Brexit? TTIP and the NHS.

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The Labour Party and many on the left support the campaign to remain in Europe. There is a case for EU membership in terms of economics and security. Beyond any facts based position there is also something about social solidarity, about dislike for nationalism, about socialism not respecting borders. It is also salutary to see who is leading the case for Brexit and to wish to be opposed to them.

Some on the left are opposing EU membership describing it as a neo-liberal clique. George Galloway has argued that the EU, far from being a progressive force, encourages the “neoliberal” policies which many on the left abhor. He said:

“The whole basis of the European Union, as we always said from 1975 onwards on the left, the European Community, now the EU, is actually built on neoliberal economic principles which are iron-clad and unchangeable however people want to vote.”

For those sharing this view the proposed Trans-Atlantic Investment Partnership – TTIP – gives the leading example of the embodiment of neo liberalism. Staying in the EU will mean agreeing to TTIP and that will destroy our NHS. Interestingly this argument of the EU putting our NHS at risk is also put by UKIP and others brexiters of the right.

So does TTIP threaten our NHS? It’s something of a familiar refrain as we have previously heard that the Tory changes in the early 1990’s destroyed the NHS; that the Labour flirtation with internal markets in the 2000’s destroyed the NHS and that the Health & Social Care Act 2012 destroyed the NHS. Some interest recently has been directed at writing an NHS Bill to reinstate the NHS. It’s not at all clear what has been lost and what might be restored or how TTIP will destroy anything not already destroyed. But restoring something lost through the rise of neo-liberalism has a strong emotional resonance in some places

The claim is that TTIP prevents a future government from making changes to the NHS which reverse privatisation and which increase the level of public provision hopefully to 100%. TTIP ensures the NHS has to be opened up to liberalization/privatisation – that is if it is not already.

Once you begin to frame the actual issues a bit more precisely than claiming the end of the NHS is nigh then it is obvious that this is about politics and not Treaties. The only way to ensure that public services are not privatized is to have a government that does not do it. Or put another way if there is a government that wished to privatize the NHS or even to move the NHS on to an entirely different model – perhaps with charges and copayments and a two tier service – then they will find a way to do so.

Again there is a familiar theme here. Advocates of the NHS Bill argue (wrongly) that in the extremely unlikely event that it was passed it would prevent privatisation and reinstate a fully publicly provided NHS (something that has never existed). It ignores the obvious fact that a government intent on privatisation would simply repeal the Bill or use it in ways that fitted their agenda – it’s the politics that matter.

So what about TTIP? Some care is needed as at present it is not known what will actually be agreed, if anything. The negotiating position of the EU has been made public and it is clear what EU Treaties currently say about pubic services. It is also becoming clear that any TTIP has to overcome many hurdles in many countries before it could be agreed at all.

The current position on public services and liberalization was most recently set out in Directive 2014/24/eu of the European Parliament and of the Council of 26 February 20141.

(5) It should be recalled that nothing in this Directive obliges Member States to contract out or externalise the provision of services that they wish to provide themselves or to organise by means other than public contracts within the meaning of this Directive. The provision of services based on laws, regulations or employment contracts should not be covered. In some Member States, this might for example be the case for certain administrative and government services such as executive and legislative services or the provision of certain services to the community, such as foreign affairs services or justice services or compulsory social security services.

This accords with many years of reality. It was the H&SC Act 2012 that introduced the requirement for compulsory tendering of NHS clinical services – nothing at all to do with the EU. And, despite the H&SC Act, on 1 April 2016 some £35bn of NHS services will be “commissioned” by CCGs from NHS Trusts and Foundation Trusts without the merest hint of any competition – this is perfectly acceptable under EU procurement law.

So again it is clear that it is the domestic politics that are of importance. The Coalition government decided to try and turn the NHS into a regulated market and to widen the scope for the entry of private providers – nothing to do with any EU Treaty or trade agreement. The policy was ideologically driven, hopelessly badly thought out and is being ignored; it was the coalition’s greatest mistake!!!

But does TTIP force a move away from established EU policies? Not according to the European Commission – Many EU politicians are also on record as saying they will oppose anything in TTIP which challenges the established right of individual member states to decide how to organize their public services. And not according to respected academic Martin McKee, previously an opponent of TTIP,

But just to be on the belt and braces safe side many have said why not put into TTIP something which makes things absolutely clear in terms of exemption for the NHS (and social care? and education?). This might even make more watertight the EU position, with or without TTIP, that in England we can reverse privatisation and keep services publicly provided if that is the wish of our elected government. Without this reassurance there is a threat; amplified by uncertainty.

