Protect our NHS in future trade deals

4 min read01 July 2019

The UK appears unprepared for trade talks and is vulnerable to US demands. Our next Prime Minister must set-out explicitly how our health service will feature in any trade deal plans, says Lord Brooke

President Trump made several characteristically bold statements during his visit to Britain last month. But his assertion that the NHS would be “on the table” in discussions about any post-Brexit US-UK trade agreement was by far the most contentious. One by one, Conservative MPs who had thrown their hats into the ring to succeed Theresa May were at pains to denounce this possibility.

As many have been quick to point out, the NHS has long been ‘on the table’. Despite the common notion that our health system is a public endeavour, the private sector — including US-owned companies – already play a significant role.

For several decades – and boosted by the 2012 Health and Social Care Act – private firms have run NHS services for profit, with BBC analysis suggesting the health service now buys in a £1bn a year in care. And such companies have made no secret of the fact that they see Brexit as a key opportunity to expand their operations.

Another area of significant interest is pharmaceuticals, where the US could try to incorporate a new reimbursement structure in a trade deal. Big Pharma spends hundreds of millions worldwide opposing measures to limit drug prices, and the great success of our NICE regime is a prime target. Last year, President Trump accused the rest of the world of “freeloading” because it pays less for drugs than in US hospitals, while his Heath Secretary Alex Azar has threatened to use trade talks to push up prices outside of America.

An outline of negotiating priorities for a US-UK deal, issued by the office of the US trade representative, included a section on ‘procedural fairness for pharmaceuticals and medical devices’. This vowed to “seek standards to ensure that government regulatory reimbursement regimes are transparent, provide procedural fairness, are non-discriminatory, and provide full market access for US products”.

'Companies have made no secret of the fact that they see Brexit as a key opportunity to expand'

Let us be under no illusion that for Big Pharma, a ‘fair’ reimbursement regime is one where the NHS pays much considerably more for pharmaceuticals. It is unlikely that any UK government would cede to such a demand. But the ability of the NHS to hold down prices and demand cost-effectiveness before approving their use may become challenging for a country desperate to replace lost EU trade.

Indeed, the weakening of “non-tariff barriers” – including domestic and EU-wide regulations that demand drugs, technology and staff meet strict standards of safety and utility – may prove to be a significant risk.

Patient data is another area of interest to commercial healthcare firms. The NHS database holds the medical records of 65 million people. As such, it is a priceless treasure trove of data for technology giants and healthcare firms alike and could become a major bargaining chip.

Trade negotiations have transformed in the past few years. Recent deals have incorporated a digital section that sets agreements on ecommerce and data access, and similar terms can be found in the White House’s ‘negotiating objectives’ for the UK. The US wants access plus the power to use the information under its own laws. It also wants full intellectual property protection for algorithms and an unrestricted market in which to sell the final product.

Using such data ethically is obviously going to create concerns. Although strict GDPR control cross border data flows, the UK post-Brexit will be free to implement a new regime.

Having not negotiated a trade deal independently of the EU for decades, the UK seems unprepared for talks with the US. Indeed, while the latter has already published its objectives, no equivalent document has materialised here. Quite possibly because our government has yet to decided what it wants from a deal.

That is why it is imperative that the two candidates vying to succeed Mrs May move beyond their platitudes about the value of the NHS and start to explain – openly and transparently – how it will feature in their trade deal plans.

Lord Brooke of Alverthorpe is a Labour peer. His debate is on Thursday 4 July.

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