle, stakeholders including the British Nuclear Medicine Society and the British Medical Association have significant concerns. Considerable uncertainty remains. As such, we are clear that the UK Government is playing with the lives of the people of Scotland and, indeed, the lives of people in the rest of the United Kingdom who depend upon these life-saving products.

I want to clarify that in no way was I trying to paint “a rosy picture”. I am an ardent remainer—one of the 62 per cent in Scotland, or the 48 per cent in the UK. We all make political points, but all that I was trying to say was that, within the Brexit environment, it is massively important that we get the opportunity to raise such issues continually and keep them on the agenda.

Brian Whittle is correct, but many risks are associated with Brexit and many of them fall in areas that are reserved to the UK Government, which makes it difficult for us. As he said, it is important that we have these discussions as, indeed, Mr Stewart has brought this Euratom debate to the chamber.

There are huge risks to supply of medicines, medical isotopes and medical devices. If the UK Government persists with its position of leaving the single market and the customs union, it will be doing so knowing the harm that that will do to our invaluable NHS.

We are clear that all people living in Scotland, including those who have to deal with life-changing diagnoses, deserve clarity and reassurance from the UK Government—especially clarity that supplies of crucial medical products including isotopes that are used in diagnosis and treatment of diseases including cancer will not be disrupted.

Members can be assured that we will continue to push the UK Government for those assurances. Scotland did not vote for Brexit. As the potential consequences become clearer by the day, it is time for the UK Government to wake up and to start working to retain Scotland and the UK’s place in the single market and the customs union, and to keep us in Euratom.

Meeting closed at 17:42.