Trade Deals and the NHS — [Graham Stringer in the Chair]

– in Westminster Hall at 4:30 pm on 16th November 2020.

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Photo of Graham Stringer Graham Stringer Labour, Blackley and Broughton 4:30 pm, 16th November 2020

I remind hon. Members that there have been some changes to normal practice in order to support the new call list system and ensure that social distancing can be respected. Members should sanitise their microphones before they use them, using the cleaning materials provided, which they can then dispose of as they leave the room. Members are also asked to respect the one-way system around the room.

Members should speak only from the horseshoe—the debate is not oversubscribed, so there will be no one sitting at the back who can speak. Members are not expected to remain for the wind-ups. In the latter stages, Members on the call list seated in the Public Gallery need to move on to the horseshoe. I remind hon. Members that there is less of an expectation that Members stay for the next two speeches once they have spoken. This is to help manage attendance in the room. Members may wish to stay beyond their speech, but they should be aware that doing so may prevent Members in the seats in the Public Gallery from moving forward to the seats on the horseshoe.

Photo of Martyn Day Martyn Day Shadow SNP Spokesperson (Public Health and Primary Care) 4:31 pm, 16th November 2020

I beg to move,

That this House
has considered e-petition 307339, relating to trade deals and the NHS.

It is a pleasure to serve under your chairmanship, Mr Stringer. This e-petition raises

“concerns that a trade deal between the UK Government and the US deal might not exempt our NHS, leaving it vulnerable to privatisation and in direct contradiction to promises this would not happen.”

It was launched on 11 May and closed on Remembrance Day last week, attracting just under 112,000 signatures. The UK Government responded on 23 June, stating:

“The government has been clear that protecting the UK’s right to regulate in the public interest and protecting public services, including the NHS, is of the upmost importance.”

The petition also highlights that if a deal quietly went through during the coronavirus crisis, it would be unethical, lack transparency and, if US finances were involved in our medical system, potentially create a direct health risk to us. This latter point relates to the fact that US Government statements have suggested that they intend to negotiate for US pharmaceutical companies to charge higher prices for medicines sold to the NHS as part of any UK-US free trade agreement. The cost of drugs to the NHS is already growing much faster than inflation, driving deficits across the service. Allowing big business and pharmaceutical companies to behave as they see fit would drive costs for new drugs well beyond the NHS’s ability to afford them, threatening our health, safety and national security.

In their response to the petition, the Government went on to reiterate their overall objectives, which were stated in their UK-US freed trade agreement document. They said that, along with the NHS, the price the NHS pays for drugs and the services the NHS provides would not be on the table when negotiating trade deals. Their response also said that no changes would be made to the UK’s

intellectual property regime that would lead to increased medicines prices for the NHS.”

However, the timing of the launch of this petition is significant because, as the Government response also pointed out, the negotiating objectives for a free trade agreement between the UK and the US were published on 2 March, more than two months before the petition’s launch. Therefore, it is a reasonable assumption that, as the petition was launched after the publication of the UK-US trade deal negotiation objectives, either the petitioners thought that the Government had not been clear in their response, or they were not convinced that the price the NHS pays for drugs or the services it provides would not be on the table when negotiating trade deals.

Indeed, who can question the petitioners’ doubts, when we have seen the UK Government’s repeated refusal to guarantee excluding the NHS and other public services from future trade deals? For example, most recently, on 28 August, Charlotte Nichols tabled a written parliamentary question to the Secretary of State for International Trade, asked if she will make it her policy to exclude the NHS from potential future trade deals. Unfortunately, although the question was direct, the answer the hon. Member received did not give a direct commitment.

Furthermore, the UK Government’s response said that their negotiating positions had been made clear to all their trade partners, including by the Secretary of State in her written ministerial statement to Parliament on 18 May. Although the Secretary of State’s statement on the future trading relationship with the US mentioned negotiations many times, not once did it confirm that the NHS was not a part of them. I therefore struggle to see what reassurance that statement gave.

The Secretary of State’s next statement on the matter, on 30 June, entitled “Negotiations on the UK’s Future Trading Relationship with the US: Update”, stated:

“the Government remains clear on protecting the NHS”.

Those eight words would have been welcomed across the House, of course, and we all wanted to take consolation from them. Yet our hopes were again dashed less than a month later when Conservative MPs voted overwhelmingly against an amendment to the Trade Bill that would have enshrined in law the protection of our NHS and other vital public services that this petition is calling for. That is a significant inconsistency and contradicts previous promises, which is a tenet of the petition. I hope that the Minister can throw some light on why only two Conservative MPs saw the perceived duplicity in saying one thing and then acting against it, not least because neither of the Secretary of State’s subsequent statements have repeated that assurance.

The people who have signed the petition just want that assurance. They want a cast-iron guarantee—not words that can easily be rescinded—that the vital services provided by our NHS will be protected. Those vital services have come to the fore in an unprecedented way throughout this terrible covid-19 pandemic. Quite simply, the petitioners do not want our NHS to be weakened and undermined by private companies being able to trade unhindered on the back of it, which, I think—I am sure others here agree—is a perfectly reasonable position, given what has already occurred with the Trade Bill.

It is important to note at an early stage in this debate that, because the Trade Bill was able to pass without the amendment that would have protected the NHS and publicly funded health and care services in other parts of the UK from any form of control from outside the UK, one independent MP joined 336 Conservative MPs to reject protecting the provision of a comprehensive, publicly funded health service, free at the point of delivery, from being undermined or restricted by any international trade agreement. It is also worth noting that the rejected amendment would have, among other things, recognised that an appropriate authority had the right to enact policies, legislation and regulation that protect and promote health, public health, social care and public safety in health or care services. Furthermore, it would have excluded provision for any investor-state dispute settlement, a clause that provides or is related to the delivery of public services, healthcare, care or public health. I will discuss the relevance of ISDS clauses shortly.

I want to highlight another amendment proposed to the Trade Bill that would have required the UK Government to secure the approval of both Houses of Parliament and the devolved Parliaments of Scotland and Wales and the Northern Ireland Assembly before a trade agreement could be approved. Notably, 323 Conservative MPs voted down the proposal. The reality of those two amendments being rejected, which has been reported by the BBC’s Reality Check, is that Parliament does not have a statutory role in either scrutinising or voting on any future trade deals because the Government have the power to pass some aspects of trade deals without there even needing to be a vote in Parliament.

