The following amendments have been selected: amendment 1 in the name of Darren Millar, and amendment 2 in the name of Rebecca Evans. If amendment 1 is agreed, amendment 2 will be deselected.

Item 8 on our agenda this afternoon is the Plaid Cymru debate on Brexit and future trade, and I call on Delyth Jewell to move the motion. Delyth. 

Motion NDM7214 Rhun ap Iorwerth

To propose that the National Assembly for Wales:

1. Notes that:

a) the UK is currently due to leave the EU on 31 January 2020;

b) informal trade negotiations between the UK and US concerning a future trade deal has begun, which reportedly include references to the marketisation of patents/NHS drug pricing;

c) international treaties are outside the scope of powers of the National Assembly for Wales;

d) Section 82 of the Government of Wales Act 2006 allows the Secretary of State to direct Welsh Ministers to take any action required for the purposes of giving effect to any international obligation.

2. Believes that:

a) Wales’s future would be best served by continued membership of the EU and that a referendum should be held between remain and a credible leave option;

b) the Welsh NHS should not be forced by the UK Government to open up its market for greater private provision, or have increased drug costs imposed upon it as a result of any international agreement that extends patents and restricts use of generic drugs;

c) a future trade deal between the UK and the US which included provisions relating to the NHS would be a disaster for the Welsh NHS;

d) the health care system in the United States has failed to properly regulate the marketing and prescribing of Opioids, and notes that this inadequate regulatory environment has contributed to over 70,000 deaths in the U.S  from opioid overdoses in 2018, and this is just one example of the dangers of deregulation that could follow a trade agreement written in the interests of US pharmaceutical companies;

e) the UK Government should not be able to direct Welsh Ministers to take actions in devolved fields which have the potential to detrimentally affect Welsh public services.

3. Calls for:

a) the devolved parliaments of the UK to be given a veto over trade matters which have the potential to affect devolved fields;

b) Welsh MPs to support the NHS protection bill due to be introduced in Westminster in the new term;

c) Section 82 of the Government of Wales Act 2006 to be repealed.

Motion moved.

Diolch, Dirprwy Lywydd. Our NHS is in dire peril. We are now a week away from the election. The election that's meant to get Brexit done, according to Boris Johnson. Meanwhile, Donald Trump is visiting the UK to assure us that he has no plans to gain market access to our NHS. Both these viewpoints are lies. The Conservatives' Brexit plans will not get Brexit done. Passing the withdrawal agreement will only be the end of the beginning, while the future relationship negotiations are yet to begin. And Donald Trump's assurances are about as reliable as a Tory manifesto commitment for Wales, unfortunately.

Trump said yesterday that he wouldn't want the NHS to form part of any deal, and that he also had no idea who started this vicious rumour in the first place. Well, I can help him with that because it was, of course, Donald Trump himself who did just that. During a visit to the UK on 4 June, he was asked whether the NHS should be on the table, and his answer was:

'When you’re dealing in trade everything's on the table, so NHS or anything else or a lot more than that but everything will be on the table, absolutely.'

So, that's clear, then. Two days earlier, the American ambassador, Woody Johnson, had told Andrew Marr the same thing. There is also clear evidence that gaining partial access to the NHS forms a big part of the US's trade objectives, which are to be found in an official US department for trade document entitled 'United States-United Kingdom Negotiations'. Further proof was contained in the documents released last week by the Labour Party, which show exploratory talks were already ongoing and that drug patents and pricing, health insurance and medical devices were discussed. And only yesterday, Dominic Raab confessed on Sky News that US companies could indeed increase drug prices for the NHS through provisions likely to be enacted in a future trade deal.

Now, I think it would be useful to give some detail about what exactly the US is after here, and how it could affect patients here. We're not talking about privatising the whole of the health service. Private companies would have no interest in running accident and emergency departments, for example, because, to put it bluntly, there are no easy profits to be made there. What they want is to cherry-pick the most lucrative parts of the market, in order to divert money from front-line NHS services to the pockets of US big pharma. The simplest way of doing this is through changing rules around patents and drug pricing, which is exactly why these two factors form the main part of US negotiating demands. Now, if the US were successful in gaining full market access for US drugs, they would greatly limit the National Institute for Health and Care Excellence's ability to decide which medicines patients can receive. In the US, drug prices are inflated to, frankly, obscene levels, because the licensing is lengthy and under control of powerful lobbyists, which means only a few companies have the expertise to navigate the process.

Will the Member give way?

Yes, I will.

When she says that US drug companies want to gain full market access to the NHS for drugs, what does she mean by 'full market access', and to what extent do they not have such access currently?

US pharma would want to deregulate the whole market, so that US drugs could compete. And we've all read the stories, Mark, about how pharmacies in the UK at the moment—for example for any kind of paracetamol, the price is a lot lower than what it would be for an equivalent drug in the US. So, if you have evidence to the contrary, in your contribution, which I'm sure you'll make later, I'd be very glad to hear it.

But as I was saying, US drug prices are obscene and very few companies have the expertise to navigate the complicated process that governs that. This allows unscrupulous vultures to acquire off-patent drugs on the cheap, then, to hike prices. So, when Trump says that drug prices in Europe are too low, what he actually means is that they aren't artificially hyper-inflated in order to increase the profits of the pharma industry. So, this is the nightmarish reality that could face us in the UK. If the US was successful in changing rules around patents and prices, the UK would either have to dramatically increase the size of the NHS budget to pay these huge additional costs, or move NHS funds from services to drug expenditure.

Now, the second biggest threat is the effect that deregulation of drug prescriptions would have on the health of patients. To see how this can affect public health you only need to look at the opioid crisis in the US, which has led to nearly 0.5 million deaths over the past 20 years. The pharmaceutical industry successfully shifted the prescribing policy in US states so that opioids were prescribed for a wide variety of reasons above their intended use, leading to widespread abuse and dependence. So, the threat is real.

