“NOT FOR SALE! NOT FOR SALE! NOT FOR SALE!”
So chanted a crowd in Battersea in October, in response to Jeremy Corbyn’s pledge not to allow Donald Trump to “get his hands on our National Health Service” should Labour win the General Election.
“Despite [Boris Johnson’s] denials, the NHS is up for grabs by US corporations in a one-sided Trump trade sell-out,” he told the audience.
“It’s not for sale, to him or anyone.”
And shadow chancellor John McDonnell has, in recent days, repeatedly insisted Labour will stop the privatisation of the health service.
But ask the Tories and they are also unequivocal – health secretary Matt Hancock last month said in a tweet: “How many times do I have to say this?
“The. NHS. Is. Not. For. Sale.”
So why are politicians arguing about it still? What does privatisation of the NHS actually mean? And is it the same as selling it to the US in a trade deal? And aren’t parts of the NHS already privatised?
All valid questions that HuffPost UK will answer for you in due course.
The NHS – some basics
Unsurprisingly, the NHS – which has provided healthcare that is free at the point of use for more than 70 years – is a hot issue on the campaign trail. Signs declaring ”no to health privatisation” and similar have been mainstays at political protests for years now.
The only subject that voters currently rank as more important is, you guessed it, Brexit.
The NHS was founded in 1948 on the principles that its services should be comprehensive, universal and free at the point of delivery. There are separate and independent systems in England, Wales and Scotland.
It is funded mostly through taxation and national insurance contributions with a small portion collected through charges to patients, such as those paid-for prescriptions.
The NHS is immensely expensive to run – the total budget allocated for the NHS in England 2018/19, for example, was £126.4bn and nearly 10% of the UK’s gross domestic product (GDP) goes towards healthcare expenditure.
What does privatisation of the NHS actually mean?
Those who raise concerns about the privatisation of the health service are in essence saying they are concerned about how much of these vast sums of money are given to private companies to provide services, rather than being given to NHS bodies.
Why are people against this?
Critics argue that because private companies are driven primarily by profit, they will only take on services that will make them money.
Dr Adrian Heald is an NHS hospital specialist and is standing as Labour prospective parliamentary candidate for Mid-Norfolk in the general election. He told HuffPost UK: “If you have an environment where private providers are encouraged to work in parallel with the traditional NHS providers, they’re not going to be interested in the stuff that’s high intensity and low margins.
“They’re going to cherry-pick the elective services that actually do make money and have favourable tariffs attached to them.
“We can’t have private providers coming in and doing the easy bits while the NHS is left to do mental health, long-term condition care and complex cancer care and older people’s medicine, which is an increasing part of what us doctors do.”
Aren’t parts of the NHS already privatised?
Yes. Dentistry, optical care and pharmacies have been provided by private companies for decades and most GP surgeries are private partnerships. Both Labour and Conservative governments have outsourced various functions of the NHS to private providers.
A 2019 study by The King’s Fund estimated that, in 2017/18, about a quarter of the NHS’s budget was spent on the private sector.
Heald acknowledges there is a role for the private sector in the NHS, but is wary of which areas come under its remit.
“There is a role for the private sector, not in direct patient care, but in other areas,” he said.
“A very good example of that is the IT systems that are provided in our hospitals, health facilities and GPs’ practices, and the providers of those systems are independent companies.
“They do things that the public sector couldn’t do. We tried, in a very expensive programme, to create a unitary [single] healthcare record of people living in England. But despite many millions of pounds being spent in the 2000s, it didn’t come to pass.”
Where does Trump come into all this?
When Britain leaves the EU it will have to negotiate a trade deal with the US, which has already laid out a “Summary of Specific Negotiating Objectives”, part of which has made critics of NHS privatisation nervous.
It reads:
Procedural Fairness for Pharmaceuticals and Medical Devices: Seek standards to ensure that government regulatory reimbursement regimes are transparent, provide procedural fairness, are nondiscriminatory, and provide full market access for US products.
The key phrase here is “provide full market access for US products” and how it applies to drugs bought by the NHS for use in the UK.
Currently, the National Institute for Health and Care Excellence (NICE) determines the price of drugs by looking at how much they improve quality of life. It then puts a value on that and tells US drugs companies that is how much the NHS will pay for it.
Dr Andrew Hill is a senior visiting research fellow in the pharmacology department at Liverpool University. He told HuffPost UK: “The Americans are saying they want rid of that and they just want a drug that is approved with a certain price, which is much harder to contest.
“The reason they want to do that is the UK is what’s called a reference pricing country, so the prices that the UK gets are then looked at by other countries and they won’t pay more than that.
“So if American companies can get a higher prices for drugs in the UK, it could reap benefits for them in a whole host of other countries.”
The bottom line is “full market access for US products” would mean higher drug prices for the NHS. How much higher? A lot.
“US drug prices are two and a half times higher and that’s a very conservative estimate – they could go even higher,” says Dr Hill.
“And that’s when you have this doomsday scenario of £500million extra a week [being charged to] the NHS.”
How likely is this to happen?
This depends on who you ask. The US Board of Trade is saying it is up for discussion but Matt Hancock has ruled it out.
But if we’ve learned anything from Brexit discussions with the EU, it’s that the UK on its own doesn’t always get its own way and, as the world’s second largest economy, the US has far more bargaining power than Britain.
And although the Conservative government has insisted the NHS “is not on the table”, a Dispatches investigation last month revealed drug pricing had already been discussed in meetings between the US and UK.
Is it the same as privatisation?
No, although the two issues have become conflated in discussions about the NHS.
“I don’t think it’s privatisation,” says Dr Hill. “The NHS would remain under state control. It would just mean the charges the NHS accrues would be much higher.
“The NHS would have a higher drugs bill and it would have to adjust accordingly. If you have a higher price for a drug it would potentially mean less money for front-line services, doctors, nurses, A&E – there is a fixed budget.
“The worst-case is we reach a Mexican standoff with the American government and they say: ‘Well, we insist drugs are on the table, and if they’re not then we won’t sign a trade deal with you.’”
That sounds bad
It is, and it’s a scenario the Tories in particular will be seeking to avoid.
Dmitry Grozoubinski is the founder of ExplainTrade.com. He told HuffPost UK: “When people go to the pharmacy and their drugs suddenly cost four times as much, that’s the kind of thing they tend to notice.
“And it’s precisely this demographic that the Conservative Party relies on the most and it’s incredibly difficult to picture a scenario where they fundamentally change the way NICE works.”
Unsurprisingly, people over the age of 60 use more prescription drugs than younger people and, although they currently get them free on the NHS, it’s difficult to imagine this continuing should the health service find itself facing a bill for an extra £500m a week.
And who votes Conservative? Well, almost half of Conservative voters are 65 or older.
Is there a way to avoid this?
Yes, but as things stand currently it’s very unlikely to happen – if Britain remained in the EU it would not have to negotiate a trade deal with the US and drug pricing would be guaranteed to remain in the hands of NICE.
“The one legitimate thing to say is that the UK will never more vulnerable in a trade negotiation than immediately after Brexit with the US,” says Grozoubinski.