Apart from the worrying lack of scrutiny that situation presents in protecting our NHS and other public services, I believe it to be fundamentally undemocratic. Indeed, the bottom line is that, despite the UK Government’s response to the petition stating that they

“will continue to ensure that decisions on how to run public services” will include “Devolved Administrations”, the devolved Administrations—like Parliament—will not play a statutory role in the UK Government’s international trade policy. That is undemocratic and highlights the wider implication that a trade deal could undermine the constitutional powers that devolution delivered.

It is plain for everyone to see that the NHS is a prime example of that, because health is a devolved matter. Therefore, given that the UK Government are in a position to influence devolved powers without a statutory requirement to seek consent from, or even to consult, the devolved Administrations, will the Minister today also explain the Government’s position that it is constitutionally inappropriate for devolved Administrations to have a statutory role in a reserved area, while it is not deemed constitutionally inappropriate for the UK Government to legislate in areas of devolved competence?

If the UK Government want us to believe that they will keep their promises that the NHS is not on the table in trade negotiations, they should commit to legislation that will ensure it is taken off the table. I am certain that I am not alone in finding it hard to understand why an amendment that would have ensured market access to healthcare services was restricted was roundly rejected by all but two Conservative MPs. Having discussed how trade deals could negatively impact on health services, what possible reason did the Government have for not seizing the opportunity to commit legally to ensuring that trade agreements could not be concluded if they risked altering the way our NHS services are provided?

That brings me to investor-state dispute settlements, which are a threat to public services, particularly when they are permitted speculatively or retrospectively. That was a red line when the EU negotiated TTIP—the transatlantic trade and investment partnership—with the US. The EU would never accept a trade deal with the US in which such principles were compromised, because the trade agreements that include investor-state dispute settlement clauses have the potential to undermine the procurement process and regulations within public procurement, especially within the NHS, if not restrained properly and fairly.

Indeed, the creator of the petition, Joanne Barlow, saw investor-state dispute settlements as one of the major problems of a trade deal with the US, pointing out that they could include legal challenges by any US markets deprived of access to the market or if their profits were threatened. Joanne explained that that would make it difficult to return the NHS to a fully publicly owned and run institution. In addition, Ms Barlow noted that she could not find evidence of a specific clause exempting the NHS from American investment. It would therefore be of some comfort to the petitioners if the Minister could today confirm that there will be no investor-state dispute settlement clauses in any trade deal signed by the UK.

To summarise, if this Government’s insistence that the NHS is not on the table in a trade deal with the US is indeed the case, why did they not accept the amendments that were put forward and commit their pledges in law? The petitioners want that insistence to be in legislation, to ensure that our NHS is not left vulnerable to privatisation or becomes a victim of broken promises that it will not be sold off to the highest bidder. No one needs reminding that we are still in the depths of the covid-19 pandemic, which has caused physical, mental and financial hardship to people across the UK. Given the lack of scrutiny and democracy that the Trade Bill has delivered, I urge the UK Government to respect the request of the petitioners in their negotiations with the US and not to progress a trade deal that will risk our NHS in any way.

Photo of Graham Stringer Graham Stringer Labour, Blackley and Broughton

Within the Chamber now are five Members on the call list, with two Members not in the Chamber, so it is difficult for me to calculate a time limit. I intend to call the Front-Bench spokespeople from 5.30 pm, so we have about 45 minutes for Back-Bench speeches. If Members keep an eye on the clock and make short speeches, I will not have to impose a time limit.

Photo of Mick Whitley Mick Whitley Labour, Birkenhead 4:45 pm, 16th November 2020

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank Martyn Day for his hard work in securing the debate.

I am sure that I am not the only Member to have been inundated with messages from constituents in recent months, urging me to do whatever I can to protect the NHS in any future trade deal with the United States. Those messages were full of gratitude and admiration for the nurses, doctors and support workers who have worked tirelessly through the pandemic to save lives and stop the spread of this terrible disease. I am sure that all hon. Members would echo those sentiments. However, they were also full of fear about the fact that, in just a few short months, our health services could be laid waste by predatory multinationals and the American healthcare industry. I welcome this opportunity to restate my opposition to any part of the NHS being treated as a bargaining chip in trade negotiations with the USA.

I wish I could tell my constituents that their fears are without foundation, but in Washington politicians from across the board are pushing for the NHS to be on the negotiating table in free trade negotiations. Chuck Grassley, the influential Chair of the Senate’s Committee on Finance, said that

“a trade deal ought to include almost anything”.

He added:

“I would hope that the National Health service would be open to some competitive approach that would benefit our pharmaceutical companies”.

The ambition of the American healthcare lobby is clear. It wants full market access to our national health service and an end to price controls on drugs and pharmaceutical products so that it can rinse the NHS of every penny. It also wants to exploit investor-state dispute settlement mechanisms so that it can sue the British Government for making decisions that may be in the best interests of the public but fail to reward corporate private shareholders.

The Prime Minister has said repeatedly that the NHS is not up for sale, but when the time came for him to put his money where his mouth is, he refused to support amendments to the Trade Bill that would have enshrined protections for the NHS in law. I am not fearmongering; I am issuing a clear warning that, without those legal protections, the NHS remains at risk of having “for sale” signs slapped on its services.

As a member of the International Trade Committee, I have followed the ongoing trade negotiations closely, and I know that the UK is not negotiating from a position of strength. The Government are playing a dangerous game of chicken with the European Union, our single largest trading partner. The looming prospect of a no-deal Brexit leaves us dangerously dependent on securing a trade deal with the United States. Although I welcome the end of the Trump era in Washington, President-elect Biden has been clear that he will prioritise a deal with the EU over one with Britain.

The fear that I share with my constituents is that, as the EU transition period ends, the scramble for trade deals will be stepped up, the pressure to put the NHS on the table will grow, and a deal at any price will be rushed through. We cannot allow that to happen. Our NHS must remain just that: ours.