Our NHS is facing a clear and present danger. The question is what can we do about it? The easiest way of taking the threat completely off the table would be to not leave the EU. If we decided to remain following a referendum, the threat to our NHS would disappear, and we would also have more money to spend on public services because we would have avoided an expensive divorce and a likely recession. But if a Tory Government is returned a week tomorrow, it's difficult to see how a hard Brexit followed by a dangerous trade deal with the US is to be avoided, unless we do something about it. That isn't something we can ignore because it's not politically expedient to admit to the possibility during an election period.

Plaid Cymru is today proposing three measures to protect the Welsh NHS. First of all, we want the devolved legislatures to hold a veto over UK trade deals that have the potential to affect devolved fields. The UK would not include measures that were unacceptable to Wales, Scotland an Northern Ireland, when Stormont is reconvened, because they'd want to avoid the veto being used. Our proposal is not without precedent, since the Wallonia region in Belgium possesses this veto and uses it in a responsible way. They've only invoked it once over the CETA trade deal between the EU and Canada, before allowing the deal to go ahead once they'd secured the concession they required. By voting against our proposal, Labour will be voting against giving themselves a veto over NHS privatisation. They may want to think this over before doing that.

We're also calling for Welsh MPs to support the NHS protection Bill, due to be introduced in Westminster in the new term by the SNP, with Plaid Cymru support. This would give added protection to the NHS against the effect of a future trade deal.

And finally, we want to repeal or modify section 82 of the Wales Act to take away the powers Westminster currently has to force Welsh Ministers to implement directives in order to give effect to international agreements. Our fear is that the UK Government could use this little known section to force damaging privatisation measures on the Welsh NHS. Again, I am at a loss as to why Labour does not agree with this. Surely, they'd rather not allow an Alun Cairns to tell them what to do in devolved fields? I hope Members will support our proposals to defend the Welsh NHS from the dual threat of Boris Johnson and Donald Trump.

I have selected the two amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. Can I call on Mark Isherwood to move amendment 1, tabled in the name of Darren Millar?

Amendment 1—Darren Millar

Delete all and replace with:

To propose that the National Assembly for Wales:

1. Notes that Wales voted to leave the European Union in June 2016.

2. Believes that the outcome of referendums should always be implemented.

3. Welcomes the opportunities for Wales which will arise as a result of new free trade agreements post the United Kingdom's departure from the EU.

4. Recognises that, under the devolved settlement, responsibility for international treaties is a matter for the UK Government.

5. Acknowledges the assurances provided by the UK Government regarding market access to the NHS in future trade deals. 

Amendment 1 moved.

Once again, the nationalists are in Brexit denial. On 23 June 2016 the UK voted to leave the European Union. Wales voted to leave. Ynys Môn, Conwy, Denbighshire, Flintshire and Wrexham voted to leave. Carmarthenshire voted to leave. The Rhondda voted to leave, as did the rest of the south Wales Valleys. They repeated that pattern in the European elections this year, and even replicated it in the Brecon and Radnorshire by-election, when over 50 per cent voted for strong pro-Brexit candidates in August.

Yet, Plaid Cymru, Liberal Democrat and Labour AMs, supposedly here on a democratic mandate, continue to defy the democratic will of the people of Wales. Had there been a referendum on Welsh independence with 52.5 per cent in favour, it's inconceivable that the nationalists would be suggesting people didn't know what they were voting for, or calling for a rerun. Instead of getting Brexit done and beginning to heal the divisions, another referendum would take the UK back to square one, erode trust in the political system and make a mockery of our democracy.

Making up accusations about your opponents as a way to win votes also erodes trust, and this motion continues the scaremongering about the future of the NHS. The Conservative manifesto is crystal clear: our NHS is not for sale. It states, quote:

'When we are negotiating trade deals, the NHS will not be on the table. The price the NHS pays for drugs will not be on the table. The services the NHS provides will not be on the table.'

Last week—

Will you take an intervention?

By all means.

Does it also say that patents and changing the rules of patents are not on the table?

I'm sorry, I didn't catch what you said.

Does it also say that changes to the rules on patents will not be on the table? Because that's an important factor in deciding the funding and the prices of medicines coming from outside. 

That is more scaremongering.

Last week Labour's Barry Gardiner, in fact, was unable to point to any evidence that the NHS would be on the table in trade talks. Jeremy Corbyn has claimed that under a free trade deal with America, the cost of medicines in the UK would increase by £500 million a week. That's £27 billion a year. However, the entire annual UK drugs bill is only £18 billion.

Last week, Jeremy Corbyn accused Conservatives of a plot against the NHS and said:

'Imagine opening a five-figure bill for your cancer treatment. Imagine paying to give birth. Paying to have a check-up at the GP.'

These desperate fear tactics demean political debate, and I hope all sides of the Chamber will condemn those preying on sick and vulnerable people with these false claims. It's desperate stuff from a Labour Party—and Plaid Cymru—with nothing positive to say about the future of Britain. 

Seven per cent of the UK's NHS services are currently in private hands. The biggest growth in private involvement in the NHS was not under the Conservatives, but the Labour Governments of Blair and Brown. It's the latest in a long line of propaganda claims at general elections—in 1979, 1983, 1987, 1992, 2010, 2015 and 2017—in which the Labour Party claimed the Conservatives would privatise or destroy the NHS if the party won the election. Well, the Conservatives have won seven of the last 10 general elections, and have protected the NHS far better than the Labour-run Welsh Government has managed the NHS in Wales. We cannot trust the only political party in the UK to have ever imposed cuts on the NHS budget. NHS Wales is still recovering from the legacy of Labour's decision, with key patient waiting targets not being met once in the past decade and patients forced to pay the price. Our NHS is not safe in Labour's hands. 

