NHS and Future Trade Deals

Mike Amesbury Excerpts

Monday 22nd July 2019 Westminster Hall

[Mike Hill]

My hon. Friend makes a powerful point with which I agree. The voice of the BMA and other professional bodies is most important and must be heard.

The petition asks for the provision of “concrete safeguards” to keep NHS services out of any future trade deals. That is nothing new; that fight has been ongoing for years, even within the EU. To this very day, those British Members of the European Parliament who care about our NHS are battling to keep NHS services out of the developing Transatlantic Trade and Investment Partnership between the EU and the USA.

The Government said in response to the petition,

“The UK’s public services are protected by specific exceptions and reservations in EU Free Trade Agreements. As we leave the EU, the UK will continue to ensure that rigorous protections are included in all trade agreements it is party to”,

but that can be only an aspiration. It is not a cast-iron guarantee that the transfer of any EU regulations into UK law will specifically protect the NHS from future trade agreements. Just as the EU found with TTIP, we will need to further regulate for the exclusion of NHS services from trade agreements. Action, not words, needs to be the order of the day. Given that the Government refused in 2016 to exclude the NHS from the TTIP negotiations, that may well turn out to be a tall order.

American healthcare providers can already compete to deliver services in the UK. However, the threat to the NHS of a US trade deal would be through clauses that lock in existing levels of privatisation and prevent future Governments from rolling them back.

[Mike Amesbury (Weaver Vale) (Lab)]

It is clear that the NHS is already for sale. Only recently, the urgent care centre in my constituency was put out to tender. It was recommended that a private, for-profit company should run that facility, which was previously an NHS service. As has been stated, a record £9 billion of contracts have been awarded to the private sector. Does my hon. Friend agree that the form of trade deal we are talking about would lead to privatisation with bells on?

[Mike Hill]

As always, my hon. Friend makes a powerful point. Let us not forget the millions spent compensating private companies that lose contracts and take the Government to court.

Trade deals are not only dangerous for the future of the NHS, as they would entrench privatisation, but undermine our democracy, as future Governments would be shackled by their binding provisions. That is why some say the only way to fully protect our NHS from trade deals is to fully exclude it from them.

--- Later in debate ---

[Craig Mackinlay (South Thanet) (Con)]

It seems to me that we are debating that old chestnut, “public good, private bad.” We must take into consideration the fact that 7.6% of all NHS spending goes on what we might call private-type enterprises. They are not all for-profit enterprises; many are in the not-for-profit sector, such as community interest companies and charities. This issue is often portrayed as uniquely Conservative, with the suggestion that we want somehow to privatise the NHS, but all the facts, including the additional expenditure on the NHS in the past few years, demonstrate completely the opposite. In 2010, when the Labour Government left office, 4.4% of NHS spending went on the alternative, non-public sector. That figure is now 7.6%. The rate of growth has been exactly the same since 2010 as it was under the Labour Government.

I am sure that what underlies the petition is the petitioners’ fear of what might happen in future trade deals. One deal did not come to pass—the old TTIP, which the rest of Europe has decided not to pursue. I for one would very much welcome a future US trade deal, and I am sure we will be in a better place to negotiate one, given the rather sluggish way the EU seems to approach international trade deals. I pay tribute to the hon. Member for Hartlepool (Mike Hill) for acknowledging that international trade deals generally are for the good; they expand investment and much more besides in terms of international relations. At the time of TTIP, the same fears emerged, with people asking, “Will our NHS be up for sale?” Love her or loathe her, Cecilia Malmström, the EU’s then Trade Commissioner, made it very clear that national health services were not on the agenda in the UK or anywhere else in the EU.

We saw something similar with the comprehensive economic and trade agreement with Canada, which is deemed to be what we might call best in class. It is seen as a good free trade arrangement, which, obviously, I would like the UK to have with the EU in the future. CETA is an advanced trade deal that allows for the sort of good things that happy, friendly trading nations can achieve, such as reciprocation on many qualifications, but that deal has always contained a specific exemption for Government-procured public services

“supplied in the exercise of governmental authority.”

I can only envisage that we would do the same in any trade deals the UK might make as an independent country. That is in our hands. That is for this place to decide.

This country has always been open for business. I do not know the figures, but we have very few restrictions on foreign ownership of our companies. I do not know whether I use them myself, but frankly, I do not much care if an outsourced Indonesian company provides blood testing. I want the service to be provided at the best possible price and the best quality to the taxpayer. I am sure there are many services paid for by the NHS that are owned by foreign companies—American, French, German, Swiss, Swedish and so on. I really do not care too much, because what is important about the NHS is that it is free at the point of delivery. I am sure that in very many hospitals we enjoy equipment that is made overseas. We have the World Trade Organisation pharmaceutical tariff elimination agreement, so there are very few tariffs between any of the major countries on pharmaceutical products. We should take a wider view in these discussions than just, “public good, private bad”. We need some common sense.

Remarkably—this needs to be put on the table—many Opposition Members seem to want a customs union that goes on forever, and perhaps single market rules that go on forever. However, we would not have a seat at the table as the EU negotiated future trade deals around the world. We would be caught on the coat-tails of a customs union, just as Turkey has to suffer. We could find our NHS on the table in trade negotiations between the EU and the rest of the world on deals that, as customs union members, we would just have to follow. We would be completely powerless. To me, that would be the worst of all worlds. At the moment, our Parliament—Opposition Members and Government Members—will be in control of what is on offer.

[Mike Amesbury]

Will the hon. Gentleman clarify how many trade deals the Government have negotiated that include aspects of healthcare?

[Craig Mackinlay]

To date, obviously none, because we are not able to, but many roll-over agreements are coming to fruition. The biggest, which the Department for International Trade concluded just a few weeks ago, is with Switzerland, which is a major provider of both pharmaceuticals and high-level industrial equipment, which is often used in manufacturing and in our hospitals.

Agreements are rolling over gradually, but I want us to be more ambitious. I want us to have international trade deals that open up greater transparency and friendship and boost trade. If that means we start having zero tariffs on fantastic products from Japan or elsewhere, what is the problem with that? I want the health service in this country to be the best in class and free at the point of delivery. If UK companies are able to provide services internationally, that has to be a good thing too. But the decision on procurement and whether to open up the NHS to competition from America, Australia or anywhere else should be taken in this place. We should not be caught on the coat-tails of perpetual customs union membership, which would give us no decision-making power whatsoever. In the future, this should be a decision for us—for this Parliament, in consultation with the public and indeed the very good people who put their name to the petition.