Photo of Catherine West Catherine West Shadow Minister (Foreign and Commonwealth Affairs) 4:48 pm, 16th November 2020

It is a pleasure to serve under your chairmanship, Mr Stringer. I am unsurprised that my constituents have signed this petition in droves, because they have been contacting me with their concerns about the NHS and Brexit for many years.

We now have some concerning facts to go on. Following the Brexit vote, the Government had three fundamental jobs on trade. First, they had to get a deal to secure the half of our trade that depends on Europe. Secondly, they had to negotiate roll-over deals with the 40 countries and trade blocs with which we currently trade freely thanks to our membership of the EU. Thirdly, they had to negotiate entirely new trade deals with other parts of the world.

After more than four years, and with just weeks until the end of the Brexit transition period, the Government have failed dismally on all three counts. There is no deal in place with the EU, roll-over deals have still not been agreed with the likes of Canada, Turkey, Singapore and Mexico, and not a single genuinely new trade deal has been agreed with any other country in the world. The International Trade Secretary recently trumpeted her roll-over trade deal with Japan, but she failed to mention that 83% of the export growth resulting from the deal will go to Japanese exporters, and only 17% to British firms. What will that do to our current trade deficit of £3 billion with Japan?

With a potential trade deal with the US now on the back burner because of the election result, the Government’s trade strategy is in tatters. They said their objective after Brexit was that 80% of global trade would be covered by free trade deals, but as things now stand we will go into 2021 with little over 10% of our global trade agreed.

Turning to the question of the national health service, many civil society organisations—particularly trade unions and health organisations—have long warned about the inclusion of public services, including health, in trade agreements. The concerns are four-fold. Negative lists are clauses requiring that all industries can be included in trade agreements, unless there are specific carve-outs. It is not always easy to define which services count as health services. For instance, digital services may seem pretty irrelevant to health, but NHS data management is increasingly digitised, and apps for such things as GP appointments are increasingly prevalent. Negative lists have a broad scope, covering existing and future services, and therefore make it harder for Governments to regulate and to provide health services, let alone to reassure our worried constituents.

There are also stand still clauses. After the trade deal is signed parties are not allowed to reduce the level of liberalisation beyond what it was at the point of signature. Under ratchet clauses parties are not allowed to reverse certain measures brought in after the point of signature. Furthermore, failure to abide by those clauses can result in legal challenge from the trade partner or, if there is a separate ISDS clause, challenge from private investors. Martyn Day covered that very well in his speech, so I shall not repeat what he said.

The US Administration have stated publicly that they wish to use a trade deal to challenge the purchasing model. That could be done through specific market access provisions, or other clauses aimed at the pharmaceutical industry. That has the potential to increase greatly the cost of medicines, making some vital treatments unaffordable for the NHS. The benefit of our unitary model in the NHS is that it is a cover-all. However, should there be an infiltration into that unified system, that could be a slam-dunk for a “hostile takeover”, almost.

Another good example, in relation to digital trade, is cross-border data flows. Digital trade rules are aimed at limiting the ability of Governments to introduce localisation measures or stop data leaving the country. There are potential privacy and security implications—for example, if sensitive NHS patient data are held by private firms outside the UK. There are further points on technology transfer and the monetisation of patient data.

The other great point about the unified NHS system, of course, is that we have probably the best block of data in the world to understand health. The NHS, being a unified system, has information about every one of us. If we see NHS data in that way, it provides a wonderful trading tool. However, those of us who are concerned about the way data can be used—that includes every Member of the House, I am sure—have to ask the Government a lot of questions.

That brings me to my final point, on the lack of scrutiny of the principles behind the way the trade operation is working at the moment, and in relation to specific trade deals and the way they will come to the House of Commons. I worry a lot about the fact that we do not bring people, groups or our constituents with us when we do things in the Commons. We know that from the times we get to the end of a vote, and people ask what we were voting on—we are explaining backwards. The thing about trade is that we need to bring people with us. The wonderful, now deceased, Congressman John Lewis, whom I met when I, like my hon. Friend Mick Whitley, was on the International Trade Committee, said that he felt the transatlantic trade and investment partnership failed because it failed to bring working people and trade unions with it. I think it failed for other reasons—it was quite complex—but he made a valuable contribution. The Government are trying to cut corners now, because time is running out and because they think that they will be in government forever, which many of us hope they will not.

However, we have to see this issue less in a party political way, because it can affect trade for a long period—for 10 to 15 years—and over a series of different Governments. We now have the opportunity to put in place the building blocks of scrutiny so that, in the words of John Lewis, we can bring people with us and ensure that, at the last hurdle, these things are genuinely in the interests of our communities and the people we serve.

Photo of Dehenna Davison Dehenna Davison Conservative, Bishop Auckland 4:55 pm, 16th November 2020

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank Catherine West for her reasoned argument, and particularly for making the point that trade should not be party political, because it is far greater than that.

On that note, one of the things I have found most frustrating about my time in Parliament so far is when nonsense attack lines that are not a true reflection of the facts are used to whip up fear among our constituents. I recall very clearly a conversation I had with Joanne, who is now my constituency office manager, the first time we met. She asked to meet before the election to discuss her concerns about a number of issues, including messages she had seen online suggesting that if the Conservatives won the election we would dismantle and sell off the NHS. We had a great discussion that day, and I managed to reassure her to such an extent that she came to work for me, but I have lost count of the number of times I have given assurances to constituents—in person, by email, in writing or over the phone—that the NHS is not for sale and never will be under a Conservative Government.

The Prime Minister, the International Trade Secretary and the Minister here today have made assurances time and again—in full, in public forums, in the media and more—that the NHS is not for sale, and nor is the price of our medicine. Nor are our NHS health services open for foreign companies. It is about time that our opponents quit with the attack lines, took off their red and yellow-tinted spectacles and started to work with us to help secure the future trade deals that will help make our country more prosperous.

The NHS, we all agree, is one of the most valuable entities in our country. It is often called a jewel in our crown, but it is even more important than that. It embodies the very essence of our society—the spirit that no man will be left behind and that, regardless of health or wealth, people will receive treatment free at the point of use. The people who work for our NHS are heroes. We have seen that demonstrated so clearly throughout this covid pandemic by the doctors and nurses working for hours on end in full PPE—some even isolating from their families to help keep them safe. Their sacrifice certainly made me think twice about whingeing about wearing a mask when going shopping for groceries. However, we must not forget the porters, cleaners, receptionists, administrators and all the others who have worked so hard to keep the wheels of our great NHS turning in this difficult time. My sincere thanks go out to every single one of them.

