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Written Evidence submitted by Dr Linda Danil (TER0002)

UK- US Trade Relations

Summary

• This submission will focus in particular on the following question: The extent to which any agreement could and should open up markets in services, including public services. Further, this submission will focus on one particular form of public service – the public service provided by the NHS.

• The NHS has been regarded as one of the most important and enduring achievements of the post-war welfare state, and is widely regarded as a national treasure and a British institution. The British public is overwhelmingly and strongly committed to the NHS remaining public.

• As well as providing health-care, the NHS is underpinned by principles that promote egalitarianism, social justice, and social equality through the provision of services, and generally.

• The NHS should be entirely excluded from a UK-US trade deal, as well as any/all other trade deals.

1)     This submission will focus in particular on the following question: The extent to which any agreement could and should open up markets in services, including public services. Further, this submission will focus on one particular form of public service – specifically the provision of services through the National Health Service (NHS).

2)     The main argument made in this submission is that the NHS should be entirely excluded from a UK- US trade deal (and any/ all other trade deals for that matter).

Indeed, an online petition, which has already gained over 50,000 signatures at the time of writing, argues precisely that.[1]

3)     This submission would also like to draw attention to and re-emphasize the pledge that Prime Minister Theresa May made that “[…] the NHS is not for sale and it never will be.”[2] The International Trade Secretary Liam Fox also argued that: “As the person who will be in charge of negotiating [a deal] that would not be happening on my watch.”[3]

4)     The NHS is revered by an overwhelming majority of the British public. For example, a report[4] by the independent think-tank British Future provides that, of the people that took part in their poll, the following percentages agreed that the NHS is “A symbol of what is great about Britain”[5]: 76% in the Northeast, 75% in Yorkshire and Humberside, and 66% in the West Midlands. Moreover, 74% English, 74% Scottish, and 68% Welsh agreed with the statement overall. An Ipsos MORI survey published in 2015[6] found that of those that took part, 78% agreed that Britain’s NHS is one of the best in the world. The NHS has been regarded as one of the most important and enduring achievements of the post-war welfare state, and is widely regarded as a national treasure and a British institution.[7]

5)     When the NHS was launched in 1948 by the then Minister of Health, Aneurin Bevan, it was based on three core principles: that it meets the needs of everyone; that it be free at point of delivery; and that it be based on clinical needs, not on the ability to pay.[8] Further, the NHS Constitution provides that “The NHS belongs to the people”[9]; that it is based upon providing a comprehensive service, available to all; and that NHS services are based upon clinical need, not the ability to pay.[10] Amongst other things, the Constitution also provides that the NHS “[…] has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.”[11] The NHS thus also plays a role, and indeed has a social duty, to promote social equality through the provision of its services, and is therefore underpinned by, amongst other things, a commitment to social justice more broadly. Thus, the NHS does not just provide health-care – it is also committed to providing an equal playing field for all in terms of health-care provision, health-care outcomes, and access to health-care, and to promote equality more broadly through the services it provides. The Health Act 2009 further stipulates that all bodies providing NHS services must “have regard”[12] to the Constitution.[13] That is all the more reason to exclude the NHS from trade agreements, whether it is a UK-US trade agreement or any other trade agreement, so that corporate interests, and the interests of shareholders, do not encroach or threaten those principles.

6)     Further, the British public is overwhelmingly and staunchly committed to the NHS remaining public. A number of organizations and campaigns have defended and continue to defend the NHS remaining public, such as Keep Our NHS Public, Save Our NHS, Doctors for the NHS, the NHS Support Federation, Patients4NHS, and We Own it (which encompasses other public services more broadly alongside the NHS), amongst others. The British public has more than once expressed its aversion to the encroachment of the private sector into the NHS provision of services, for example in relation to Health and Social Care Act 2012 or the Transatlantic Trade and Investment Partnership prior to the vote for Brexit. The same objections and concerns have already been raised in relation to a UK-US trade agreement.[14]

7)     The NHS has already been subjected to what has been argued to be a form of stealth privatization, as well as increased marketization, though the Health and Social Care Act 2012, all the more so through Section 75 of the Act and its associated Regulations.[15] However, this has been argued to a part of a process that began during Thatcher’s first government in 1979, with a commitment to free market ideology being one of the key drivers for change in the NHS.[16] The British Medical Association (BMA) has been highly critical of the Regulations associated with Section 75, arguing that it could potentially be damaging to the comprehensiveness and integration of services.[17]The academic Lucy Frith has also warned, amongst other things, of the dangers of increasingly fragmenting health services with different providers.[18] The requirement for competitive tendering has also been argued to impose significant administrative burdens entailed in the commissioning, invoicing, and billing of services; to further be a waste of money and a waste of time of already overburdened clinicians; and to be seriously undermining the provision of services.[19] Further, it has also been argued that with private clinics competing with hospitals to conduct routine surgery, there is the understanding that if complications arise, NHS hospitals will provide the remedy. Hospitals can experience financial loss due to the outsourcing of such routine surgeries, and if they are teaching hospitals, the experience of routine operations is denied to trainee doctors.[20] These are just some of the issues at stake. This is a trend that should not continue or be amplified. Further, there has been considerable criticism and opposition already expressed in relation to the privatization and marketization that has already occurred, as described above.

8)     The absolute, unequivocal exclusion of the NHS from a UK-US trade agreement, as well as any other trade agreement, would therefore demonstrate that there is no intention, in any shape, form or guise, to further increase the reach of the private sector into the NHS provision of services, by any means.

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