 The final item of business is a member's business debate on motion 11849, in the name of David Stewart, on the impact of leaving Eurotom. The debate will be concluded without any questions being put. Can I ask those members who wish to speak in the debate to press the request to speak buttons now? I call on David Stewart to open the debate. Mr Stewart, please. Thank you, Presiding Officer. I thank all members who are staying behind tonight to support this motion and for signing my motion as well. Those who have not yet signed, I always welcome sinners who repent. On the surface, Presiding Officer, this debate may seem like a surrogate for another round of Brexit speeches, plus a seminar on an arcane institution, Eurotom or a poor man's lecture on nuclear physics. However, I am sorry if any member hears and any false pretenses. The issue this evening is very simple. The future treatment and care of cancer patients and the security of supply of radioisotopes. Notwithstanding my opening statement, Presiding Officer, let me attempt to set the context of the problem. The UK joined the European Atomic Energy Community, better known as Eurotom, on 1 January 1973. The UK gave notice to leave Eurotom as part of the article 50 process. The European Commission for their part is clear. In a recent statement, it said, and I quote, Eurotom treaty will cease to apply to the UK on 30 March 2019. Why is that a problem for the health services and cancer patients? Eurotom is a crucial and essential vehicle for the management of radioisotopes. As the Eurotom 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 titanium, which is derived from a parent element that is a half-life of 66 hours. The element is obtained from a small number of research nuclear reactors, none of whom are located in the UK. The Hinkley Point Nuclear Research Facility, planned for 2027, could produce radioisotopes, but the jury is out as when that facility will be completed. The bulk of the UK's supply is from the EU, facilitated by the Eurotom supply operation. For example, the HFR reactor in the Netherlands supplies the UK and has the capacity for a third of global demand. However, it is estimated that it will cease operations in 2024. The context is that we have a world shortage of medical isotopes. A key provider of Canada has just ceased production. The EU is home to four of the top six global producers. The distance to Australia and South Africa, where else are significant players, means that they are problematic providers. Supply would be limited by the decay of medical isotopes that would occur during transportation. The key issue is that isotopes have short half-lifes. That means that they decay rapidly and cannot be stored. That creates an urgent need for constant, reliable and predictable supply. However, of course, that has failed in the past and has created global shortages. Eurotom has a central and crucial leadership role here. It supervises the supply chains. For example, there was a crisis in 2008 with the closure of the channel tunnel. Again in 2015, when industrial action at Calais cost chaos to the transportation of isotopes and caused the cancellation of treatment across the UK. I am arguing today that there is a clear and present danger to the NHS in Scotland and beyond. It is the loss of frictionless borders post Brexit. That could result in a traumatic failure to deliver medical isotopes on time to cancer patients. As the Royal College of Radiologists have said, I quote, "...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." So, radioisotopes are essential tools for nuclear medicine, which 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, around 700,000 nuclear medical procedures are carried out each year, with approximately 70,000 of those in Scotland. So, it is essential in diagnosing coronary disease, detecting the spread of cancer to the bones and biomedical research. As the British Nuclear Medicine Society said, patients will be poorly served by not having a cheap, plentiful supply of titanium, the most commonly used medical isotope. So, what are options, Presiding Officer? Well, first of all, on a very simplistic level, if it ain't broke, why fix it? Stay in your atom. However, the current administration of the UK Government means that that decision is unlikely. Secondly, we could look at associated status of your atom under until 2006 of the treaty. That gives reciprocal rights and special procedures. The best example is Switzerland, who joined in 2014. That gives access to funding for nuclear research. Thirdly, we could have third country status under article 101 of the treaty, so the UK could join USA, Australia and Canada. The advantage there is that we have common research on a shared cost basis. I apologise for the technology, Presiding Officer. We could create more cyclophones in Scotland. That is not from the more recent Dr Who film, but it is a facility, a linear accelerator that produces radioisotopes for PET and CT scanners. PET scanner has been positron emission tomography. There are three in Scotland, in Glasgow, in Van Aberdeen, but no spare capacity to the other PET scanner in Dundee. When I am on my feet, I must campaign for a PET scanner in the Highlands, where Highlands spends 300,000 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? The big question said earlier, will it be on time? What will its capacity be? We still need to organise the supply chain management. During the House of