Trade Deals and the NHS

Neale Hanvey Excerpts

Monday 16th November 2020 Westminster Hall

[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.

[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]

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.

[Neale Hanvey]

Does the hon. Gentleman share my concern that the term “for sale” is used as a cover? Obviously, the NHS is not going to be put up for sale like a house, but parts of the services that it provides will be contracted out to a range of different private providers, who will suck up the funding in profits rather than ensuring that those investments go where they are properly supposed to go—to resource healthcare services.

[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.