Point 3a in Plaid Cymru's motion calls for the devolved Parliaments to have a veto over trade matters, which are clearly non-devolved. The UK made a collective decision to leave the EU, and the UK will negotiate future trade agreements with the rest of the world. And, yes, we do believe the Welsh Government has a part to play in that, but it is yet another benefit of our United Kingdom that we can engage with other countries as a union of four nations, giving us far greater influence globally as a critical mass of almost 70 million people.

It's sad that Labour and the nationalists are fighting this election on the basis of fearmongering. Boris Johnson has been very clear about his priorities: getting Brexit done by 31 January to respect the result of the referendum; recruit more police; invest in our NHS; and put more money into schools. It's a positive vision to exploit the opportunities outside the European Union, to unlock investment in our economy and to unleash Wales's potential. You should be ashamed of yourselves.

Can I ask the Counsel General and Brexit Minister to move formally amendment 2, tabled in the name of Rebecca Evans?

Amendment 2—Rebecca Evans

Delete point 3 and replace with:

Calls for:

a) The devolved institutions to have a formal role in negotiations on international agreements when devolved competence is engaged, applying at all stages of negotiations and having statutory backing.

b) A UK-wide constitutional convention to ensure that future constitutional arrangements reflect this and prevent the UK Government over-riding the National Assembly where it is acting within devolved competence.

Looks forward to the election of a UK Government which is fully committed to safeguarding the NHS in Wales and across the UK.

Amendment 2 moved.

Formally.

Formally. Thank you. Helen Mary Jones.

Thank you, Deputy Presiding Officer. In terms of the reality of this threat, we've heard a lot of people using the word 'scaremongering' and I just want to say a little bit more about a matter that was touched upon in Delyth Jewell's contribution with regard to the opioid crisis in the USA. Now, we have all heard of this. It crops up in popular fiction. We have hundreds of thousands of US citizens addicted to substances that they should never have been prescribed in the first place.

Opioids, of course, are properly used for patients who are terminally ill, who are suffering very severe pain, but they have been prescribed across the USA willy-nilly for all kinds of conditions for which they are entirely unsuitable. Over 70,000 deaths last year were attributed to this addiction; over 400,000 in the last 20 years. So, how was this able to come to be? Well, this was able to come to be from a complicated set-up that was to do with the deregulation of some kinds of drugs, the inappropriate regulation of others, the hyperinflation around certain, perhaps more appropriate, medicines, which Delyth Jewell has already touched on. 

Now, we are all, I think, in this Chamber—I'd accept that Mark Isherwood probably is as well—[Interruption.] Of course. 

Wouldn't you agree that there are many hundreds of thousands of people in this country who are the victims of the overprescription of drugs—in this country, at this moment?

It is certainly the case that there have been issues, but there is nowhere near the scale of crisis that we're facing now. Now, nobody is saying that our current system for regulating medicines is perfect. The health Minister regularly has some of us on our feet in this Chamber asking him to make medicines available that haven't gone through the NICE process, but the reality is that the NICE process is there to protect people, and, if we do the deal that Donald Trump wants—and it's perfectly clear that that's what he wants—if we do the deal, our NHS will have to be exposed to these kinds of US practices, because if they—[Interruption.] If Janet Finch-Saunders would like to make an intervention, I'd be delighted to hear from her, as always. Otherwise, perhaps she could allow me to continue. 

Thank you for taking an intervention. Recently, I've been contacted by somebody working within the medical profession in north Wales, and they state now that the health board under our health Minister is already, in terms of knee and hip replacements, actually dealing with America in terms of the provision of those knees and hips, and they're patented in America. So, why are we not buying them now in-house in our country? Why are we already dealing with America—

I'm very sorry to have to interrupt—

—if it's so bad?

—Janet, but my time is limited. Of course, we buy and sell medicines and equipment from the USA, but they are subject to a rigorous regulation system that begins in the European Union and ends in our doctors' surgeries. And I know who I trust and who I don't. Anybody who thinks that there would be any kind of meaningful deal to be done with the USA unless these matters were on the table is living in cloud-cuckoo-land. Now, we know that this is a part of the stratosphere that many Conservatives do inhabit, but the realities are the realities. Unless we've got stuff to give the USA, why would they do a deal at all? 

Now, I want to be clear, Deputy Presiding Officer, as I bring my remarks to a close: in tabling this motion today Plaid Cymru is not accepting that Brexit is inevitable. We very much hope that the outcome of this election will be an outcome where there will be enough remain MPs to be able to ask the people again, but that is not a reason, as Delyth Jewell has said, not to be prepared for the worst possible option. Now, I actually believe that Mark Isherwood believes what he says, but, when you read about the connections in the highest levels of the Conservative Party in the UK with right-wing think tanks who would happily dismantle our NHS, I have to say that I believe that Mark speaks for himself, and I don't believe he speaks for the majority of the people at the top of his party in Westminster. And those are the people that we have to fear. [Interruption.] Those are the people that we have to fear. If Mark Isherwood would like to make an intervention, if the Deputy Presiding Officer will allow it—. [Interruption.] Well, of course, the Deputy Presiding Officer—

Well, he's not getting up. He's not getting up, so you carry on. 

—has already heard from him.

Mark Isherwood rose—

Oh, right, he is. 

We know what those—.

Well, yes, you've been inviting—. 

Is that a 'yes' or a—?

I think—. You've invited him. He's on his feet, so—.

Only because I was invited. I quoted exactly what this section of the manifesto states. Have you read it? 

Yes, actually, the part of the manifesto that may impact directly on Wales, I have, the problem being that I simply don't believe it, and I'm not sure—[Interruption.] I am not sure, because, when Conservative colleagues here get on their feet and bluster at length, I am always left with the Shakespearian quote, 'Me thinks, my lord, he doth protest too much', in my head, because I think there are elements that you may be as concerned about as I am. 

