Trade Deals and the NHS

Graham Stringer Excerpts

Monday 16th November 2020 Westminster Hall

[Graham Stringer (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new call list system and ensure that social distancing can be respected. Members should sanitise their microphones before they use them, using the cleaning materials provided, which they can then dispose of as they leave the room. Members are also asked to respect the one-way system around the room.

Members should speak only from the horseshoe—the debate is not oversubscribed, so there will be no one sitting at the back who can speak. Members are not expected to remain for the wind-ups. In the latter stages, Members on the call list seated in the Public Gallery need to move on to the horseshoe. I remind hon. Members that there is less of an expectation that Members stay for the next two speeches once they have spoken. This is to help manage attendance in the room. Members may wish to stay beyond their speech, but they should be aware that doing so may prevent Members in the seats in the Public Gallery from moving forward to the seats on the horseshoe.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I beg to move,

That this House has considered e-petition 307339, relating to trade deals and the NHS.

It is a pleasure to serve under your chairmanship, Mr Stringer. This e-petition raises

“concerns that a trade deal between the UK Government and the US deal might not exempt our NHS, leaving it vulnerable to privatisation and in direct contradiction to promises this would not happen.”

It was launched on 11 May and closed on Remembrance Day last week, attracting just under 112,000 signatures. The UK Government responded on 23 June, stating:

“The government has been clear that protecting the UK’s right to regulate in the public interest and protecting public services, including the NHS, is of the upmost importance.”

The petition also highlights that if a deal quietly went through during the coronavirus crisis, it would be unethical, lack transparency and, if US finances were involved in our medical system, potentially create a direct health risk to us. This latter point relates to the fact that US Government statements have suggested that they intend to negotiate for US pharmaceutical companies to charge higher prices for medicines sold to the NHS as part of any UK-US free trade agreement. The cost of drugs to the NHS is already growing much faster than inflation, driving deficits across the service. Allowing big business and pharmaceutical companies to behave as they see fit would drive costs for new drugs well beyond the NHS’s ability to afford them, threatening our health, safety and national security.

In their response to the petition, the Government went on to reiterate their overall objectives, which were stated in their UK-US freed trade agreement document. They said that, along with the NHS, the price the NHS pays for drugs and the services the NHS provides would not be on the table when negotiating trade deals. Their response also said that no changes would be made to the UK’s

“intellectual property regime that would lead to increased medicines prices for the NHS.”

However, the timing of the launch of this petition is significant because, as the Government response also pointed out, the negotiating objectives for a free trade agreement between the UK and the US were published on 2 March, more than two months before the petition’s launch. Therefore, it is a reasonable assumption that, as the petition was launched after the publication of the UK-US trade deal negotiation objectives, either the petitioners thought that the Government had not been clear in their response, or they were not convinced that the price the NHS pays for drugs or the services it provides would not be on the table when negotiating trade deals.

Indeed, who can question the petitioners’ doubts, when we have seen the UK Government’s repeated refusal to guarantee excluding the NHS and other public services from future trade deals? For example, most recently, on 28 August, the hon. Member for Warrington North (Charlotte Nichols) tabled a written parliamentary question to the Secretary of State for International Trade, asked if she will make it her policy to exclude the NHS from potential future trade deals. Unfortunately, although the question was direct, the answer the hon. Member received did not give a direct commitment.

Furthermore, the UK Government’s response said that their negotiating positions had been made clear to all their trade partners, including by the Secretary of State in her written ministerial statement to Parliament on 18 May. Although the Secretary of State’s statement on the future trading relationship with the US mentioned negotiations many times, not once did it confirm that the NHS was not a part of them. I therefore struggle to see what reassurance that statement gave.

The Secretary of State’s next statement on the matter, on 30 June, entitled “Negotiations on the UK’s Future Trading Relationship with the US: Update”, stated:

“the Government remains clear on protecting the NHS”.

