Privatisation of the Scottish NHS: TTIP and independence


Neil Bennet (Sept 6, p 843)1 has given stark warnings about irrevocable future privatisation of the National Health Service (NHS) as a result of the proposed Transatlantic Trade and Investment Partnership (TTIP).


This is an even more serious issue for Scotland, as people decide how to vote on its independence on Sept 18, 2014.

The Scottish NHS would inevitably be drawn into TTIP and privatisation, because the TTIP agreement is with the UK Government in Westminster.

There is no opt-out possible for the currently devolved Scottish NHS.

The planning behind UK involvement in TTIP appears to go back to Margaret Thatcher’s Centre for Policy Studies in the 1980s, designing reforms to open up public services for privatisation.2

Throughout, either Westminster has not thought about implications for NHS Scotland and the devolved health administrations in Wales and Northern Ireland, or has considered TTIP a covert vehicle for forcing the privatisation agenda.

Either way, Scotland has no voice in matters of great importance to its people. For the same reason, Plaid Cymru (Welsh party) has urged the UK Government to make the Welsh NHS exempt from TTIP.3

The NHS in Scotland is now very different from that in the rest of the UK.

It is increasingly under threat because of funding cuts from Westminster.

The plan for the UK to enter TTIP, without an opt-out clause for NHS Scotland, is symptomatic of the way Scotland has been treated in general, and an even more potent reason for Scottish people to be able to elect governments with full economic and bargaining powers through independence.

We declare no competing interests.

The Lancet

1 Bennet N. Health concerns raised over EU—US trade deal. Lancet 2014; 384: 843-844. Full Text | PDF(207KB) | PubMed

2 Reynolds L, McKee M. Opening the oyster: the 2010—11 NHS reforms in England. Clin Med 2012; 12: 128-132. PubMed

3 Anon. Party of Wales calls for NHS exemption from EU—US trade deal. (accessed Sept 8, 2014).

(From Occupy London)

1. Health services, medical services (including midwifery and physiotherapy) and dental services are all included in the TTIP negotiations. We already knew this because we saw it with our own eyes in the EU’s draft offer to the USA that was uncovered last month. Indeed, Garcia Bercero’s letter acknowledges that health services are on the table. The only sector that has been excluded from the TTIP talks is audio-visual services, as a result of dogged insistence by the French. All other public services are in, and can be traded away for further liberalisation if the US negotiators so demand.

If David Cameron wished to exclude the NHS or any other public service from the negotiations, he could do as the French government has done. All that is needed for this to happen, as the British Medical Association (BMA) has demanded, is for no mention of health services to appear in TTIP at all. In reality, of course, it is Cameron’s government that has already opened up the NHS to private providers by means of the 2012 Health and Social Care Act. Why would he raise a finger to get it excluded from TTIP?

2. Garcia Bercero’s letter also confirms another key charge from opponents of TTIP: that the NHS is open to attack under the new investor-state dispute settlement (ISDS) rules that TTIP would introduce between the EU and USA. For the first time, US corporations would be able to bypass our domestic courts and challenge our national health policy decisions before ad hoc arbitration tribunals, and to sue us for hundreds of millions of dollars in ‘damages’ as a result of future policy changes that might affect their bottom line. This is one clear mechanism that would prevent any future government from bringing the NHS back into public sector hands, as the cost of compensating private providers would render such a move instantly unattractive.

Garcia Bercero would like us to believe that future challenges to the NHS would be ‘unlikely’. Yet the Slovak Republic has already lost a multi-million dollar case under similar rules to Dutch insurance company Achmea for reversing the country’s earlier (and deeply unpopular) privatisation of health insurance. Tobacco giant Philip Morris is currently using ISDS provisions to sue the Australian government for billions of dollars over its new public health law that all cigarettes must be sold in plain paper packaging. Ken Clarke MP, the minister with responsibility for TTIP, has admitted that the UK could face exactly such challenges from US health corporations if the treaty goes through.

3. Garcia Bercero’s next argument invokes the safeguard on services supplied ‘in the exercise of governmental authority’ that was first introduced in the 1994 General Agreement on Trade in Services (GATS) and has become standard in other trade agreements since. Yet this safeguard is worthless in protecting public services in the modern era, as the definition of services supplied ‘in the exercise of governmental authority’ requires them to be supplied (a) not on a commercial basis, and (b) not in competition with any other service supplier. As trade experts have confirmed over many years now, the NHS does not qualify for this protection on either of the two counts.

4. This brings us to the final reason given by Garcia Bercero as to why we should not worry about the inclusion of public services in TTIP. Individual EU member states are still allowed to register their own special reservations for particular services in the liberalisation tables drawn up by the negotiators and submitted to the other side in the talks. Yet the UK government has entered such a reservation in TTIP for ambulance services only. Under TTIP, US health care companies would have the right to supply hospital services or social services.

International trade negotiations are deliberately complex, and this has long allowed officials to bamboozle the general public with impunity. Releasing Garcia Bercero’s letter into the public domain (it is available here) has allowed TTIP’s supporters to claim that the treaty poses no threat to the NHS. The opposite is true, and our struggle against TTIP continues as before.


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