I'll bring my remarks to a close by saying this: I think there is consensus on the Labour and Plaid Cymru benches that this is a serious issue. Clearly, that's the way the Government has chosen to amend this motion. What I cannot understand is why, if the Government does believe it's a serious issue, they are not prepared to actually support doing something practical about it, because, if the Counsel General is going to ask me to believe that any Conservative Government is going to treat any Welsh Government respectfully around these issues, then I'm afraid he's another one who's heading for cloud-cuckoo-land. 

I had thought that this debate would be on Brexit and trade, but I heard the Plaid Cymru spokesperson this afternoon in questions to the Counsel General say it's about NHS privatisation, and I've heard nothing else other than NHS privatisation this afternoon. I'll try and keep off it as much as I can and focus on the issues of trade. Just to plug an issue, the committee produced or is producing a report on international trade agreements. It's imminently to be published, and I urge everyone to read it. I will avoid using too much of it today because it's for your future reference. 

Now, I do welcome the motion this afternoon, and particularly how it reflects upon future international agreements that should be structured following Brexit. I do not disagree with the first two points of the motion and, in fact, I think—Delyth Jewell, in the first half of her contribution, I totally agreed with everything she said; it's the second half I perhaps have some challenges with, particularly the impact—. I don't want to highlight the impact on the NHS in a US-UK trade deal. There's no question about it. No matter what Mark tries to do, or the Conservatives try to do, in denying it, it is likely to be on the table, and the discussion—and we talked about opioids—is one aspect. We all know about medications; I think it's been mentioned by Delyth Jewell—the costs. Let me give you some highlights: insulin, £16.61 in this country, £215 in the US; epipens—and, if you know about epipens, you have to have them; you don't use them necessarily, but you have to have them, and, after a while, they go out of date and you can't use them—£52 in this country, £523 in the US. Now, that's the type of pricing that the US want in the UK by this deregulation and removal of patents. So, it's definitely a threat to the NHS in any trade negotiations. It's real, and it puts our citizens at risk. Let's not hide from that fact, no matter what the Conservatives will try and hide.

However, the question is: how can Wales be protected from having to suffer the consequences of such trade deals? It's one that must be addressed, but I do not believe it's addressed by establishing a veto, though I'm sure Plaid Cymru would love to be able to use such a rejection as another reason for independence.

Currently, there's no formal mechanism to ensure that Welsh Government or the Assembly would have any say in negotiation and confirmation of these agreements, even in circumstances where they engage devolved competence. There's been talk of a joint ministerial council on international trade—that's not yet happened, and, if it does, will it have the same teeth as the other JMCs have, particularly the robustness and impact of JMCs, which have been heavily criticised by many in this Chamber? So, it's not really a mechanism we would support, in one sense.

The issue of a veto could be seen as an attractive one by many who wish to show that Wales cannot be forced to act against the policies of a Welsh Government that it has been elected on. However, there are clear concerns as to the timing of such a decision. A veto occurs at the end of a negotiating process. What we want to actually do to ensure the best interests of Wales is get involved at the start of the process. That's the critical element. It's about setting the direction of the negotiations and being included in establishing the mandate for negotiations. It's getting involved early, being in the room where negotiations are discussed, and particularly when they're on devolved competencies, and they're there when matters that impact on devolved competencies—. This is often the case across European neighbours and elsewhere in the world. It happens.

Research by the Wales Centre for Public Policy highlights that the only example in Europe, which has been mentioned before, is Belgium, where an individual sub-state elected legislature can prevent ratification of an agreement, and it was Wallonia in the CETA agreement, but it wasn't Flanders and it wasn't Brussels, it was Wallonia, so it's one, which held that nation up and which then held the 28, at that time, other nations also up on their application. So, that's the only example in Europe.

In other states, subnational Governments actually are involved in the development of policies, and this is done through a constitution and exclusive powers given to them through Government—written constitutions. That's what we haven't got—we haven't got a written constitution, so it makes it more difficult for us. Germany is a good example, where the Länder are influencing and able to influence international agreements that could negatively impact upon their powers. It's by giving them a formal role in the discussions and negotiations when devolved issues are involved. They're also able to act through a second Parliament, the Bundesrat, as well. So, there are examples of where legislatures can work in agreements without the veto and influence the agreements in the best interests of their citizens. That's a possible solution we should be looking at.

Now, the Welsh Government has looked at the agenda, moving forward, and has brought forward its own papers, recently on 'Reforming our Union, Shared Governance in the UK'. In there, it talks about the inter-governmental machinery that's needed to look at these policy agendas, and we need to address that. We need to look at how do the agendas go.

I am aware of the time, Dirprwy Lywydd, and I want to conclude, therefore, by reflecting upon the Conservative amendment. To be honest, I looked at that and I thought, 'They're denying that there are valid concerns about the current trade negotiation stance of this UK Government. They are trying to block them out of people's minds, trying to hide them from the public.' The amendment states we should have no involvement in trade negotiations, as it is a reserved matter. They think Westminster can do better for us, without our involvement and our input. I think that they should be ashamed of such a consideration—they are representing Welsh people and yet they think that Westminster can do better for the Welsh people. They should be ashamed of that denial.

Now, future trade agreements will be important, once we leave the protection of agreements we have benefited from as being a member of the EU, where there's a need to respect devolved nations in those agreements. And, as such, they must be negotiated and agreed with the full involvement of the devolved Governments and devolved legislatures. 

I must say, it is incredibly naïve of the Conservative Party to think that, somehow, the UK can expect to cut a deal with the United States that gives the UK exactly what it wants without giving the US some of what it wants. I think it's even more naïve to think that the UK can somehow demand that the US abandons key elements of its basic negotiating positions. Everything is on the table; that is quite clearly what Donald Trump expects. And when UK Government starts demanding what is and what is not on the table, I'm quite sure that the United States will tell the UK to go and look for another table to go and sit around. 