For years now, there has been this weird obsession with Tory privatisation of the NHS, so if hon. Members will indulge me, I will take a little trip back in time. First, on 17 April 1997, Tony Blair claimed that there were just 14 days to save the NHS. Then, on 21 March 2009, according to the Morning Star—not a paper I usually cite—there were six weeks to save the NHS. Some say that the reason the NHS needed saving was the prospect of a Tory Government, so let us go a little further forward. On 4 February 2012, under a Conservative Government, Edward Miliband said we had three months to save the NHS. That same month, The Mirror said there were just 12 days to save the NHS. In January 2015, The Mirror said there were four months to save the NHS, and in 2017, there were three days to save the NHS.

Yet in 2020, after 10 years of Conservative Government, the NHS still stands, and it stands strong, with record investment. In our manifesto, we pledged to build 40 new hospitals. Forgive me, but we did not stick to that commitment, because we are actually delivering 48. The NHS has existed for 72 years, almost 45 years under a Conservative Government, so it is time to end this narrative and to stop the NHS being used as a political football, because it is far too important for that.

Having started with some heavy myth-busting, I reassure the Minister that I intend to talk a little bit about trade. I have long said that trade is the answer to the UK’s future prosperity. In this globalised world, where technology has made it not only possible but easy to do business with our friends right around the world, global Britain must truly embrace the opportunity we have been granted to set our future trade policy as we leave the EU.

As we know, our single biggest trading partner is the USA, which is also the nation with which we have the biggest positive trade balance. In 2019, we exported £112 billion to the USA and imported £70 billion. By reaching a comprehensive free trade deal with the USA, we will have even more trading opportunities, which means more opportunities for businesses in all of our constituencies. I think of Equus Leather in my constituency, where I took the Trade Secretary last year: the UK exports over 80% of its leather production, and our biggest export market for finished leather is the USA. I also think of our farmers—those in Teesdale and Weardale, who work so hard to keep our country fed. The US trade deal is often sold by our opponents as though it will be harmful to farming, but on the contrary it presents a huge opportunity for our farmers. With market access to US beef being granted this year for the first time in over 20 years, the industry estimates that beef exports to the USA will be worth £66 million to our farmers over the next five years.

More broadly, I think of the benefit of trade for County Durham and the north-east. County Durham exported almost £2 billion-worth of goods last year, so the removal of further international trade barriers can help my county’s exports grow even further. Looking at the north-east region as a whole, analysis by the Department for International Trade has shown that the north-east is one of the regions of the UK that has the potential to benefit the most from a UK-US trade deal. If Members will forgive me, a trade deal can even help us to “level up” the north-east.

Martyn Day, who secured this debate, spoke about amendments to the Trade Bill. However, he knows as well as I do that the Trade Bill was not about the US trade deal or future trade deals, but about the continuity of existing trade agreements. The amendment he referred to would not have had an impact on any future US trade deal. Furthermore, I wish that Opposition Members would talk about the work the Department is doing to allow scrutiny of future trade deals, such as the regular MP engagement events that I have been invited to and have attended—I hope many other Members will take up the opportunity to do so as well. Also, any future trade deals will need parliamentary approval. I for one certainly would not approve a trade deal that included our NHS, and it is safe to say that my Conservative colleagues would not do so either.

I hope that what I have said today acts as some reassurance to those who signed the petition. However, to reiterate the point one final time—I cannot say this enough—the NHS is not, and will not be, for sale under a Conservative Government.

Photo of Claudia Webbe Claudia Webbe Labour, Leicester East 5:02 pm, 16th November 2020

It is a pleasure to serve under your chairmanship, Mr Stringer. I begin by congratulating Martyn Day on having secured this important debate.

This Government have repeatedly asked the public—even today, Dehenna Davison asked them again—to blindly trust their promise that the NHS will not be for sale in any future trade deals with the US, despite mounting evidence to the contrary. They have repeatedly been provided with opportunities to put those fears to bed, with amendments tabled to the Government’s post-Brexit trade deal explicitly stating that the NHS would be excluded from any future trade agreements. One amendment was supported by more than 400 doctors and health professionals, yet rather than deliver on their promise, not a single Conservative MP voted for the amendment, which was defeated by 89 votes.

The Government claim farcically that they voted against the amendment because it legitimises the concept of NHS privatisation, which in the realms of hypotheticals and metaphysics they claim to oppose, yet when faced with a concrete opportunity to enshrine in law the safety of our most treasured public institution, the Government sat on their hands. Now our NHS will be at the mercy of US negotiators, who are heavily influenced by the multibillion-dollar private healthcare interest in carving up our health service for corporate gain. That clearly demonstrates the Government’s commitment to ensure that the NHS is on the table during trade negotiations.

However, there is an even clearer reason why we cannot trust them—or the words of the hon. Member for Bishop Auckland—when they say the NHS is not for sale. That is because they have already been selling it off, piece by piece, for the best part of a decade. Since the disastrous Health and Social Care Act 2012, NHS outsourcing and privatisation have been incentivised. Clinical commissioning groups are under pressure to outsource; in 2015, private firms won 40% of all contracts. In the last five years alone, private companies have been handed £15 billion of NHS contracts. Some 18% of healthcare bids go to private providers. It is true that the NHS logo remains and in some cases it is even co-opted by private providers, as happened with the disastrous so-called NHS Test and Trace, which is predominantly run by Serco. Yet the direction of travel under the Government has been towards a fragmented, underfunded and increasingly privatised healthcare system.

The danger of sliding towards a US-style private insurance healthcare system cannot be overstated. Research by the Commonwealth Fund in 2018 found that nearly half of working-age Americans—a staggering 87 million people—were underinsured or had no coverage at all. Rather than spending money on doctors, nurses, mental health professionals, dentists and other professionals who provide services to people and improve their lives, the US wastes hundreds of billions of dollars a year on profiteering, huge executive compensation packages and outrageous administrative costs. Despite widespread myths regarding the efficiency of the free market, the US spends nearly double what we spend on healthcare for generally worse healthcare results. That is the system that recently appointed advisers to the Secretary of State for International Trade believe is superior to our own.