Those eight words would have been welcomed across the House, of course, and we all wanted to take consolation from them. Yet our hopes were again dashed less than a month later when Conservative MPs voted overwhelmingly against an amendment to the Trade Bill that would have enshrined in law the protection of our NHS and other vital public services that this petition is calling for. That is a significant inconsistency and contradicts previous promises, which is a tenet of the petition. I hope that the Minister can throw some light on why only two Conservative MPs saw the perceived duplicity in saying one thing and then acting against it, not least because neither of the Secretary of State’s subsequent statements have repeated that assurance.

The people who have signed the petition just want that assurance. They want a cast-iron guarantee—not words that can easily be rescinded—that the vital services provided by our NHS will be protected. Those vital services have come to the fore in an unprecedented way throughout this terrible covid-19 pandemic. Quite simply, the petitioners do not want our NHS to be weakened and undermined by private companies being able to trade unhindered on the back of it, which, I think—I am sure others here agree—is a perfectly reasonable position, given what has already occurred with the Trade Bill.

It is important to note at an early stage in this debate that, because the Trade Bill was able to pass without the amendment that would have protected the NHS and publicly funded health and care services in other parts of the UK from any form of control from outside the UK, one independent MP joined 336 Conservative MPs to reject protecting the provision of a comprehensive, publicly funded health service, free at the point of delivery, from being undermined or restricted by any international trade agreement. It is also worth noting that the rejected amendment would have, among other things, recognised that an appropriate authority had the right to enact policies, legislation and regulation that protect and promote health, public health, social care and public safety in health or care services. Furthermore, it would have excluded provision for any investor-state dispute settlement, a clause that provides or is related to the delivery of public services, healthcare, care or public health. I will discuss the relevance of ISDS clauses shortly.

I want to highlight another amendment proposed to the Trade Bill that would have required the UK Government to secure the approval of both Houses of Parliament and the devolved Parliaments of Scotland and Wales and the Northern Ireland Assembly before a trade agreement could be approved. Notably, 323 Conservative MPs voted down the proposal. The reality of those two amendments being rejected, which has been reported by the BBC’s Reality Check, is that Parliament does not have a statutory role in either scrutinising or voting on any future trade deals because the Government have the power to pass some aspects of trade deals without there even needing to be a vote in Parliament.

Apart from the worrying lack of scrutiny that situation presents in protecting our NHS and other public services, I believe it to be fundamentally undemocratic. Indeed, the bottom line is that, despite the UK Government’s response to the petition stating that they

“will continue to ensure that decisions on how to run public services”

will include “Devolved Administrations”, the devolved Administrations—like Parliament—will not play a statutory role in the UK Government’s international trade policy. That is undemocratic and highlights the wider implication that a trade deal could undermine the constitutional powers that devolution delivered.

It is plain for everyone to see that the NHS is a prime example of that, because health is a devolved matter. Therefore, given that the UK Government are in a position to influence devolved powers without a statutory requirement to seek consent from, or even to consult, the devolved Administrations, will the Minister today also explain the Government’s position that it is constitutionally inappropriate for devolved Administrations to have a statutory role in a reserved area, while it is not deemed constitutionally inappropriate for the UK Government to legislate in areas of devolved competence?

If the UK Government want us to believe that they will keep their promises that the NHS is not on the table in trade negotiations, they should commit to legislation that will ensure it is taken off the table. I am certain that I am not alone in finding it hard to understand why an amendment that would have ensured market access to healthcare services was restricted was roundly rejected by all but two Conservative MPs. Having discussed how trade deals could negatively impact on health services, what possible reason did the Government have for not seizing the opportunity to commit legally to ensuring that trade agreements could not be concluded if they risked altering the way our NHS services are provided?

That brings me to investor-state dispute settlements, which are a threat to public services, particularly when they are permitted speculatively or retrospectively. That was a red line when the EU negotiated TTIP—the transatlantic trade and investment partnership—with the US. The EU would never accept a trade deal with the US in which such principles were compromised, because the trade agreements that include investor-state dispute settlement clauses have the potential to undermine the procurement process and regulations within public procurement, especially within the NHS, if not restrained properly and fairly.

