It is a pleasure to serve under your chairmanship, Sir Roger. I thank Mike Hill for opening the debate and representing the more than 160,000 petitioners who put their signatures to the document.
It is clear that the NHS is something that all of us here and the public as a whole care deeply about. There can be no doubt about that. We have heard and seen it in many forums before and we know it is true. However, I want to set this out right at the start, because I do not want there to be any room at all for ambiguity: I guarantee the House that the Government will protect the NHS in trade negotiations. That means no requirement to increase private provision, no allowing American companies to ramp up drug prices, and no undermining the safeguards on healthcare data. That is a guarantee that I, the Secretary of State and many others have repeated on many different occasions—most recently, when I appeared before the International Trade Committee last week and said the self-same thing there.
The NHS is an excellent healthcare system. It tops the Commonwealth Fund’s rankings of the best healthcare systems in the world. More than that, it is there for all of us when we need it the most. Those are not just words. Many of us—probably all of us—have an “NHS story” to tell of a time when the NHS helped us or those we love. I am afraid that mine is a story of when the NHS could not be there for someone.
I am married to an American. My brother-in-law could not afford proper healthcare for his illness because his insurance broker made the mistake of not renewing his health insurance for one week. There was one week’s gap, and in that one week he was diagnosed with a brain tumour and was thus both uninsured and uninsurable. I do not particularly want to elaborate on all that the family went through and faced over the next three years of his life, but it was pretty miserable. I was convinced before that it was only civilised to have the sort of system that we have here in the UK, and that experience did nothing but reinforce that view. It is simply not civilised not to provide healthcare for our citizens when we can afford to do so. The US health system is one where even those with insurance can never be sure whether their insurance will pay out; where insurance policies can often be limited in extent, condemning families to penury even when they started with quite a lot; where people with insurance routinely do not seek help at all because of the excess policies and where those who cannot afford to cover themselves are left to depend entirely on charity at best, or at worst are wholly abandoned.
As hon. Members might imagine, I want to protect the NHS and so do this Government. I cannot imagine a Government who would not want to do so. I have also called both campaigns today to make absolutely certain that the candidates whose names are on the ballot paper for leadership of the Conservative party also agree with that position—just to be 100% sure. Of course, they do both take that position.
Even if there ever were a proposal to pursue such a course, I think we in this room all know that, quite rightly, the British people simply would not have it. More than 160,000 people signed the petition that we are discussing today, and only last year a YouGov poll found that more than two thirds of people thought the NHS was Britain’s greatest achievement. Given that strength of feeling, why would this or any future Government who purported to represent the people use trade deals as some kind of back door to privatise the NHS? It just does not make any sense in anybody’s language. Even if a Government tried to do so, how would a trade deal get through Parliament? Not only could it not be ratified without scrutiny by Parliament, but there is separation between international and domestic law in our constitution, so any changes made to the NHS through a trade deal would need domestic implementing legislation, not just in England, but in Scotland, Northern Ireland and Wales. There is no back door here to sidestep Parliament. So much would have to change in our domestic legislation, and I cannot see any way—even if a Government were to decide they wanted to do things that way—that it could actually happen. The good news is that nobody has any intention to use free trade deals in that way anyway.
I simply ask that we agree that there is no prospect whatever of any British Government of any colour or flavour seeking to privatise the NHS by the back door. Can we please put that one to bed? There are perfectly legitimate reasons to discuss issues around the NHS, which I will come to in a moment, but let us please stop scaremongering and pretending that the Government are about to try to privatise the NHS. It is not going to happen.
So what about the particulars? How we protect our public services in trade deals is well known. We already have multiple layers of protection around the NHS and all our public services. The WTO’s general agreement on trade in services explicitly exempts services that are
“supplied in the exercise of governmental authority”.
The trade in services aspects of all agreements to which the UK is currently a party explicitly set out exceptions and reservations for public services. Indeed, my hon. Friend Craig Mackinlay pointed out that Cecilia Malmström, the Trade Commissioner for the European Union, issued a letter at the time of TTIP making that absolutely crystal clear to anybody who wished to read it. She said that people could object to any number of things about TTIP in all sorts of ways, but the one thing they could not do was pretend that this was a way for US health interests to take over publicly provided health services in the European Union. It plainly was not.
No trade agreement has ever affected our ability to keep our public services public, and no one has ever forced us to change the way we run them. The Nuffield Trust, which is one of the most respected commentators on healthcare in the UK, has pointed out that:
“A trade deal would not have the power to stop the NHS being a free, universal service.”
I think it was Rachael Maskell, who is no longer in her place, who made a point on section 75 of the Health and Social Care Act 2012. The Act was not about privatisation, but about placing the financial power to change health services in the hands of the NHS professionals whom the public trust most, and putting clinicians, rather than politicians, in control of healthcare. The 2012 Act did not introduce competition into the NHS; previous Governments introduced competition as a core part of their earlier reforms. The Act established a level playing field in which any qualified provider can provide NHS-funded services, to encourage greater diversity in supply and improve patient choice.
I ask Members to consider for a moment where they think NHS procurement and provision finishes and starts. I cannot imagine a world where we would not buy our pharmaceuticals from the private sector. There is no Government in the world—other than perhaps the Cuban Government—who design pharmaceuticals. Is it suggested that outsourcing accounting is somehow a bad idea? How different can accounting for the NHS be, honestly? What about building hospitals? Does that have to be done by the NHS? What about the equipment used in operating theatres? Does it have to be provided by the NHS? I think we all know that there are areas where it makes sense for the private sector to be involved.
Like the hon. Members who have spoken in the debate, I have no particular interest in the private sector providing actual straightforward healthcare. There are some cases where even that seems sensible. Perhaps if there is not capacity in a certain area of expertise and the capacity exits outside, it might be right to commission it. I think we can all agree that there are some areas around the national health service where there will always be provision by the private sector, because that simply makes more sense.
It is said that investor-state dispute settlement mechanisms would allow foreign firms to take the UK to court for not opening the NHS up to further competition. That, of course, is a concern, but it is not the truth. Let us be clear: ISDS does not and cannot force the privatisation of public services. The mechanisms only provide protection for established investments that companies have made in a partner’s market. At the end of 2017, UK businesses and investors of all sorts had around £1.3 trillion invested around the world, so those protections can be crucial, particularly where legal jurisdictions are perhaps a little less rigorous than they are here.