That political hot potato rears its head again – trade talks and the NHS

Whilst we don’t want to start a political debate, we couldn’t help but notice a bit of a Twitter furore around last month’s vote in parliament – new clause 17 – an amendment to the post-Brexit trade deal. The clause was intended to protect the NHS from any form of control from outside the UK, but was voted down by MPs, leading to some saying it now leaves the path open to ‘sell off’ parts of the NHS as part of trade deal discussions, leaving no safety net for the NHS.

Much of the concern was sparked last June when Donald Trump said that the “NHS or anything else” would be in the sights of US firms in any post-Brexit trade deal. Even though he later contradicted himself, saying instead that “I don’t see it being on the table…that’s something that I would not consider part of trade”, it has lead to some questioning what is behind these comments. Is the NHS up for sale, and could a post-Brexit trade agreement with the USA lead to the privatisation of our Health Service?

For the moment the government has said “the NHS is not, and never will be, for sale to the private sector, whether overseas or domestic. Nothing in the Trade Bill undermines this commitment.”

However, ongoing trade deals negotiated as the next part of the Brexit process could certainly have some implications for healthcare and it will be up to the government to decide what kind of services foreign providers can bid to supply.

We’re not going to pretend we know what the government will do in the future, but we thought it would be interesting to look at some of the concerns and issues surrounding these pending trade deals.


The heart of the issue – privatisation

Given the founding principles of the NHS; free to all on the basis of need at the point of use, private sector involvement in the NHS has always been controversial, but competition in the NHS is not new. Some NHS services are already provided by US-owned and other foreign-owned companies and spending on the private sector is as much as 25%* if you include primary care, pharmacy, dental and optical.

What are the biggest concerns around trade talks?

Healthcare is not usually on the table when it comes to trade deals and many argue that it never should be, given its founding principles. There is a fear that any increasing scale of foreign involvement might ultimately compromise patient care, whilst private companies battle for profits.

It remains to be seen what the US would ask for as part of trade negotiations, but the biggest fear seems to be that the US wants to get its hands on the most profitable parts of the NHS (although these are limited) and the pharmaceutical companies will seek to push up prices. Currently the NHS and the pharmaceuticals industry have an agreement which caps NHS expenditure on branded medicines, keeping prices in the UK down for both patients and the NHS.

The future picture

In many cases the use of private providers to treat NHS patients has been used to overcome operational challenges within the NHS and is a continuation of longstanding practices. Many believe that as long as patients receive the right care at the right time and is free at the point of use, the provider of a service is less important than the quality and efficiency of the care they deliver.

With demographic challenges and technological innovations increasing the pace of change, the healthcare system in the UK is under pressure, so finding new, creative ways of delivering services, whilst maintaining standards and integration in patient care is vital. Any trade deals will need to be mindful of this to ensure the NHS can deliver healthcare solutions fit for the future.

Watch this space.




* Is the NHS being privatised – The King’s Fund Oct 2019