Indeed, the creator of the petition, Joanne Barlow, saw investor-state dispute settlements as one of the major problems of a trade deal with the US, pointing out that they could include legal challenges by any US markets deprived of access to the market or if their profits were threatened. Joanne explained that that would make it difficult to return the NHS to a fully publicly owned and run institution. In addition, Ms Barlow noted that she could not find evidence of a specific clause exempting the NHS from American investment. It would therefore be of some comfort to the petitioners if the Minister could today confirm that there will be no investor-state dispute settlement clauses in any trade deal signed by the UK.

To summarise, if this Government’s insistence that the NHS is not on the table in a trade deal with the US is indeed the case, why did they not accept the amendments that were put forward and commit their pledges in law? The petitioners want that insistence to be in legislation, to ensure that our NHS is not left vulnerable to privatisation or becomes a victim of broken promises that it will not be sold off to the highest bidder. No one needs reminding that we are still in the depths of the covid-19 pandemic, which has caused physical, mental and financial hardship to people across the UK. Given the lack of scrutiny and democracy that the Trade Bill has delivered, I urge the UK Government to respect the request of the petitioners in their negotiations with the US and not to progress a trade deal that will risk our NHS in any way.

[Graham Stringer (in the Chair)]

Within the Chamber now are five Members on the call list, with two Members not in the Chamber, so it is difficult for me to calculate a time limit. I intend to call the Front-Bench spokespeople from 5.30 pm, so we have about 45 minutes for Back-Bench speeches. If Members keep an eye on the clock and make short speeches, I will not have to impose a time limit.

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[Neale Hanvey (Kirkcaldy and Cowdenbeath) (SNP)]

It is a pleasure to serve under your chairship, Mr Stringer. I thank my hon. Friend the Member for Linlithgow and East Falkirk (Martyn Day) for securing this important debate. The genesis of and support for this petition reflect our values and the esteem in which each nation’s NHS is held. The petition is also a reflection of the public’s mistrust of whether the Prime Minister and his Government will honour their word, and their concern about the risk to the NHS from corporate avarice should it be on the table in any US trade deal.

Before the cronyism, incompetence and allegations of corruption began to dog the Government, the petitioners recognised that the deals the Government had conducted during the coronavirus crisis could be unethical and lacked transparency. Although we are set to see an end to Trumpian politics, in the USA at least, the concern still stands that involving the US financially in our health system could pose a serious health risk to us and our NHS.

Save our outstanding landscapes and convivial culture, there is little more precious to the people in Scotland than their NHS. The NHS in Scotland is unencumbered by a false internal market and there is minimal involvement of the private sector. The public service ethos is rewarded by a satisfaction level of 78%—an impressive 36% higher than for the NHS across the UK.

Perhaps I am worrying unnecessarily, and perhaps the hon. Member for Watford (Dean Russell) is right. Ministers have given repeated assurances on the record that there will be no requirement to increase private provision and no ramping up of drug costs, and that health data is safe, but if the Government are so confident and are assuring us not to worry, why are they hesitant to put an explicit protection in primary legislation?

Sadly, in Scotland we have a track record on which to judge this Government, and an ever sadder track record on which to judge promises and vows from any Westminster Government, whatever their stripe. To digress slightly, this weekend I watched the first ever episode of “Taggart” —from before it was called “Taggart”, in fact. It was set in Glasgow in 1983, at the height of the North sea oil boom, yet the deprivation on show was truly shameful. It was no fluke of filming location. Like many, I walked through those desolate scenes of economic devastation. The loadsamoney Thatcherism was less about the pooling and sharing of resources, or about any dubious acclaim for her ideology, and more about the pulling of that oil wealth from Scotland. Greed is never attractive. Of course, the true value of that wealth was deliberately concealed from the Scottish people, as evidenced by the McCrone report. As the wealth was removed, so too were jobs and hope.