Commons withdrawal bill debates, many MPs made telling contributions that if we draw from the club, the URATM supply agency, during a global shortage of radioisotopes, why then should the club care for us? As the old saying from Capital Hill goes, if you are not at the table, you are on the menu. You do not need the predictive powers of the brand sear, who, incidentally, predicted the Second World War from the 17th century to divine the future in this area. We have a global shortage of radioisotopes, we produced 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 it 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 cannot change the direction of the wind, but I can adjust my sails to always reach my destination. Emma Harper, who is followed by Donald Cameron. I would like to start by congratulating Dave Stewart on bringing this extremely important debate to the chamber this evening. In his opening remarks, David Stewart has clearly outlined the purpose of URATM and the importance of the agency, which was created in 1957. The URATM framework has enshrined the regulation and safeguards for the transportation and use of radioactive materials, and it is worth repeating as the agency has been established for over 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, and for our nuclear industry rapid withdrawal from the URATM spell disaster. Many experts in the field of nuclear energy, including the British Nuclear Energy Society, have suggested that, following the UK's departure from URATM, many power stations across the country may 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 our services for our patients. Given my health background, I would like to focus my speech on the health implications of leaving URATM. The shipment and stock of radioactive medical isotopes used for x-rays in MRS scans and PET scanners, as David Stewart mentioned, is really necessary to provide cancer treatment for certain patient populations, and I see it as under threat. The means that there may be significant delays to patients who are looking to access life-saving medical treatments in a timely manner may lead to premature and unnecessary deaths. Earlier this year, my colleague Dr Philip Whitford spoke in the House of Commons debate on the subject. She has first-hand knowledge of medical isotopes as a breast surgeon herself, and I would like to echo what she said. The Royal College of Radiologists are 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 URATM. Those are not pharmaceutical medicines that can be stockpiled, as has been suggested by other medicines. The scans and treatments that Dr Whitford is referring to—in many cases, they will have saved lives. As many will further be aware, medical isotopes are very particular products, and their transportation must be carried out safely and in line with international guidelines, and alternative to those are limited. In a letter on 6 September 2018, the president of the British Nuclear Medicine Society, John Buscom, 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 also likely to significantly increase. In the same letter, President Buscom urges local health boards across the UK to make preparations for the increase in cost, which I find extremely concerning. I would like to ask the Scottish Government what it can do to support our NHS health boards to address the challenges of leaving URATM. That is a 60-year-old treaty to support safety and supply of much-needed medical isotopes. Those isotopes are saving lives, and it is really important that we bring that attention to the chamber today. I thank David Stewart for allowing us to have this discussion here tonight. I cannot pretend to match his scientific expertise, but Brian Whittle has a chemistry degree, I am told, so please save your questions for him. I also promise not to do a standard Brexit speech, not least given the very serious implications that this has for cancer patients. I do not represent the UK Government, but I do feel that it is only fair to put their position forward to the chamber. A significant amount of discussion has already taken place at UK level on the matter of our membership of URATM. I do believe that this is an issue on all sides, whether you 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 EU and that the UK would like the option to fully associate ourselves with the excellent-based European science and innovation programmes, including, and she quoted the successor to Horizon 2020 and URATM R&T. Last year, the Secretary of State for Business, Greg Clark, said that it is the Government's ambition to maintain as many benefits as possible through a close association with URATM in the future. It has been recognised that the need to protect the progress that has been made over the years—a significant progress over the years between the UK and the EU in respect of nuclear research and nuclear decommissioning expertise, for example, and that Brexit must not hinder this in the future. Part of the Czechos proposal includes continued co-operation and information sharing with the European Observatory on the supply of medical radioisotopes. I would say that the UK Government has prioritised ensuring a close relationship with URATM exist after we leave the EU. While I recognise that much of David Stewart's motion relates to radioisotopes, there are some important points to make about the passage of the Nuclear Safeguards Act 2018, which is an important aspect of all this for several