Is the NHS for sale? What a US trade deal after Brexit would mean for healthcare – and if the NHS would be ‘on the table’


What does it mean to suggest the NHS is for sale and how would this impact healthcare in the UK?

Friday, 6th December 2019, 6:10 pm

Is the NHS for sale? (Photo: Getty Images)

Jeremy Corbyn and Boris Johnson have been repeatedly clashing over accusations that a Conservative government would be prepared to sell off aspects of the NHS in order to secure a post-Brexit trade deal with President Donald Trump.

Labour has led its election campaign with rallying calls that the “NHS is not for sale” and produced the redacted minutes of trade meetings which reveal US negotiations floating ideas about how a new trade agreement would impact healthcare in the UK.

But Mr Johnson has dismissed these accusations, saying it is “nonsense” that he would be prepared to sell off the state healthcare system to big American companies.

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Who is telling the truth, if anyone? And what would all of this mean for people anyway?

i has spoken with Professor of Politics and Brexit trade expert Simon Usherwood about whether the NHS is, indeed, for sale and what this would actually mean for healthcare.

What do people mean by saying the NHS is ‘for sale’?

Professor Usherwood said that the constant arguing over whether the health service is “for sale” is more of a question of semantics than anything else.

As a result, he said, Labour and the Conservatives are both correct and simultaneously twisting the truth.

“We have a state health service so its owned by the government, so the idea that it is for sale as a unit is clearly not what is being talked about. So in that sense, when people say it is not for sale that is true,” he said.

Jeremy Corbyn with redacted copies of the trade documents which he said prove the NHS is for sale (Photo: Leon Neal/Getty Images)

“But the way it actually works is that NHS has competition within it, so we have different providers of services, and GPs and healthcare trusts can shop around to try and get the best value for their needs. The idea was that it would be a way of trying to improve efficiencies, but it also offers the opportunity where non-NHS providers can carry out some of those services.”

This outsourcing of certain services is something that we already have in the NHS, the so-called “marketisation” of healthcare in the UK has been happening in varying degrees for the past 30 years.

The question politicians are grappling over now is not so much whether to sell the health services, but to what extent does the UK want to continue to outsources services and give more access to private companies.

Professor Usherwood said: “There are elements like operations where you might be in a private healthcare facility in a building that is run by someone else, but equally there might be back office stuff that you never see as a patient that is being dealt with by a private company.”

He said the problem for politicians is that people in the UK are “sensitive” to the idea that healthcare is being commercialised and, as a result, it is a complex political issue.

The NHS is a politically sensitive issue (Photo: Getty Images)

Is privatisation inevitable in a post-Brexit trade agreement?

Mr Johnson has repeatedly said that there would be no circumstances in which he would be prepared to offer up aspects of the NHS to the US in a post Brexit trade agreement.

But trade experts have pointed out that there is a degree of inevitability that, when agreeing a free trade deal (FTD) with the US, it would automatically expect access to the healthcare and pharmaceutical industry in the UK.

Professor Usherwood said that there is a way which the Government could prevent any access to the NHS by setting out a specific exclusion to any agreement and insisting there is no change to the rules that exist with relation to healthcare.

But he added that the government will likely come under intense pressure from US companies demanding access to the service.

“What we know from experience of the US negotiating guidelines with the EU is that the US healthcare providers have lobbied hard and successfully to have the US Government try and negotiate better access to those markets,” he said.

The NHS already outsources some services (Photo: Getty Images)

“It’s not inevitable but it’s pretty certain that the US Government, if it was negotiating a free trade agreement with the UK, it would want to have a discussion about those things.

“Of course that doesn’t mean there would be an agreement about it necessarily. It is clear from the documents leaked [to the Labour party] that the US is aware of the sensitivity involved, and it’s not that they don’t care but it still means that there will be careful discussions.”

What could change for the NHS?

So what would it actually mean for NHS patients if the US market gained more access to the UK’s health service?

The leaked documents have already shown that US trade officials discussed the notion that pharma companies want to be able to extend the patent lifespan of their drugs.

This means effectively extending the copyright of a drug to prevent other companies from making the same drug and selling it for a cheaper price, allowing companies to make more money from the drugs for longer, too.

There are concerns that a post-Brexit trade deal would lead to higher drug prices (Photo: Getty Images)

As a result drugs could become more expensive in the UK. This would not impact patients directly as they pay a set – and small – amount for a prescription.

But it could leave the health service making difficult decisions about which medication it can afford to buy and which it cannot.

Professor Usherwood said the impact of a new trade agreement on healthcare would really depend on the limits of it, whether it was confined to pharmaceuticals or also medical goods and services as well.

He said primarily it would be politically damaging for the UK government because it is a lot to do with “what the NHS represents for people”.

“It is about that the NHS is and what it should be. People in the UK want something that it theirs and the thought of having outside people getting involved jarrs slightly with that image,” he said.

Secondly there is the issue that US companies may not be held to account in the same way we have come to expect from healthcare, especially if the UK is desperate to sign an agreement post-Brexit.

Leaked documents have revealed that US trade negotiators discussed the prospect of extending drug patents (Photo: Getty Images)

“I am not sure there is anything intrinsically wrong with US companies doing more,” he said. “But its a question of what they would actually be doing and how they are doing it. Are they following the same rules and regulations as everyone else.”

He added: “It is also an opportunity to make money than improve services. But how successful the marketisation of the NHS has been over recent decades is debatable.

“If you think about healthcare provision in the UK and the problems it’s facing now – like shortages of beds – it doesn’t seem to have been successful. This may well have been worse under the old system but it’s not as if the problems have gone away.

“Markets can be very powerful instruments but when it comes to something like healthcare, it can be somewhat different.”



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