When we're talking about trade, trade deals and seeking trade deals, it's not just about what is bought and sold, what goods can be bought and sold back and forth, it's how they're sold, what rules apply to those sales, what regulatory frameworks or regulatory alignments are needed in order for that trade to be facilitated, and perhaps what tariffs are on some goods, as quid pro quos for others. There are a whole host of elements that need to be considered, and it's not just about goods either, of course, it's about services. And in terms of goods and services, it is quite clear that there is a desperate threat to the NHS from getting a US-UK trade deal wrong, and I fear that the UK would be in a very weak position going into those negotiations. 

Now, I could talk about services. The Conservatives will tell you that they have no proposals to sell off the NHS. Of course, what they won't stop is the death by a thousand cuts, the introduction of more and more private elements, private companies working within the NHS, profiting from the NHS. Sadly, we're seeing it from the Labour Government here in Wales, too. And health service deliverers in the United States will be vulture-like, circling the NHS in the UK, looking for ways in through a US-UK trade deal.

But I'll just concentrate on drugs, too. Trump is on record saying he thinks drug prices in Europe are too low. The US pharmaceutical industry has submitted arguments to US trade negotiators complaining about the UK's longstanding market access barriers. It's possible that trade agreements, for example, will require NICE to change the way it appraises the cost-effectiveness of drugs. That could be one of the elements of small print to such a trade agreement. And it could require changes to collective purchasing arrangements, because such arrangements are seen by some in the United States pharmaceutical industry and the Government, it seems, as being anti-competitive. 

Now, we should all understand that lengthening patent protections will increase costs for the NHS—there's already been reference to that. You keep those patent protections that keep some drugs very, very expensive and that clearly can have an impact on us, if the NHS had to pay those prices.

Will you take an intervention?

Yes.

Thank you, Rhun. Would you agree that we had a trade agreement with the United States long before we went into the EU and that there was an opportunity all along, from 1948 when we had the NHS, right up to 1975 when we went into the EU, for the United States pharmaceutical industry and all the other industries to have done exactly what you're saying to the NHS at that time?

Two things: those were organic agreements that were arrived at over time, rather than this desperate United Kingdom going begging to the United States for a deal, but also this is another generation, now. We're not quite the same generation, David, and that is a time that is before I was born. We need to look to the time when my children and grandchildren will be living, because those are the times that we need to protect now. 

I've referred to the patent-protected drugs; there are real fears on generic drugs, too. The way the system works in the United States, we've seen it through the story of Martin Shkreli—Trump supporter, now a convicted felon—in the way that he used generic drugs and pushed their prices up in the United States. When you have a generic drug, you would expect economic forces to come into force and to drive costs down. The way the United States works, it is the opposite. We are lobbying in the United States to make sure that—. It's a protracted process when a company wants to introduce a generic drug. That's the kind of process that they will want introduced here, too. There's an example with Cuprimine, which is a niche drug. It was approved in the United States in 1970, a generic drug currently priced at $31,000 for 120 capsules in the United States. The British equivalent generic drug costs $230 for 120 capsules. That is the kind of system, the regulatory framework, the context in which the pharmaceutical companies in the United States would want to operate and deal with the United Kingdom national health service.

I'll leave it there, but do not believe for a second when Trump and Boris Johnson, for electoral reasons in this general election, say that the NHS is somehow going to be left untouched; it is clearly not, and the US pharmaceutical industry will make sure that it's not.

I congratulate Plaid on tabling this debate and a relatively lengthy motion. It would be a challenge to respond to every point in it, but generally, I don't know whether Plaid have put this motion because it's a cynical effort to exploit the NHS and scares of a US trade deal in advance of the election, or whether it's because of genuine, albeit misconceived, concern about how the health market and regulation operates in the United States.

I agree with point 1 (a) of their motion about leaving the EU on 31 January 2020, and I think points 1 (c) and (d) are factual. But point 1 (b) and I think the references at 2 (b) and (c) to their beliefs I think I will address in combination. They refer to the marketisation of patents. Patents are issued by Governments or their patent offices and are enforced through the courts. Someone who has a patent can buy or sell that patent, but I don't think either of those are going to be influenced by any trade negotiation.

The references—I think broadly they have a number of fears. One, and I think it's been suggested this isn't really held, is that the NHS is just going to be sold to US providers. The NHS costs about £140 billion a year across the UK, and it doesn't take in, generally, revenue, hence it's not attractive for a private provider to come and seek to buy it. Clearly there are other issues, which I'll turn to, but I'll take the intervention from Rhun.

Just very briefly, as I said in my contribution earlier, it's not a matter of the NHS being sold off as one unit; it's the private sector having an ever-larger foothold within the NHS, and profiting from the NHS.

I respect that point, and I think Plaid had been clear that they're not suggesting a broader sell-off in the way that some people perhaps on the Corbyn side have done. To address the point they make, I think the single largest expansion of the private sector into the NHS was the diagnostic and treatment centres brought in by the Blair Government. They were legislated for, in England at least—[Interruption.] Indeed, the First Minister makes the correct point that they weren't brought in in Wales. I won't take that intervention; I need to make progress. What they did do is—they were introduced in England in 2003 and they had a mixed record. I'm not here to defend them. I think they had some limited success in reducing waiting lists in particular areas, but I think some of the criticism of them for cherry picking the easier cases was also justified. But in terms of any trade impact of those, I don't see how it would really bite, because in this country, we haven't tended to be protectionist within the public sector. There are, within the EU, rules about that, but we haven't tended to exclude non-EU providers. Some areas where compulsory competitive tendering—indeed, it required equal access for overseas countries. We tend to give it anyhow.