reasons. First, it allows the UK Government to make regulations for and implement international agreements in relation to nuclear safeguarding, which will be required once the UK leaves URATM. It allows existing legislation to be amended by regulation in relation to withdrawal, and it extends as a bill to the whole of the UK. Ultimately, I believe that it will allow for continuity. On the main issue relating to medical radioisotopes, there have been assurances that leaving URATM will not affect the UK's ability to import medical radioisotopes. In a paper published by the Department for Business, it notes that the URATM treaty refers to medical radioisotopes and the prohibition of custom duties, etc. Those references do not set any restrictions or limitations on trade in such materials with countries outside the EU. I would submit, Deputy Presiding Officer, that there is nothing in the URATM treaty to 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 withdrawal from URATM. Emma Harper There are issues around the URATM treaty, which means that there is a free flow of movement of scientists. Is that part of the red line that Theresa May has where we are not going to allow migration of workers? That would impede the ability to continue with research in URATM. Donald Cameron I do not accept that. I am not going to get stuck into a debate about migration, but I would say that there has been a very clear commitment to EU citizens even in the event of no deals. I think that the UK Government has made the position more than clear. To conclude, Deputy Presiding Officer, I welcome this opportunity to have a debate. Leaving the EU is clearly one of the most important political moments of our lifetime and it is right that we have a frank debate about it. However, I would say that it is in the interests of the UK and the EU to ensure that the trade of medical radioisotopes is as frictionless as possible for the benefit of patients here in Scotland. After all, they are the people that we must keep in mind more than anyone. Given that significant forward planning has taken place, that will be realised in the months and years ahead. Lewis MacDonald I congratulate David Stewart on bringing this debate on a very important topic that was highlighted in a report from the Health and Sport Committee earlier this year. I am pleased to support this debate for us, the convener of the committee, also 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 magnetic resonance imaging and of PET scanners belongs to pioneers, such as the late Jim Hutchison and John Mallard at Forrester Hill. Aberdeen royal infirmary is also today one of the several centres of nuclear medicine in Scotland cities that provide vital diagnostic and treatment tools for cancer patients in particular. The delivery of those services depends on nucleophysicists, on radiologists and on radiographers, all in the different ways that are highly skilled and high-value staff, some of whom are sadly in short supply, not just in Aberdeen but across the Scottish NHS. In addition, hospitals such as ARI have radio pharmacies that are responsible for procuring the isotopes and managing the radioactive material so 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 and further afield have played an important role in ensuring the reliability of supply on which patients depend. That said, this 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 needs. Their core business is typically military or civil nuclear power generation or related research. It is a credit to all concerned that what is essentially a by-product from other much larger business activities has become so valuable in its own right to the point where Britain leaving the European atomic energy community carries such significant risks for medical treatments. The reason for the British Government giving separate notice of the UK's intention to leave Uratum as part of the Brexit process is simply that the members of the European Union are signatories of their relevant treaty. However, as both David Stewart and Emma Harper mentioned, it is technically separate from the EU itself. There is therefore nothing to prevent UK ministers from seeking to protect the many benefits of Uratum membership including access to radioisotopes as part of the wider negotiations on our future relationship with the European Union. That, of course, depends on ministers putting forward serious and credible proposals for that relationship across the board, in particular around the terms of trade, for the avoidance of tariff and other barriers between the United Kingdom and the European Union, and the prospects for that clearly remain to be seen. As has been said, the commissioning of Hinkley Point C, perhaps in 2027, will resolve those critical supply issues at that time. However, that is no consolation to those who need access to radioisotopes in the next few years. Supply from EU countries like France, Belgium and the Netherlands, which has been mentioned, remains essential. Securing that supply well into the 2020s has to be a high priority for the UK Government. If UK ministers are able to address those issues in the next few weeks or months, the negotiating position is strengthened by the fact that European countries rely on being able to import radio ligans that 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 must be a risk that GE Healthcare will ultimately choose to relocate that high-value, high-technology business to