Fears Are Growing for England’s NHS
Former Conservative PM John Major famously said that the NHS would be as “safe as a pet hamster in the presence of a hungry python” if Boris Johnson and Michael Gove rose to power after Brexit. New developments are causing many to fear that he was right and that bars are being bent on the hamster’s protective cage.
How does this affect Scotland – surely health care is devolved?
At the moment, health care is devolved to the Scottish Parliament – but the UK Supreme Court has ruled that Westminster only ‘lends’ powers to Holyrood. The UK Government can overrule the Scottish Parliament whenever it wants. There is little that can legally be done to protect Scotland’s NHS without independence.
FIVE recent developments are causing concern
#1 The Internal Markets Act mandates that any international trade deal the UK Government signs will cover Scotland
The UK Government has made it clear it will not hesitate to override devolution in regard to international trade deals. The Internal Markets Act, which became law a year ago, has the specific goal of ensuring that these deals automatically cover Scotland.
The UK Gov announcement said the Act would protect businesses, jobs and livelihoods by ensuring there are no “harmful new barriers to trade between all parts of the UK”. It also said “world-leading standards” would be maintained after leaving the EU. However, they have been watered down in many cases – one example was the post-Brexit relaxation of rules on pumping raw sewage into rivers.
As a result many fear that the UK Government will make deals, especially with US-based, privately owned healthcare providers that impact the NHS in all four UK nations.
#2 A clause protecting the NHS from being on the table in trade negotiations was removed from the Trade Act.
The House of Lords inserted a clause into the Trade Bill as it passed through Westminster which would have protected the UK’s ability to provide “a comprehensive publicly funded health service free at the point of delivery”. The amendment would also have restricted “the sale of patient data” and protected NHS drug prices but those protections were rejected.
But 357 Conservative MPs voted to remove this amendment to the government’s bill. Trade Minister Greg Hands said: “We do not see the need for this amendment, as protecting the NHS is already a top priority in negotiations.” The Trade Act was passed last year.
#3 The UK Government is trying to join the Trans-Pacific Partnership.
After leaving the EU single market, the world’s largest trading bloc, the UK Government wants to make up for some of the huge loss of trade by joining another trading bloc at the other side of the world – the TPP.
To succeed in joining, it will have to sign up to the bloc’s terms and conditions, which include rules to protect drug companies’ intellectual property. These allow them to bloc generic drugs. That would affect the ability of the NHS to negotiate cheap prices for medicines.
Joining the TPP would be seen as a stepping stone to a trade deal with the US. US officials and businesses have repeatedly said that the NHS must be “on the table” in trade talks, with US pharmaceutical companies and healthcare businesses eyeing the UK health market as a source of profit.
#4 Trade deals are likely to give legal protection to trans-national companies’ profits, tying future UK Governments’ hands
When the Conservative Government enters into new international trade deals it signs legally binding contracts. These deals will enable companies to bid for contracts within England’s NHS “market” for services and products.
The small print protects these companies’ business and profit – any future Government that wanted to get out of these obligations would find the trade agreements contain multiple obstacles and financial disincentives. This means they could incur massive legal costs and have to pay compensation.
5 The new health and care bill (England) allows private company reps to sit on commissioning bodies
The new health and care bill passing through Parliament is the latest in a series of Conservative reforms which aim to create a pretended free market within the NHS with private companies “competing” for public money which is “spent” by commissioning bodies.
This latest form of this allows people with an interest in these private companies to sit on the boards of the commissioning bodies. The rules and protections that were in place under EU procurement rules will no longer apply. The UK Government’s poor track record on public procurement in the pandemic has caused international comment. Its lack of oversight of the loan scheme caused government minister Theodore Agnew to resign this week, which does not inspire confidence.
It is difficult to predict with certainty what effect this will have on Scotland’s NHS. But the concern – which is shared by many in England – over the increasing role of private companies is profound. It may make the provision of health care in the UK more profit-orientated and less universal. While Scotland remains part of the UK it may be difficult to resist that pressure.
There is a degree of urgency in taking steps to protect Scotland’s NHS. The UK Government under the Internal Markets Act has assumed the power to effectively sign Scotland’s name on international trade deals as it wishes. This could burden Scotland with legal obligations which are costly to escape.
There are challenges for health care provision in the 21st century – dealing with an aging population; implementing new technology; increasing mental health support. An independent Scotland would be able to plan, budget and make policy decisions in line with its democratic choices.
An independent Scotland would be in a much stronger position to pursue its own course with confidence and clarity.
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