No doubt, in a trade deal with the US, we would like to break down some of their Buy American Act provisions within their public sector, but overall, I don't think our public sector is particularly protectionist. And if, for one of those diagnostic and treatment centres, a US provider had come in and offered to do it on a cheaper or higher quality basis than other providers, I presume that the Blair Government would have accepted that. Having made a contract with that provider, would we then want that to be sort of ripped up by a future Government? I would expect our courts, in any event, to protect an overseas investor in that context, and I doubt the US will be much concerned about that in the way it was with the transatlantic trade and investment partnership, because of concerns about some European courts in some countries, they don't necessarily—[Inaudible.] I will briefly take that intervention.

Thank you. With regard to the 460-page document that we're referring to in terms of that potential for trade, and we've talked marginally about diagnostics, what do you feel that document was all about? How would you paraphrase that very intricate document, which we now know is in the public domain for anybody to pick up and look at?

Well, they're informal discussions with relevant groups rather than negotiations, because of our peculiar interpretation of EU law. The bits that Labour have highlighted and tried to make a big thing of, none of them appear to me to be a smoking gun. I think the issue about patents is the one they've probably twisted the most. But, broadly, the UK and the US patent system are relatively similar in terms of the level and length of protection given. What happens in the US largely reflects their market structure and the way the insurance companies work. Because we have the NHS as the monopsony purchaser of drugs, and because we have the National Institute for Health and Care Excellence to deal with whether it's going to be cost effective, those are the two things that keep costs low in the UK market.

What makes drug prices ridiculously high in parts of the NHS—and actually GlaxoSmithKilne and AstraZeneca benefit also from that when they're selling into the US—is a structure where the insurance companies buy these drugs without effective cost control. And that's partly because many employers still give employees schemes where they can go to whatever doctor they want, and if that doctor prescribes, then the insurance company will pay the drug company. So, hence, there's neither effective market competition nor an overall regulation or monopsony provider, as we have.

None of those things are going to be influenced by trade discussions. So, for that reason, I consider this as scaremongering. I agree with what has been said about the opioids, and I think that reflects prescribing behaviour in the market and the nature of the patient-doctor relationship, which we don't have in this country, and wouldn't have irrespective of any trade deal with the US. 

To deal just quickly with point 3, we don't agree with a veto in trade policy because it's reserved and we don't support an independent sovereign Wales in the way that Plaid do. We will support the Conservative motion, which we think plays a relatively straight bat given it's pre-election period, and we will abstain on the Government motion, because we have some sympathy with what the Government is trying to do and we do think Wales should have a proper consultative role in trade negotiations. But we don't believe in vetos or having a federal constitution with the Supreme Court overseeing that in the way I think they imply.

As regards this debate on NHS and trade deals, one of the things this Plaid Cymru motion calls for is for the NHS in Wales to be protected by law so that devolved competence is not lost after Brexit. Now, Delyth, Rhun and Helen have eloquently outlined the case, because we do live in fearful times—feverish, febrile, polarised times. Tumultuous events led to the creation of the NHS in the first place. Aneurin Bevan removed the fear of paying for healthcare individually. As a community, as a nation, we all bear the cost collectively, so that individuals cannot be bankrupted to pay for their health. Mind you, we still haven't got there as regards social care, but that's a story for another day. 

Now, my youngest son lives in Oklahoma in the USA. And so, as a family, we know all about the challenges of paying for healthcare individually by health insurance, dependent on whether you've got a job and what type of job. And just like car insurance, the premium can be very high if you've got additional risks. So high, sometimes, that you're uninsurable. And obviously, if there's something else on top, like x-rays or blood tests or individual drugs, the cost mounts. You're charged individually. So, yes, it can run into hugely expensive individual healthcare bills.

Now, we've heard it—'All this is scaremongering', I hear people say, but we really are protected here in Wales, as regards the reality of the NHS elsewhere even in these islands. Yes, we complain about the NHS here in Wales, but the NHS in Wales performs daily miracles on a shoestring with overstretched, phenomenally brilliant staff going that extra mile, that we forget what's happening elsewhere.

Now, the One Wales Government here in Wales, from 2007 to 2011, outlawed GP commissioning and PFI in health. Not so England, where GP commissioning is now clinical commissioning groups. They are largely deregulated and enabling huge swathes of the NHS in England to be privatised now as a result of the disastrous Health and Social Care Act 2012—Andrew Lansley's malevolent creation. So, as a result, private Virgin healthcare has been awarded over £2 billion-worth of NHS work in recent years, with over 400 contracts ranging from dementia care in the elderly—cherry-picking, as Delyth mentioned—the school immunisation programmes that are private in many areas in England, to prison healthcare, running actual NHS trusts and individual GP services. That's what Virgin healthcare does now.

And vast slices of mental health services are already privatised and run at huge profits by American healthcare companies in England today—American-run private residential units for challenging adolescent and adult mental health services for autism, for learning disability, complex issues, troubling nature. They charge the earth for their services from the NHS and local government, and people from Wales can find themselves in these units and our public services charged as a result. That's the reality today.

Arcadia, a Tennessee-based health corporation, boasts of earning £188 million in just three months from British public services. That's according to reports this week. Cygnet is another US health organisation earning millions operating in the same complex mental health fields where we have no residential provision in the NHS. So, it's no use crying, 'The NHS is not for sale'. Large swathes have already been sold. But that's mental health, isn't it? It's okay—nobody cares.

And our personal health data is a potential goldmine for American pharmaceutical giants as well. We must legislate to protect our own personal data. 'Take back control', as somebody once said. And don't let me get started on deregulated prescribing because I haven't got the time, but it's been covered very well by both David Rees and Rhun.