I also had my usual dose of Marr on Sunday morning, and up popped my Kirkcaldy and Cowdenbeath predecessor thrice back. It was a really odd experience, because I thought they were showing a clip from 2014, but actually it was new footage and it was, almost verbatim, the same story and script endorsed by all the Westminster parties in 2014 to disingenuously secure a pyrrhic victory that served only to drive—

[Graham Stringer (in the Chair)]

Order. The hon. Gentleman is straying quite a distance from trade and the NHS. Can he refocus on that?

[Neale Hanvey]

It is the next line, Mr Stringer.

--- Later in debate ---

[Graham Stringer (in the Chair)]

I am grateful to the hon. Gentleman.

[Neale Hanvey]

As I was saying, that only served to drive a surge of support for the SNP and Scottish independence.

Before I am accused of straying too far, what relevance has that to trade deals and the NHS? Well, one simple but absolutely essential word, when the word of another is what our future depends on, is “trust”. Why should my constituents trust this Government? I say that not just because of historical wrongs, but because of their conduct in the here and now.

My hon. Friend the Member for Linlithgow and East Falkirk set out serious questions and concerns, which deserve full and transparent answers. When the crony virus stalks the halls of power, when Ministers puff out their chest and defend their intention to break international law, when the Prime Minister refuses to answer questions in the Chamber but casually insults, when the promises of devo-max have led Scotland to a devo-destroying United Kingdom Internal Market Bill, when the child poverty that this Government have created is dismissed and hunger ignored, and when a pay rise for carers and nurses is unaffordable but an MP’s pay rise will do quite nicely, thank you, why should the people who dedicate their lives to the NHS take this Government’s word for anything? Those people’s belief in altruism and shared endeavour is in peril. They understand the implications of negative lists, standstill clauses, ratchet clauses and the ultimate con, the investor-state dispute settlement process, all of which have the potential to eviscerate the NHS.

The petitioners want to protect the NHS through primary legislation because, as we all know, to neoliberals, health is never the priority; profit is. There is no place in the Scottish NHS for profiteering. This Government must commit to legislating and protecting each part of the NHS. Only then will any trust return.

--- Later in debate ---

[Bill Esterson]

I will not give way to somebody who has not been here for the whole debate.

[Graham Stringer (in the Chair)]

Order. May I explain something that might be useful for future debates? If hon. Members are not on the call list, they may not intervene in Westminster Hall debates under the present rules. I call Bill Esterson.

[Bill Esterson]

Thank you, Mr Stringer. The petitioners are concerned about the market access to the national health service that is outlined in the trade agreement objectives of the United States. A long-stated objective of American pharmaceutical companies is to take away the NHS’s influence on drug pricing, not just in this country, but across the European continent. That is a very real concern.

The petitioners are concerned about access to data. Alan Winters from the Trade Policy Observatory has set out those concerns in real detail: a potential cost of £10 billion to the national health service to get access to our own patient records; the payment of royalties to silicon valley, and legal action against the national health service to boot; and the dilution of data privacy rules if the American trade negotiation objectives are put into law.

Those are the many concerns that led people to sign the petition. Their concern applies not just to US healthcare companies, but to UK right-wing think-tanks and their link-ups with their American counterparts and allies. We have already heard the name Daniel Hannan this afternoon. He is a co-author of “The Ideal U.S.-U.K. Free Trade Agreement”, a document that was launched in London with the Cato Institute on the same day as the Secretary of State for International Trade spoke at the Cato Institute’s Washington office. I do not believe in coincidences, and I suspect I am not the only one in the room who feels that way. Like the petitioners, I am greatly concerned that this is not just about US healthcare companies, but about UK right-wing think-tanks and their representatives.

Let us remember what Mr Hannan and his friends have had to say. When the Cato Institute launched the report, the co-editor who spoke at the launch, Daniel Ikenson, said:

“Healthcare is a service, we call for opening services to competition… This is a free trade agreement, the purpose of liberalising trade is to expose incumbent business to competition, including healthcare.”

Including healthcare—it is there in the words of the think-tanks with which the Secretary of State works and which advise her on the Board of Trade, to which she appointed Mr Hannan only a few months ago.