It is common sense that profiteering and corporate greed should be off limits in services essential to human life. That reflects public polling that shows that 84% of Britons believe that the NHS should be in public ownership. The NHS is a gleaming beacon of human achievement—an embodiment of socialist universal principles—from which everyone, no matter what their position in society, benefits equally. It is therefore up to all of us who value healthcare as a human right to protect our most treasured public institution. It is incumbent on the Government to make their rhetoric a reality and legislate to ensure that our NHS is truly off the table and is never put up for sale.

Photo of Rachel Hopkins Rachel Hopkins Labour, Luton South 5:07 pm, 16th November 2020

It is a pleasure to serve under your chairmanship, Mr Stringer. I fully support the e-petition relating to trade deals and the NHS, which has been signed by more than 110,000 people, including a number of my constituents. I, too, pay tribute to and thank our superb NHS staff for their public service. I also thank Unite, Unison, We Own It, Keep Our NHS Public, Global Justice Now and other organisations for their campaigning to protect our NHS.

Our NHS was founded on a set of collectivist principles that bind our communities together. Those principles represent a commitment to a comprehensive free healthcare service that delivers excellent and professional care to all who need it in the UK. They are also an obligation to provide the best value for taxpayers’ money and ensure that services remain accountable to the public.

That seems to be at odds with the Government’s current trade strategy, however, which does not omit the NHS from future trade deals, but exposes it to competition and the market. That runs the risk of damaging standards of care and diluting the transparency of decision making. The threat posed to our healthcare system is clear for all of us to see. US officials have repeatedly stated that they regard the NHS as being on the table and that they specifically want to ensure that big US healthcare and drug companies can compete fairly to provide medical services, sell drugs and access NHS patient data.

We should not just be looking across the pond. The Secretary of State for International Trade has close relationships with right-wing think-tanks that want the NHS to be opened up to private competition, notably Daniel Hannan. In 2018, Hannan and his Initiative for Free Trade joined forces with the US Cato Institute and 10 other UK and US right-wing think-tanks to promote their ideal US-UK free trade agreement, which called for the opening up of all services in both countries to competition. Its co-editor, Daniel Ikenson, said of the report:

“Healthcare is a service, we call for opening services to competition. And I know some people are worried about what happens to the NHS…We think competition is a good thing and it would lead to better quality healthcare.”

When the Minister responds to the debate, will he explain why the other co-editor of that report, Daniel Hannan, is now a lead adviser on his Department’s Board of Trade? Is it any wonder that we do not feel inclined to trust the Secretary of State when she says publicly that the NHS is not for sale but then surrounds herself in private with advisers from the Institute of Economic Affairs, the Cato Institute and other right-wing think-tanks who argue the exact opposite?

We must remember that even if the US healthcare industry is prevented from directly competing with the NHS for Government-funded services, the Government’s trade agreement may open up access to NHS procurement contracts for buying medicines, delivering medical treatments and providing patient accommodation. US healthcare would then have the power to drive up the price charged for those services in future contract rounds. It is not accurate for the Government to state that the NHS is not for sale when we have already seen them privatise our covid-19 response, handing out huge contracts to companies such as Deloitte, Serco and KPMG, which have put profits and cost-cutting before care and wasted millions of pounds of taxpayers’ money.

The UK-US trade situation is likely to change as the incoming US Administration takes office in January. However, we must also monitor discussions regarding the UK joining the Comprehensive and Progressive Trans-Pacific Partnership, which demands a very open approach to competition in services, potentially including healthcare. I hope the Minister will address that point and say specifically whether membership of the CPTPP will oblige the UK to accept a “list it or lose it” approach to private competition in the public sector. If so, will the Government guarantee to negotiate a carve-out for the UK from those provisions when it comes to our NHS and other essential public services?

I agree with campaigners that we must oppose the gradual marketisation and outsourcing of NHS care at all costs. Our ethical and communitarian-focused NHS is not compatible with private greed. The Labour party’s stance on this issue is simple and clear: the best way to remove the threat to the NHS, from whatever direction it comes, now or in the future, is to legislate in the Trade Bill that the NHS should be outside the scope of any future trade agreements. However, it speaks volumes that the Government refuse to do that. The NHS is more than a logo.

Photo of Dean Russell Dean Russell Conservative, Watford 5:12 pm, 16th November 2020

It is a pleasure to serve under your chairmanship, Mr Stringer.

First, I say thank you to those who organised the petition and to those who signed it. It is great to be able to stand here to clarify matters and reassure those people regarding the concerns they may have had about the privatisation of the NHS or any act towards that under the trade deal. The reality is that the Trade Bill has nothing to do with that; it is an extension of the existing agreement, which does not cover US activities. More importantly, this Government have not engaged in any activities to privatise the NHS.

In fact, the fearmongering that happens around this issue, as I wrote in an article earlier this year, actually causes many people anxiety. It causes fear and concern among the very people who need to be reassured that they can always access their NHS services at the point of need and for free. The reality is that nuanced debate is stifled, ironically, by the Opposition.

I do not wish to score points on this issue, because I really do not like political point-scoring, but it was the Opposition that brought in the private finance initiative. The Labour Government brought in the privatised Hinchingbrooke Hospital, and they introduced prescription charges for spectacles and dentistry. This Government have undone much of that work. We bought back Hinchingbrooke. We have invested millions, if not billions, in the NHS over the past year.

As a member of the Health and Social Care Committee, I have seen at first hand the good, but also the challenges the NHS faces. When we look at those challenges, one of the biggest problems I have seen over the past few decades, and particularly over the past few years, is that the rhetoric and fearmongering around privatisation of the NHS have built and built. Yes, it helps people to put leaflets through doors; yes, it helps them to make political points; and, yes, it helps to create coverage and news headlines. However, what it also does is make the people at the very heart of the NHS, who need support, worry about their futures.

Photo of Rachel Hopkins Rachel Hopkins Labour, Luton South

The hon. Gentleman’s point about fearmongering is interesting. Has he, like me, had many NHS employees contact him with their concerns about privatisation of the NHS? They are fearful not for their jobs, but for the future of the NHS.