somewhere else in the European Union. There is a lot of stake in economic terms, as well as in health terms, and the UK Government must go forward and do everything that it can to resolve that issue as early as possible for all our stakes. Thank you, Deputy Presiding Officer. I can also thank David Stewart for bringing this 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 fallout, if you will excuse the pun, or otherwise that Brexit may bring. It also serves to highlight the importance of the negotiations that are currently underway and what our role could and should be in ensuring that important issues such as today's topic are not allowed to fall through the cracks. I was going to intervene in a couple of speeches there, but I do not want to underestimate the need to establish the movement of isotopes across our borders. However, I want to note that, although isotopes that have a very short half-life, which David Stewart has mentioned, are those that have a very long half-life that we currently use. I have scribbled in here the strontium 90, which is 30 years, and cobalt 60, which is five years, and radium 74 days, which are also used in that process. It is important that we have this debate to make sure that we stay factual, but that is not to underestimate the need for those with that very short half-life. Euroatom has that responsibility for establishing that single market for trade in nuclear materials and technology across the EU, acknowledging that it provides that key role in facilitating a secure and constant supply of radioisotopes that are used across a range of sectors, including medical, industrial and scientific fields. As my colleague Donald Cameron has said, looking at the response from the UK Government, I think that it is welcome that it seeks to continue to support that organisation and seek that continuity of co-operation and standards. I think that that includes the wish to maintain the UK's mutual successful civil nuclear co-operation within the European Union. I think that that is good news indeed, and that whole intention has been outlined very clearly in the industrial strategy to support the scientific community and to build as much support for it as we can after we leave the European Union. When we discuss medical isotopes, I think that, contrary to what has been in some reports, medical radioisotopes are not classed as special ffisial material and therefore are not subject to the same nuclear safeguard. The UK's ability to import medical isotopes from Europe and the rest of the world should not be affected. I was very reluctant to argue with people with degrees in industrial chemistry, but I have a letter from the European Commission, because I knew that this issue would come up. They make 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. What that means is that their import or export are still subject to customs procedures or regulatory ethics. In respect of the URATAM issue, which is the main supply agency, the commission has a vital role over import and export, and it has a locus in this area. Brian Whittle I thank David Stewart for that intervention. Of course, I am not going to argue with that. I was merely pointing out that it is not classed as special ffisial material, so it can actually be imported from around the world and from Europe, just the same. I also wanted to have a look at the BMA's view on that. It is suggesting that the UK Government should negotiate a formal agreement with URATAM, similar to the ones that are in place with non-EU countries such as Switzerland. There is a precedent that is already set for collaborative working with countries outside of the EU. From the UK, I think that negotiating a formal agreement with URATAM 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, which supports EU involvement in research projects. However, if it fails to make an agreement, a withdrawal agreement by March 2019 in the UK would have to operate outside of the URATAM, which has already been reported, and source radioisotopes outside of the framework, which I agree would be problematic. We must also remember that that would close off a market for those countries that supply such projects and the UK market is a major market. In the longer term, I think that it would restrict the ability of the UK and UK to benefit from sharing expertise in radiation research, radiation protection and the disposal of radioactive waste. If I could finish, in the blizzard of political posturing that surrounds Borexit, I also think that we have a responsibility to ensure that issues such as our relationship with the URATAM remain high on the agenda in those Brexit negotiations. I would prefer that we do this in a public forum to inform the public of the work that is being done, but I do understand why political parties may be reluctant to act on those issues in public. At the very least, we, as a Parliament, do so behind closed doors. I once again thank Dave Stewart for giving us the opportunity to keep the URATAM on the agenda. I thank Colin Jones for his approach to the Government. First of all, can I join others in congratulating Dave Stewart on securing this important debate tonight? In 2016, 62 per cent of voters in Scotland indicated their wish to remain within the European Union. Despite the clear and decisive wishes of the Scottish people, the UK Government has pressed ahead, regardless of its intention to take the whole of the UK out of the EU. The Scottish Government