So, the call from this motion is to vote to protect the NHS in Wales by law. If you think it's scaremongering and it's never going to happen, despite all the evidence from the reality on the ground that it's already happening, well, why not vote for the legislation anyway? Because it's never going to be enacted, so what's the harm? But if you think, if you truly think, like we do, that the NHS in Wales is at risk, then vote for this Plaid Cymru motion to protect our magnificent jewel of the NHS in law. Wallonia can.

Can I now call the Counsel General and Brexit Minister, Jeremy Miles?

Thank you, Deputy Presiding Officer. I welcome the opportunity to reply to this debate. It is timely because it places the implications of the UK’s departure from the EU under the spotlight, along with the possible outcomes of trusting in a Conservative Government led by Boris Johnson to undertake that process.

The Welsh Government supports the original motion to a great extent. It reflects the views of the majority of Members of the Senedd that the UK should remain a member of the EU and that principle under which the NHS was established, namely that services should be free at the point of delivery, should be put at risk.

We also agree that the current constitutional settlement is entirely inadequate to cope with the future challenges of a future outside the European Union. We expressed our views on this quite clearly in our policy documents, 'Brexit and Devolution' and 'Reforming our Union'. If we don’t continue with our membership of the European Union, then there is a risk that the line between international negotiations and those areas where competence is devolved will be crossed.

We have staged a number of debates on Brexit in this Chamber, but, despite that, we still hear from those who want to get Brexit done or a clean-break Brexit, calls which are entirely harmful to the interests of Wales. The damage caused if the UK were to depart the European Union was highlighted once again in the short and the long term by the National Institute of Economic and Social Research just last week. They came to the conclusion, just as Welsh Government economists have done, that the benefits of negotiating free trade deals with non-EU members are very small. On the other hand, the damage of leaving the customs union and the single market of the European Union would be significant and would remain for many years.  

Getting Brexit done means damaging the economy, risking the livelihoods of our citizens and starving our essential public services of the investment needed. Yet, the Conservatives during the election campaign have again been making completely undeliverable promises, such as that we can turn our back on the EU's approach to state aid and competition and still have a best-in-class free trade agreement with the European Union. If, heaven help us, they return to Government, they will rapidly realise this is a recipe for a breakdown in negotiations. 

So, turning to the amendments from the Welsh Conservatives, while of course we support the merits of free trade, there is a huge risk to British interests if a Tory Government were to rush into the embrace of an America-first Trump administration, an administration that has shown itself in equal measure ruthless and reckless in seeing trade as a zero-sum game, where America can only win if it trashes the interests of its negotiating partner. We can no more believe the assurances given by Boris Johnson that the NHS will never be sacrificed in negotiations with the EU than we could believe that he would deliver Brexit by 31 October come what may.

Let me absolutely clear: the NHS in Wales is run in Wales, for Wales, and, under this Welsh Government, it will remain in public hands. Our NHS is not for sale. And the UK Government has been making all the same mistakes in its preparations for trade negotiations with the USA that it made when starting out on negotiating the withdrawal agreement with the European Union—a lethal combination of indifference, ignorance and woefully overestimating the strength of our negotiating hand. It has failed—not even tried, in fact—to articulate a vision for future trade that is shared by all the Governments of the United Kingdom, and there is also a complete lack of transparency. The UK has not even published a draft negotiating mandate for negotiations with the USA. But we now know, of course, as has been referred to in the debate already, that months of secret negotiations have already taken place, summarised in more than 400 pages of notes and minutes. This only fuels suspicion and undermines trust, particularly when the impact on people, on businesses, on communities across the whole of the UK could be so profound.

By contrast, we have been clear to the UK Government that we need a formal and structured involvement in all aspects of trade negotiations, which brings me to the closing part of the motion from Plaid Cymru. The motion identifies the right challenges but not, I'm afraid, the right solutions. As a Government, we favour an overhaul of the constitution so that it fully recognises and respects the equal authority of the four Governments and Parliaments to deal with issues within their competence.

But even fully federal constitutions like Canada, like Germany, Australia or the USA do not give individual below-federal-government-level governments a veto over trade agreements. And I would stress this is also true in Canada, where the involvement of their provinces in the comprehensive economic and trade agreement process is often held up as an exemplar. Doing so, of course, would make the role of the federal Government in conducting international negotiations, practically unworkable. Rather, they embed the rights of state governments, province governments, or Länder governments to help shape negotiations, and, in some cases, as David Rees mentioned in his contribution, including the possibility of the Länder acting collectively to block treaties, all be that through their representation, as David said, in the federal parliaments.

Only in Belgium do individual state-level governments have a formal role in ratifying and potentially vetoing international agreements. But the devolution settlement in Belgium devolves trade, but does not devolve health. So, that is a signal to us of the caution which we must attach when we look at precedents elsewhere. And those who advocate a veto of international agreements by the Senedd, or by the Scottish Parliament, are, in effect, advocating not to reform, but, in practical terms, the dissolution of the union. And whilst I don't support that objective at all, I do think it would at least have been more transparent to reflect that in the motion. 

Will you take an intervention?

Certainly. 

Is your priority protecting the union or the NHS?

Our priority is protecting both the union and the NHS, and the best way of doing that is to elect a Labour Government to Westminster after this election. Our priority is to continue, in fact, pressing the UK Government for the Welsh Government to be fully involved at all stages of the process of international negotiations on devolved matters, and also to have a say in matters that impact on devolved responsibilities. 

Will the Minister give way?

Yes, certainly. 

There is a really interesting example that's already come up on the committee, so ably chaired by David Rees, which is the negotiation, or the re-negotiation, of the UK-Korea trade deal, compared to the previous EU-Korea trade deal. In the EU trade deals, it has become common practice to put as part of the legally binding agreement human rights. It is common practice. In the UK-Korea agreement, it has been downgraded to a part of the written protocol that accompanies it. Now, on that basis, it is imperative that we do actually engage on devolved issues, which include well-being and future generations policy frameworks, so we can tell UK Ministers on no account do they downgrade human rights obligations when this could beggar people on the far side of the world when we are taking products and services from them. 