Photo of Dean Russell Dean Russell Conservative, Watford

I thank the hon. Lady for her question. Yes, they have, and where have they got that from? From leaflets and newspapers. In fact, I was about to make the point that in my volunteering at Watford General Hospital, I have spoken to staff who are anxious about what the future looks like. I was anxious to speak to them because I want to understand what their fears are. Often the fears are based on rhetoric, not on fact, and what there might be in the future, which is based on past Governments, not the current Government.

The anxiety goes deeper. Recently, while volunteering at the hospital, I held an iPad for a gentleman who had had a stroke. It was quite a moving moment. I explained to him that he had time to speak to his daughter and, as I sat there on my knees holding the iPad for him, he reached his hand over to hold my wrist and said, “Just a few minutes longer,” because he wanted to speak to his daughter for a little longer. In that moment, I realised the fear and vulnerability of the patients who are in the hospital beds, and how they, the staff and the families worry about what support they will get. In that moment, I realised also that the issue is not only about medicine, pharmaceuticals and trade deals, but about real people who are suffering and need support. What they also need is the continued reassurance that we are not privatising the NHS, even though the Government have never—not once—opted to do so, and neither will they.

We heard an excellent contribution earlier about data, which is something I am passionate about. Digital and data are the future of the NHS. We want the ability to cure cancer and diseases by looking at data in a much fairer way, and by making sure that people feel comfortable sharing their data online and with the NHS and organisations to help them solve the biggest issues in the world. Why would they not do that? Because of the fear around where the data would go. Yet every single day, people share where they are, what they eat and who their friends are with Facebook, Google and all the big corporate organisations without a second thought. However, because of the rhetoric—I will not blame it fully, to be fair—they are fearful of giving data and important information to the Government and the NHS to help them solve the big issues.

We have seen with the test and trace app that when the safety and security are created and people are reassured, they use it. Being able to use the app saves countless lives, and people can look to see whether other people need support or need to be isolated. That is about people feeling secure and safe, but the constant rhetoric—this drumbeat—just to get leaflets through doors to make the constant argument about privatisation is fearmongering at its worst. In fact, it scares the most vulnerable.

As a member of the Health and Social Care Committee, I hear the good and the concerning from the NHS and social care. I am not saying that it is an amazing organisation—I am not even saying the Government are perfect in every possible way— but there is scrutiny there. There are opportunities to delve into it and to have a much-needed calm and nuanced debate about what it will look like in future. What does the NHS need in the next five, 10, 20, 30 years? We must not constantly look at the next election cycle. We need to take the rhetoric out so that we can have calm, consistent and thoughtful debate about what it will look like. I am pleased to see colleagues here from the Committee. I am sure they will agree that we work closely and very well together on the Committee to be able to have debate and discussion around this. When we cannot do that in the public realm, it stifles our ability to continually improve the NHS.

The Trade Bill is about existing trade. I will not go into the details because I am sure the Minister will go into it in much more detail, but let us move forward. I urge those watching and listening to this debate and who signed the petition to please look at the facts and be reassured by what the Government have done and what we say about the NHS not being on the table. I urge colleagues to come together and have a calm debate about what this will look like in the future, because if we do not, the people who need the most support, who are the most anxious and fearful, will be harmed the most simply by words.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 5:20 pm, 16th November 2020

I congratulate Martyn Day. I have not seen him in the House in ages, so it is good to see him back. I thank all hon. Members who have contributed. I am my party’s health spokesperson, so this issue is close to my heart as part of my portfolio, but it is more than that. As the hon. Gentleman said, our NHS stands for more than just an organisation; it stands for the care that it gives. I want to refer to that in the few moments remaining.

There are valid concerns about our trade deals. I understand that. That is why we are having this debate. The vote for Brexit presented this place with a once-in-a-lifetime opportunity to make trade deals, to enhance the wealth of the country. I believe that can happen. Others may have a different opinion, but we will wait and see to make our own decisions. As it says in scripture, to whom much is given, much is expected, and there are high standards for all of us in this place and further afield.

What unites us in this debate is our love of the NHS. We have been united together to protect it: the unions, patients, the Government, elected representatives and our constituents. Collectively, we have all made it clear what we need to do and why we are here to debate this matter. The road to attainment is difficult enough without setbacks, but my constituents have made it abundantly clear that our NHS is a treasure not to be touched, other than to enhance and improve in-house.

In the past few weeks, I have come to know at first hand what the NHS can do. I have realised how important the NHS is to my family. Many of us have family members who are alive today thanks to the contribution of the NHS and its staff. I think of my father, who died six years ago. When he was living, he had three operations for cancer. I have no doubt that the skill of the surgeon’s knife, the love of the nurses and the prayer from God’s people saved him on three occasions. The NHS is an important part of all of our lives.

I am sure I am not the only MP to be inundated with emails regarding the trade deal and the NHS. I also received a few personal messages reminding me of how truly exceptional our NHS is. I want to quote one letter. I get lots of letters regularly. It is good to get letters from people. People usually contact me to say how bad things are and to give off. That is in the nature of our job, but people also contact me to say, “Thank you for what you are doing.”

One lady wrote to me:

“I seem to be writing to you a lot recently but our NHS is very important to me personally when I was diagnosed with Acute Lymphocytic Leukaemia Stage 4. What seemed to compound the problem was that when I had to have chemo treatment I had to be admitted due to the problems I have with my back problems. The care I received was excellent and would not have a bad word said against any Doctors or Nurses that give me care during my long time stay in hospital. Jim I’m depending on you and all of your colleagues to make sure that the NHS is protected in LAW and safe from any trade deals. This government says one thing”—

I want to be clear that I am not being critical here—

“and promised they’ll protect the NHS but we need to see it in law.”

This debate is really important because there is a chance to see that in law. My constituents want to know that the NHS is protected in law in the Trade Bill.

The message is clear: we have something that is worth protecting. I am not in any way dismissing the American medical staff. My parliamentary aide’s daughter was taken into hospital with pneumonia while she was on holiday in Florida. Claudia Webbe referred to some of what happens in America.