has demonstrated in our analysis of Scotland's place in Europe that staying in the EU is the best option for Scotland's future. Failing that, our analysis shows that continued membership of the European single market and customs union is essential for our economy, our society and our people. It was good that Lewis MacDonald brought in the economy into today's discussion. The potential consequences of leaving the EU are far-reaching and damaging, and it is only as the negotiations progress and become more complex that everyone can see just what is at stake. We must ensure that the Scottish voice is heard throughout negotiations and that we continue to push to give real and meaningful input into the negotiations. Last week, the First Minister called on the UK Government to seek an extension to 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 medical isotopes supply, such as entry and customs control, are outside the Scottish Government's control. However, we continue to press the Department of Health to co-operate and to fully engage with us around 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 the past months to mitigate the risks and potential implications where possible. NHS boards are taking forward their own planning for Brexit, and I can assure Emma Harper that we are supporting them in the work in the context of a fluid and rapidly developing situation. All boards have consistently identified concerns relating to the obvious workforce issues. They have also identified issues around medicines, medical isotopes, medical devices, clinical trials, accessed 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 case of a no-Brexit deal. That included intent to stockpile medicines, which might be impacted by delays at the UK border to ensure that there is an additional six-week supply. Officials are currently working with the Department of Health on the issue and are discussing preparedness plans with NHS Scotland. Emma Harper outlined the medical uses of medical isotopes. Those used for the diagnosis and treatment of diseases such as cancer are all made outwith the EU. As Dave Stewart said, those products cannot be stockpiled because they rapidly decay. Obviously, Mr Whittle, with his industry experience, was able to highlight one or two that do not rapidly decay, but many of those isotopes have fast, half-lives and rapidly decay. 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 the membership of Eurotom, the European Economic Energy Club, and, although it is possible to have other arrangements, it is better to be part of such a club than to be a bystander. In leaving the EU and, by extension, Eurotom, the UK Government risks the future production and supply of medical isotopes to the whole of the UK. David Stewart. I think that the first time that I have said every word that the minister has said is contribution. Has the Scottish Government looked at doing a contingency plan for the potential shortages in the future, for example using healthcare improvement Scotland to do analysis of that? The other point that I was making about cyclotrons is that they are important, because we have control over that. Your own city of Dundee does not have that raw material that is needed. Could you put a plan for looking at decentralising that, particularly in Rygmawr and Inverness? There is a real need for that. As the clarity of the implications of Brexit has become clearer, we need to look at all the options to make sure that we can try to mitigate what is a really bad situation. In contrast to the rosy picture painted by Donald Cameron and Brian Whittle, there are significant concerns by stakeholders such as the British Nuclear Medicines Society and the British Medical Association. There remains considerable uncertainty. As such, we are clear that the UK Government is playing with the lives of those people in Scotland and, indeed, those in the rest of the United Kingdom who depend on those life-saving products. I will take an intervention just to clarify. In no way was I trying to picture a rosy picture as an ardent remainder and one of the 62 per cent in Scotland, as you say, or the 48 per cent in the UK. I was trying to say that, in this environment that we have, it is massively important that, yes, we are making political points and political statements here, but in this particular debate it is massively important that we get the opportunity to continually raise those issues and keep them on the agenda. The member is correct, but there are many risks that are associated with Brexit, and many of those areas are reserved areas of the UK Government, which makes it difficult for us. As Mr Stewart brought that to the chamber, it is important that we have those discussions, but there are huge risks around supply of medicines, medical isotopes and medical devices. If the UK Government persists with its position on leaving the single market and the customs union, it does so knowing the harm that it can do to our invaluable NHS. We are clear that all people living in Scotland, including those who have to deal with a life-changing diagnosis, deserve clarity and reassurance from the UK Government, particularly those that supply critical medical products such as isotopes that are used in their diagnosis and treatment of diseases such as 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 start working to retain Scotland and the UK's place in the single market and customs union and keep us in your aton.