Trade Deals and the NHS

Bill Esterson Excerpts

Monday 16th November 2020 Westminster Hall

[Bill Esterson (Sefton Central) (Lab)]

It is always a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Linlithgow and East Falkirk (Martyn Day) on introducing the petition to us. I also thank my hon. Friends for their excellent speeches. We heard from my hon. Friends the Members for Birkenhead (Mick Whitley), for Hornsey and Wood Green (Catherine West) and for Luton South (Rachel Hopkins).

The petition is about omitting the NHS from future trade deals with the US. The concerns raised by the petitioners would be relatively easily dealt with were the Minister, in a few minutes’ time, to commit not just to what he has said before about the NHS being off the table, but to putting protections in the Trade Bill—to passing in the House of Lords the amendments that were turned down in this place and retaining them when the Bill comes back here in the next few days or weeks. That would be the simplest way of dealing with what the petitioners are asking for.

The petitioners are concerned about the American healthcare system, the size and scale of the industry in America, the fact that it accounts for one in eight jobs in the United States, its importance to the US economy and its importance to shareholders. Those US healthcare companies have a responsibility to maximise shareholder wealth—as do all companies, of course—so they are only doing what they must do, and that means looking further afield. It means looking with great interest at the national health service. We know that they do that, did it and will continue to do it—for the next few days anyway, with the support of the Trump Administration. Yes, it is welcome news that we have President-elect Biden, hopefully, to take over—court cases notwithstanding —on 20 January, but this petition was signed when President Trump was in office and the petitioners had no way of knowing whether that would change.

The petitioners are concerned about the US objectives published in March. They are concerned about the market access being requested by US negotiators for pharmaceuticals. They are concerned about what that market access means in practice.

[Richard Graham (Gloucester) (Con)]

Will the hon. Gentleman give way?

[Bill Esterson]

I will not give way to somebody who has not been here for the whole debate.

[Graham Stringer (in the Chair)]

Order. May I explain something that might be useful for future debates? If hon. Members are not on the call list, they may not intervene in Westminster Hall debates under the present rules. I call Bill Esterson.

[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.

[Graham Stringer (in the Chair)]

Minister, before you start your speech, I ask that you save two or three minutes at the end for the hon. Member for Linlithgow and East Falkirk (Martyn Day) to wind up the debate.

--- Later in debate ---

[Bill Esterson]

Will the Minister give way?

[Greg Hands]

I am coming to a conclusion.

The UK’s high standards of data protection will be maintained. The Government are clear that health and care data should only ever be used or shared lawfully, treated with respect and held securely, with the right safeguards in place. I am going to leave a few minutes for the response, Mr Stringer. It is absolutely clear that any trade deal could not be ratified without scrutiny by Parliament. There is also a separation between international and domestic law, so any changes made to the NHS through a trade deal would need domestic implementing legislation, just as much as if those changes were to be made without a trade deal. There is no way to sidestep Parliament. The Government will never agree to a trade deal with the US or any other country that risks the future of our national health service or which could undermine the Government’s ability to deliver on our manifesto commitment to the NHS.

There are, however, benefits of trade for the NHS. The whole debate has been focused on fears and threats, but there are benefits. To continue supporting public services such as the NHS, which we all value and from which we all benefit, it is crucial that we have a strong economy. Now that we have left the EU, we find ourselves with a golden opportunity to strike free trade deals around the world, which will help to fuel our economic recovery from covid-19.

In conclusion, the question is asked over and over again, but the answer is not going to change. The NHS is not on the table in any future trade deal. The price it pays for drugs is not on the table and the services it provides are not on the table. The Government will not accept any trade deal that changes our ability to regulate the NHS or any public services, nor will we agree to any measures that would put NHS finances at risk or reduce clinician and patient choice. Scare stories otherwise simply do not fit with the facts. The Government will always put patients and the sustainability of the NHS first.

As an independent trading nation, the UK is reaching out to partners around the world that support our shared values of freedom and democracy and making great trade deals, starting with our friends in the United States, Australia and New Zealand and the deal with Japan that we have already delivered. It is by working together as a global community and embracing values-driven and value-generating trade with like-minded partners that we will be able to beat this dreadful virus and build back a stronger economy to sustain our vital public services, not least our beloved national health service.