I will quote again, to give the comparison between our NHS and what it means in America. She said that the care she had received in that American hospital was second to none, but one memory stuck with her when she was waiting for the consultant to come and see her child after the X-ray was brought to the room. She heard the patient next door being repeatedly told that unless she remembered her insurance details, she could not be treated. Boy, aren’t we really lucky to have an NHS that looks after and saves our people, rather than one that we pay into? That stuck with her and made her thankful for the NHS, because no matter where someone is from, what their job is and what their prognosis is, treatment will never be withheld. That is what our NHS means.

We need to treasure the expertise of the staff and think about the way in which we treat them. These are all things that need to be protected. I hope that all MPs in this Chamber, universally and across all political parties, will collectively say that this trade deal will never impact on the NHS. The Minister has said that, and so have the Government, but I want him to say it in this Chamber today.

Photo of Neale Hanvey Neale Hanvey Shadow SNP Spokesperson (Health Team Member) 5:25 pm, 16th November 2020

It is a pleasure to serve under your chairship, Mr Stringer. I thank my hon. Friend Martyn Day for securing this important debate. The genesis of and support for this petition reflect our values and the esteem in which each nation’s NHS is held. The petition is also a reflection of the public’s mistrust of whether the Prime Minister and his Government will honour their word, and their concern about the risk to the NHS from corporate avarice should it be on the table in any US trade deal.

Before the cronyism, incompetence and allegations of corruption began to dog the Government, the petitioners recognised that the deals the Government had conducted during the coronavirus crisis could be unethical and lacked transparency. Although we are set to see an end to Trumpian politics, in the USA at least, the concern still stands that involving the US financially in our health system could pose a serious health risk to us and our NHS.

Save our outstanding landscapes and convivial culture, there is little more precious to the people in Scotland than their NHS. The NHS in Scotland is unencumbered by a false internal market and there is minimal involvement of the private sector. The public service ethos is rewarded by a satisfaction level of 78%—an impressive 36% higher than for the NHS across the UK.

Perhaps I am worrying unnecessarily, and perhaps Dean Russell is right. Ministers have given repeated assurances on the record that there will be no requirement to increase private provision and no ramping up of drug costs, and that health data is safe, but if the Government are so confident and are assuring us not to worry, why are they hesitant to put an explicit protection in primary legislation?

Sadly, in Scotland we have a track record on which to judge this Government, and an ever sadder track record on which to judge promises and vows from any Westminster Government, whatever their stripe. To digress slightly, this weekend I watched the first ever episode of “Taggart” —from before it was called “Taggart”, in fact. It was set in Glasgow in 1983, at the height of the North sea oil boom, yet the deprivation on show was truly shameful. It was no fluke of filming location. Like many, I walked through those desolate scenes of economic devastation. The loadsamoney Thatcherism was less about the pooling and sharing of resources, or about any dubious acclaim for her ideology, and more about the pulling of that oil wealth from Scotland. Greed is never attractive. Of course, the true value of that wealth was deliberately concealed from the Scottish people, as evidenced by the McCrone report. As the wealth was removed, so too were jobs and hope.

I also had my usual dose of Marr on Sunday morning, and up popped my Kirkcaldy and Cowdenbeath predecessor thrice back. It was a really odd experience, because I thought they were showing a clip from 2014, but actually it was new footage and it was, almost verbatim, the same story and script endorsed by all the Westminster parties in 2014 to disingenuously secure a pyrrhic victory that served only to drive—

Photo of Graham Stringer Graham Stringer Labour, Blackley and Broughton

Order. The hon. Gentleman is straying quite a distance from trade and the NHS. Can he refocus on that?

Photo of Graham Stringer Graham Stringer Labour, Blackley and Broughton

I am grateful to the hon. Gentleman.

Photo of Neale Hanvey Neale Hanvey Shadow SNP Spokesperson (Health Team Member)

As I was saying, that only served to drive a surge of support for the SNP and Scottish independence.

Before I am accused of straying too far, what relevance has that to trade deals and the NHS? Well, one simple but absolutely essential word, when the word of another is what our future depends on, is “trust”. Why should my constituents trust this Government? I say that not just because of historical wrongs, but because of their conduct in the here and now.

My hon. Friend the Member for Linlithgow and East Falkirk set out serious questions and concerns, which deserve full and transparent answers. When the crony virus stalks the halls of power, when Ministers puff out their chest and defend their intention to break international law, when the Prime Minister refuses to answer questions in the Chamber but casually insults, when the promises of devo-max have led Scotland to a devo-destroying United Kingdom Internal Market Bill, when the child poverty that this Government have created is dismissed and hunger ignored, and when a pay rise for carers and nurses is unaffordable but an MP’s pay rise will do quite nicely, thank you, why should the people who dedicate their lives to the NHS take this Government’s word for anything? Those people’s belief in altruism and shared endeavour is in peril. They understand the implications of negative lists, standstill clauses, ratchet clauses and the ultimate con, the investor-state dispute settlement process, all of which have the potential to eviscerate the NHS.

The petitioners want to protect the NHS through primary legislation because, as we all know, to neoliberals, health is never the priority; profit is. There is no place in the Scottish NHS for profiteering. This Government must commit to legislating and protecting each part of the NHS. Only then will any trust return.

Photo of Bill Esterson Bill Esterson Shadow Minister (International Trade) 5:32 pm, 16th November 2020

It is always a pleasure to serve under your chairmanship, Mr Stringer. I congratulate 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.

Photo of Bill Esterson Bill Esterson Shadow Minister (International Trade)

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

Photo of Graham Stringer Graham Stringer Labour, Blackley and Broughton

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.

Photo of Bill Esterson Bill Esterson Shadow Minister (International Trade)

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.

Photo of Neale Hanvey Neale Hanvey Shadow SNP Spokesperson (Health Team Member)

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.

Photo of Bill Esterson Bill Esterson Shadow Minister (International Trade)

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.

Photo of Graham Stringer Graham Stringer Labour, Blackley and Broughton

Minister, before you start your speech, I ask that you save two or three minutes at the end for Martyn Day to wind up the debate.

Photo of Greg Hands Greg Hands The Minister of State, Department for International Trade 5:46 pm, 16th November 2020

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank Martyn Day for opening this debate, as well as the more than 110,000 members of the public who raised this topic, which is hugely important to us all. There have been a lot of rumours, confusion and misstatements about this subject, so I am more than happy to set the record straight.