Yes, and it is exactly the role that we ask for, that we press for, to have an involvement in negotiations, in agreeing those mandates, and a direct role in negotiations. And the reason for that is that we can then stand up directly for Welsh interests in relation to devolved competencies. And this Senedd will have then the role of scrutinising, interrogating and ensuring that the Welsh Government is representing the interests of Wales in exactly that way. Robust arrangements for joint working and agreement between the Governments that facilitate scrutiny by all the relevant legislatures would help to ensure that situations never arise in which the UK Government could justify the use of extreme intervention powers, such as those in section 82 of the Government of Wales Act 2006. And whilst existence of those powers may be necessary in extreme cases to prevent one Government from holding the three others over a barrel, their use in any other situation would be outrageous in constitutional terms. 

Reform of the devolution settlement to reflect the changing context for international relations is necessary, but this is not a quick fix. We have called for a constitutional convention, and that process must address these key questions around international relations and devolution, as we have argued in detail elsewhere. 

Dirprwy Lywydd, I call on Members to support the Government amendment. 

Thank you. Can I call on Delyth Jewell to reply to the debate?

Thank you, Deputy Presiding Officer, and thank you to everyone who contributed to this debate this evening. Thank you to David Rees for his contribution, in which he agreed with a part of our motion at least. I agree with what David says about the threat to the NHS. Clearly we in Plaid Cymru wouldn't only want a veto, and that’s why it’s only one of the things that we propose in our motion today. But I agree with David’s analysis in terms of the Conservative amendment, because Westminster will never put us first.

Helen Mary Jones explained what the impact of deregulation would be on patient safety, and I’m sure that many who are listening would agree that we need to prevent such a situation from arising. As she said, the NICE regime is there to safeguard people and I'm pleased that Mark Reckless at least agrees with the evidence about the opioids. Rhun's contribution was also very valuable as he explained what the impact of the increase in prices for drugs would be, which the United States wants, and the impact that would have on the budget of our NHS. Thanks to Dai Lloyd for bringing the front-line perspective and for his passionate speech.

Now, in terms of the denials we've heard from Mark Isherwood, David Rowlands and others about the fact that they think the US has no intention of gaining access to the NHS, I find that frankly astonishing in the face of all the evidence. Trump has been open about his 'America first' policy. He said on 4 June that he did want the NHS to be on the table in a trade deal, and we have evidence from documents that have been released last week, which showed that the marketisation of drug prices, patents, medical devices and health insurance has been discussed. We have a copy of the official US department for trade's negotiating priorities. The evidence is overwhelming and I can only conclude that some people are just refusing to accept this reality because it doesn't accord with their view of the world. I'm afraid it's not a view that I share. 

In terms of what we've heard from mainly the Conservative benches about their faith that Boris Johnson will keep his word, in terms of the NHS, I think the people of Wales will know full well that the promises he makes can't be trusted. Boris Johnson said in a The Telegraph column in the past that he wanted to charge patients to see their GP; he told Business Insider that people would value the NHS more if they had to pay for it; he called for the break-up of what he called 'the monolithic, monopolistic' NHS in the House of Commons. And I think most worryingly, his true beliefs are reflected in remarks he made in a Centre for Policy Studies speech. He said 16 per cent 'of our species'— his words—had a low IQ and that more should be done to support the 2 per cent with the highest IQ. He said, 

'The harder you shake the pack the easier it will be for some cornflakes to get to the top.'

This is ultimately a Darwinian view of the world. What Boris Johnson believes is that vulnerable people should be left to rot so that the most successful 'of our species'—again, his words—are able to prosper. 

Will you take an intervention? 

I will take an intervention. 

Would you also agree that it is not just Boris Johnson? This is ideology that is prevalent throughout the Cabinet, and if you look at Dominic Raab's words in the book that he published not so long ago, it's exactly the same philosophy that they do wish to sell off parts, slowly or quickly, to the US of our NHS.  

Thank you for the intervention. I do agree that this is not something that is solely focused on Boris Johnson. I think that there are number of members of the Cabinet—well, they are still the current Cabinet—like you've said, like Dominic Raab whom I think some of this—. It's like this Dickensian view of the world that the prosperous world reaps all of the rewards and I agree with that analysis. It's very worrying. Again, I hope, I plead with the Labour backbenchers that they will support the motion, because selling off the NHS would be the best way for that party to realise this dystopian vision.

I must say that to describe legitimate concerns for the future of our NHS as 'scaremongering', 'desperate fear tactics' and 'preying on vulnerable people who use the NHS' is astonishing. I think that last remark in particular is offensive considering that protecting vulnerable people is the purpose of this motion. 

I listened with great care to the Minister's explanation as to why they don't want to have a veto over trade deals and why they don't want to change the law to stop the UK Government from being able to privatise the NHS. He said that Plaid Cymru, what we're proposing, sounds too much like independence to be to his liking—a remark that was echoed by David Rees, which I was a little dismayed by. I do support independence, I'm never going to deny that, but that's not what we're proposing today. We're simply calling for Wales to be given a veto over any trade deal that would have the capacity to damage our public services. 

This could work very well in practice. The UK Government would not want us to collapse a trade deal by using this veto. So, they would have to negotiate from the start so that we have a deal that leaves our NHS intact. It would achieve what the Welsh Government wants, which is for devolved governments and legislatures to be able to influence trade negotiations before they begin, which is what I think Huw Irranca-Davies was referring to in his contribution.

I think it's very sad that the Welsh Government is prioritising the future of a union that has left Wales destitute and powerless over the future of our NHS. I would urge Labour backbenchers to try to convince the Government to reassess their priorities before it's too late.

Thank you. The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Therefore, we defer voting until voting time. 

Voting deferred until voting time.