I turn to the so-called comprehensive and progressive agreement for trans-Pacific partnership, or CPTPP, because this is not just about a potential trade agreement with the United States. We do not know what stage such an agreement is at—with the potential for a fast-track agreement under the current regime, or something else later on—but we know that the Secretary of State has made clear her desire to sign the CPTPP, an agreement with 11 countries on the Pacific Rim. The service chapter of that agreement includes negative lists, ratchet clauses, ISDS and health. There is no opt-out or carve-out for health. As the Nuffield Trust tells us, negative list systems, ratchet clauses and ISDS lock out the potential for Governments to bring public services back in-house once they have been privatised. Indeed, they drive further privatisation and prevent a reduction in it. They take away control, rather than giving back control, as some might say.

[Bill Esterson]

That is right. That is the problem in America, where so much money goes to executive wealth or is wasted on administration costs, instead of going into patient care and medical activity. The hon. Gentleman is right to make that point.

I shall quote what the British Medical Association says about CPTPP. The BMA tells us that the UK would be unable to negotiate any additional carve-outs for healthcare services, and it says:

“We do not believe that the NHS is adequately protected under CPTPP.”

As a member of the CPTPP, New Zealand has an ISDS carve-out on health that will not be available to us, because the CPTPP is an existing agreement and the member countries have made it clear publicly that they will not give carve-outs to new joiners.

On 8 October, the Minister was asked about that in the Chamber. He told us he had met the lead negotiators for the 11 countries and had enjoyed discussions with them. Can he provide reassurance that what the BMA has said is not the full story? Did he ask the question and get an answer about whether carve-outs on health would be possible, given the existing agreement? When he responds, can he tell us whether he asked that question and what the answer was?

The Government’s answer to the points that my hon. Friends and I have raised is that the NHS is not on the table. If it is not, why did the US negotiating objectives state that it was? The Government say that the NHS is not in the existing agreements, and that is true. It is not in the agreements that we are currently signed up to, but this petition is about future trade agreements. For us, the CPTPP would be a future trade agreement. Right-wing think-tanks with links to the Secretary of State and Government also want this to happen, so a lot of reassurance is needed by the petitioners and by many more people besides.

The issue requires far greater scrutiny. I heard one hon. Member describing the process for the scrutiny of trade agreements, which we debated in the Trade Bill. In fact, the Minister and I have debated these matters more than once, in relation to more than one Trade Bill, and no doubt we will do so again. The reality is that the Constitutional Reform and Governance Act 2010, which provides the framework under which we operate, gives no guarantee of a debate or vote on trade agreements. It requires the laying in Parliament for 21 days of a trade agreement that has been negotiated. It does not provide a guaranteed mechanism for debate, because it relies on the Opposition being granted an Opposition day debate by the Government. The Government control the agenda in Parliament. Members will have noticed that, for the last few weeks, we have not had an Opposition day debate, and we went for a long period in the last Parliament without any Opposition day debates, so there is no guarantee of that process being implemented.

Whether a debate at the end of negotiations—if we are allowed one—is adequate scrutiny is another matter entirely. I come back to where I started. If the Government are serious about exempting the national health service from future trade agreements, they should put that in the Trade Bill, support it in the House of Lords and support it when it comes back here, because they have the opportunity to do just that.

We know that the CPTPP is a Government priority in the absence of an agreement with the United States. Will the Minister tell us whether the Government will refuse to sign it without carve-outs? As to the lack of scrutiny, that is in the Government’s hands. So far, there has been a refusal to put the exemption in the Trade Bill, key Government advisers are committed to privatisation and we have concerns about the CPTPP. That all suggests that those who signed the petition were absolutely right to do so, and to have concerns not only about the United States, but about CPTPP as well. They are right to be concerned about the future of the national health service in trade deals.

[Graham Stringer (in the Chair)]

Minister, before you start your speech, I ask that you save two or three minutes at the end for the hon. Member for Linlithgow and East Falkirk (Martyn Day) to wind up the debate.