The NHS is this nation’s most popular institution, but it is far more than an institution. For more than 70 years, it has been there for all of us, from cradle to grave. It has played a very personal role in all our lives, in some of the most joyful and, indeed, saddest moments. In the midst of this terrible pandemic, the importance of the NHS has become even more acute. I pay tribute to the extraordinary staff up and down our country who are battling the coronavirus outbreak so valiantly and selflessly, and I extend my deepest sympathy to those who have lost loved ones during the pandemic, including, I might add, to myself: my father died of coronavirus on 13 April this year. However, it is thanks to the bravery and expertise of our world-class doctors, nurses and hospital staff in containing the virus that we are able to meet here in this House today, and I am hugely grateful for that.

Let me be very clear: our NHS will not be for sale in any future trade deal with the US or, indeed, in any trade deal at all. For the sake of parliamentary time, I can be very brief—the word “no” is one of the shortest in the language—and say no, not at all and never. Protecting the NHS is a fundamental principle of our trade policy. The NHS, its services and the prices it pays for drugs are not for sale, and we will not agree measures that undermine the Government’s ability to deliver on those commitments. The NHS is not, and will never be, for sale to the private sector, whether overseas or domestic, and no trade deals will ever be able to alter these fundamental facts.

The Government have been consistently clear about our commitment to the guiding principles of the NHS—that it is universal and free at the point of need. As set out in the October 2017 White Paper “Preparing for our future UK trade policy”, the Government will continue to ensure that decisions on how to run public services are made by UK Governments, including the devolved Administrations, and not—this has never been the case—by our trade partners. No trade agreement has ever affected our ability to keep our public services public nor forced us to change the way we run them, and that is not going to change now. Safeguarding the UK’s right to regulate in the public interest and to protect public services, including the NHS, is of the utmost importance. That was, is and will remain the Government’s position.

I turn to the points raised in the debate. The hon. Member for Linlithgow and East Falkirk mentioned two or three points. First, he is right to say that the NHS is devolved in Scotland and that trade policy is reserved. We recognise the fact that trade policy impacts on areas of devolved competence, and that is why I work closely with the Scottish Government to ensure that we have a common understanding. We work well together in those spaces.

The hon. Gentleman mentioned an ISDS threat to public services. The UK is already subject to the ISDS in more than 90 agreements. We have never had a successful claim brought against the United Kingdom through an ISDS court. No ISDS court could overturn Parliament or force any change to the law. This has been stated before, but the Trade Bill refers to the continuity of existing trade agreements; it does not refer to future free trade agreements. The EU does not have a trade agreement with the United States; therefore, the United States is not within the scope of the Trade Bill.

I heard some brilliant speeches from my hon. Friends the Members for Bishop Auckland (Dehenna Davison) and for Watford (Dean Russell). My hon. Friend the Member for Bishop Auckland talked about how the Labour party and others are whipping up fear. That is absolutely correct, and I have seen it in my constituency. At the last four general elections, the Labour party has run on the fact that Charing Cross Hospital will be either demolished or close—the last four! I can report that Charing Cross Hospital is doing very well and, actually, the Secretary of State for Health announced a floor-by-floor refurbishment of the hospital just a couple of months ago. My hon. Friend is absolutely right to say that there has been record investment under this Conservative Government and that trade is the answer to our long-term prosperity.

We had a passionate, knowledgeable and superb speech from my hon. Friend the Member for Watford about his local NHS, which I know quite well. The excellent Watford General Hospital has served my family—they come from Amersham in Buckinghamshire—for two generations. It is a brilliant hospital, and he spoke with great passion about it.

We heard some of the fears from the hon. Members for Birkenhead (Mick Whitley), for Hornsey and Wood Green (Catherine West), for Leicester East (Claudia Webbe) and for Luton South (Rachel Hopkins). I will deal with the question from the hon. Member for Luton South about the CPTPP. In the negative or positive lists, one is expressly allowed to exclude public services that one does not want to be subject to a trade agreement. The UK could and would negotiate specific exemptions in CPTPP for the NHS and other public services that we deem to be important to us. Of course that lies within our rights.

The NHS in Scotland is devolved, as we know, but Neale Hanvey, in his summary, quickly moved on to talking about separation. In almost record time, even by the standards of the Scottish National party, he showed that separation is more to him important than either the NHS or trade.

I turn to my old friend—certainly not my hon. Friend, but he is a friend—Bill Esterson. I am not quite sure whether he has noticed the subtle change in Labour’s approach to trade policy as it has moved across north London from Barry Gardiner to Emily Thornberry. On drug prices, the UK has a robust intellectual property regime for pharmaceuticals and medical devices. We will not make changes to our IP regime that would lead to increased medical prices for the NHS. Our negotiation objectives—a lot of people have referred to the US’s negotiation objectives, but no one has referred to our objectives, which were published on 2 March—state that the NHS will not be on the table, the prices paid for drugs will not be on the table and the services that the NHS provides will not be on the table.

The hon. Gentleman also talked about a set of dates—he told an incredible story involving the Cato Institute and an astonishing series of dates. He said that he does not believe in coincidences, but perhaps he might believe in conspiracy theories.

As we are an independent global Britain, the Government are working hard to build our trade policy. As set out in the Government’s manifesto and again in our negotiation objectives, the NHS will not be on the table. Decisions on how to run the NHS and all public services are made by UK Governments, including the devolved Administrations, and no trade deal will change that.

Photo of Greg Hands Greg Hands The Minister of State, Department for International Trade

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.

Photo of Martyn Day Martyn Day Shadow SNP Spokesperson (Public Health and Primary Care) 5:57 pm, 16th November 2020

On behalf of the Petitions Committee, may I put on the record my gratitude to the Members from all parts of the House who took part in today’s debate? If we have learned one thing from the debate and the petition, it is that there remains a degree of public uncertainty. What the public are looking for is more than words, so I will say again: what we need is a cast-iron guarantee protecting the NHS. It is not too much to ask. If we are all in agreement, as appears to be the case from what has been said, that the NHS is not on the table, the public will be left wondering why we are not putting that into law.

Question put and agreed to.

Resolved,

That this House
has considered e-petition 307339, relating to trade deals and the NHS.

Sitting suspended.