Yesterday the department of international trade responded to a petition entitled ‘Don’t put our NHS up for negotiation – Please introduce concrete safeguards that will make sure our NHS is kept out of any future trade deals after Brexit’ with a statement designed to allay the public’s fears, but the devil is in the detail. In reality this government response offers no real guarantees, no clarification and consequently no assurance that the NHS will indeed be ‘off the table’ when it comes to forming future alliances after Brexit. Their statement reads as follows:
“The Government has been consistently clear about its commitment to the guiding principles of the NHS – that it is universal and free at the point of need. Our position is definitive: the NHS is not, and never will be, for sale to the private sector, whether overseas or domestic. The Government will ensure no trade agreements will ever be able to alter these fundamental facts.”
The NHS being ‘free at the point of need’ obscures the fact that private agencies may well be providing the care given. Upfront charging is only one version of privatisation. Outsourcing NHS services to private providers is another wasteful and inefficient path. There are more factors to consider such as quality and reliability of service provision.
We know that privatisation already accounts for 7.3% of NHS clinical provision with many companies hiding behind the trusted logo in providing services. Despite health secretary Matt Hancock asserting “there will be no privatisation on my watch” there has been at least £127m worth of NHS contracts ‘on his watch’ so far. This government cannot be trusted when it comes to domestic privatisation; why then should foreign trade deals be any different?
“We want to maximise our trade opportunities globally and across all countries – both by boosting our trading relationships with old friends and new allies, and by seeking a deep and special partnership with the EU. These benefits also matter for the public services which we want to protect. Trade is vital for the NHS, which relies heavily on vital goods and services that come wholly, or in part, from suppliers based overseas. Trade enables the NHS to buy the best possible medicines and medical devices that industry – here and overseas – has to offer. That is in the best interests of NHS patients.”
Trade may allow the NHS to purchase the ‘best possible medicines’ but they may not be getting the best possible price. The government’s inability to successfully negotiate overseas trade deals with pharmaceutical manufacturers has meant some essential drugs are now rationed.
In 2017 the British Competition and Markets Authority launched an investigation into the alleged “excessive and unfair pricing” of thyroid medication Liothyronine tablets after Canadian company Advanz Pharma increased the price of a pack by nearly 6,000% over a ten year period. The drugs company were able to exploit price increases which they say were approved by the Department of Health and Social care. They were also able to exploit a regulatory loophole to de-brand their drug thus avoiding NHS pricing rules, as there is no ceiling price on unbranded drugs. Since Advanz Pharma was the only one producing the medication, it was technically free to set its own price.
The government therefore allegedly enabled this gross profiteering through their own incompetence which now means the drug is rationed in many areas. The implications therefore of this government negotiating brand new trade deals with other countries is very worrying. Any oversight in establishing these crucial contracts could have dire consequences for patients, and America (which has been much heralded as a potential trading partner) has some of the highest drugs prices in the world.
“Trade agreements do not prevent governments from regulating as they see fit, and they also do not require governments to privatise any services. The UK Government is committed to maintaining our high standards for consumers, workers and the environment, and to protecting our public services, in any future trade agreements that we conclude.”
This paragraph is worryingly vague. Nowhere does it deny foreign trade deals or specify what form they could take. Based on this government’s previous track record, it would be folly to rely on empty platitudes. Their wording here of governments ‘regulating as they see fit’, when over the last 9 years successive governments have also ‘seen fit’ to defund, understaff and accelerate the amount of outsourcing to a damaging degree, should be cold comfort to all of us.
A spokesperson from the department for international trade told keep Our NHS Public:
“In regards to the US in particular, the government has been consistently clear that it is committed to negotiating an ambitious FTA with the US that maintains our high standards for businesses, workers and consumers. “
Only time will tell the exact nature of any future agreement, but there should be little doubt that negotiations will include the NHS in some way shape or form.
“The Government will ensure that nothing in our future trade agreements dilutes the powers of UK regulators to maintain the NHS’s position as the best health service in the world.”
This statement is composed of rhetoric and glosses over the facts, most notably that the NHS has been driven into the ground by a government that has grossly underfunded and understaffed it resulting in missed targets, massive waiting lists and consequently a slippage in league tables. No acknowledgement is made here by the government of the NHS’s (manufactured) current position and consequently there is no real benchmark for them to retain. Simply saying it is ‘the best health service in the world’ is as vague therefore as their entire statement.
At first glance the response to this petition may provide some reassurance to those worried about the NHS forming part of future trade deals, but dig even slightly deeper and the government’s reply is intentionally ambiguous. We are headed for a future where as Donald Trump recently asserted, “everything is on the table”, including our public services. In this government we have the willing enablers of private enterprise who will justify outside intervention under the heading of future-proof investment. In this brave new world, there are no rules (the government cannot be trusted to make the new ones) and their motives in doing so are an area of genuine concern.
Samantha Wathen, Press and Media Officer for Keep Our NHS Public
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