Leaving aside the ideology and politics and just looking at what we know of what might be in a possible TTIP then perhaps the best analysis of the threat comes from an expert legal opinion This should be carefully read in full. It sets out the risk that a future government may be inhibited from making changes to the NHS (even ones arguably of benefit to patients) because of possible claims for compensation from private organisations that claim they have been denied opportunities for future profits.

The advice does not say a government is actually prevented from making such changes – as some have claimed. It does however argue for a chilling effect on decision makers. This is very similar to what we have heard recently in England, where some CCGs have claimed they put NHS services out to competitive tender because they feared that they would be challenged if they did not (despite the leadership of the NHS actually saying this is nonsense).

This fear has been addressed by the EU Commission who set out what they say must be within TTIP:-

Every EU trade deal comes with solid guarantees which fully protect public services. TTIP will too. These guarantees mean EU governments can’t be forced to privatise. They remain free to keep public services public – even if they open up other services to foreign competition.

Governments can decide, or change, who delivers a public service at any time. This means there’s no so called ‘ratchet clause’ for public services. TTIP won’t affect governments’ ability to: operate public monopolies or grant exclusive rights to a particular private supplier; decide how to run water distribution services, or publicly-funded education, health or social services; or subsidise these services. These guarantees work. EU trade deals have protected public services for 20 years.

In the EU, public services such as healthcare and education are amongst the best in the world. They play a special role which Europeans value, and which EU law recognises. For that reason the EU, and individual EU countries, are required to protect public services in any new laws or policies they adopt – including EU-wide trade agreements with countries outside Europe.

And this whole debate is not confined to England and its NHS. It also applies to other countries which have strongly established public services that they will not want liberalized. Strong political opposition must be counted against the alleged influence of big business and their alleged close contacts with EU policy makers and bureaucrats.

There is a strong left of centre case for remaining in the EU. In the words of Alan Johnson, perhaps the most respected of all the campaigners in the referendum:-

Being in does not in itself solve our problems. No one pretends it could. It doesn’t guarantee us a prosperous future. Only our own efforts will do that. But it offers the best framework for success, the best protection for our standard of living, the best foundation for greater prosperity. Today we are even more dependent on what happens outside. Our trade, our jobs, our food, our defence cannot be wholly within our control. That is why so much of the argument about sovereignty is a false one. The (EC) strikes a balance, between the wish to express our own national personalities and the need for common action.

”Europe remains the backstop guarantee for workers’ rights that would vanish if Brexit were achieved on the terms preferred by a Tory-Ukip alliance. “The people who back the Leave campaign, many of them want Britain as a kind of offshore, free-market, race-to-the-bottom, anything-goes country. They have a problem with rights and protections for workers. But they don’t say it. Maybe we’ll drag it out of them.”

The idea that the labour movement will come out of this better off if we leave Europe is just so bizarre and perverse. Of any group, they’re the ones with the most to lose. I would hope that the trade unions can be evangelical about this with their members, not just saying ‘we support this’, certainly not just standing on the sidelines, but really getting involved.”

The choice is not between a Socialist England with a publicly provided NHS or being in Europe. It is possible to have both so long as the politics of England delivers the necessary administration – which looks a long way off at the moment.

The real risk to our NHS is the Tory plot to run it down through inadequate funding and constant unhelpful intervention. Using their media allies to denounce the “socialist” model NHS they replace it with a two tier service, with an insurance base, lots of private providers (as with social care) – with charges and co-payments and offering a poor service to the poor.

That’s the real politics and the NHS Bill and TTIP are a side show by comparison.

1 This has been put into (English) Domestic Law in the Public Contract Regulations 2015 – which will be fully implements in the NHS from 1 April 2016.

One Reply to “Brexit? TTIP and the NHS.”

  1. TTIP will over a relatively short period of time, destroy the NHS. The reason, the Trade treaty makes it clear, MONOPOLIES’ cannot exist and what is the NHS, the largest concentrated economic entity in the EU. So do not believe the lies of the politicians as you will find that you will be taken for a ride after TTIP is signed and sealed.

    ‘The TTIP (Transatlantic Trade and Investment Partnership) will be an Absolute Disaster for the People of the EU (European Union) and the People of America (USA) in the long-term – We simply have to Vote AGAINST this behind closed doors Transatlantic Trade deal before it is signed up and too late for the People to do anything about it’ –

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