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Today, Labour released a 451 page dossier at a press event, which they say was leaked from the Department for International Trade, and is a record of preliminary discussions that have taken place between UK and US officials over a possible future trade deal.

The Conservatives have responded with dismissal, saying that the papers have been available online for two months, that the claims are nonsense, and that the NHS would never be part of trade talks.

Who is right here? Do the papers prove that the NHS is up for grabs in a US-UK trade deal? Or is the release of these papers, in Boris Johnson’s words, a “diversionary tactic”?

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    So the ideal answer would have evidence to validate whether Johnson's claims that the papers are inaccurate or obsolete are true? It might also be good to add a citation and quotes for the claims by both Labour and the Conservatives
    – divibisan
    Nov 27, 2019 at 21:04
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    @CDJB: If a trade deal mentions the NHS, or _ includes_ it, that does not mean the NHS is for sale. It could also mean (fairly obviously) that US drugs companies may sell to the NHS.
    – MSalters
    Nov 28, 2019 at 7:08
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    @MSalters Apologies, in the rhetoric surrounding this election, the phrase “NHS is for sale” has come to mean the slow privatisation of the service, weakening of standards, or the NHS being forced to pay higher prices for non-generic medicines from the US. I could make that clearer in my question. I’m not asking if the NHS is literally going to be sold.
    – CDJB ♦
    Nov 28, 2019 at 7:45
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    @CDJB: To give an objective answer to the question, you need an objective definition of the meaning "for sale". And you'll have to overcome the usual definition, which is "someone can pay to buy it". Boris Johnson can objectively say the NHS is not for sale using the normal meaning, that seems undisputed.
    – MSalters
    Nov 28, 2019 at 7:53
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    I think the phrase is fairly well understood, but I’m happy to clarify - does the dossier contain any proof that the NHS will be negatively impacted in order to serve American interests in a trade deal?
    – CDJB ♦
    Nov 28, 2019 at 8:02

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Yes. The documents do at least prove that parts of the NHS are on the table. While we are not really talking about Hospitals and service provision, at least not yet, these documents show that how the NHS selects and purchases drugs will be covered by a US-UK trade deal under a Conservative Government.

This guardian article and linked PhRMA statement show as much.

The Guardian overview tells us;

Our source told us to forget about suggestions that US corporations were going to buy up hospitals, medical services and fleece the NHS – this was just political scaremongering. But they said that the key issue worrying some inside Whitehall was negotiations relating to the complex world of intellectual property (IP) and patent law, which could pave the way for US drug firms demanding higher prices for their medicines and over a longer period of time.

Key points in the linked PhRMA document such as this one stand out.

As such, innovative medicines should be priced and reimbursed at levels that appropriately recognize their value to patients and society. Unfortunately, UK patients experience materially longer delays in accessing new medicines than patients elsewhere because of rigid national HTA processes, sub-national duplicative assessment or commissioning processes, and prescribing policies and incentives aimed at containing costs to meet unreasonable budgets.

As the article discusses, this paragraph is aimed squarely at the removal of NICE, the NHS commissioning service that sets evidence, cost and value for money limits on what drugs the NHS will buy. Removing NICE opens the door to fragmentation of purchasing services, reducing the strength of the UK Health services' negotiating position inevitably leading to higher drug prices as seen under the US model.

The first section of the BBC article covers much of the same ground.

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    @Displayname considering the two positions are "NHS for Sale" and "No part of NHS on Table" would you be surprised to find the reality is somewhere in the middle. The NHS is clearly part of the trade negotiation pre-discussion talks though. And I hope my answer makes clear the scope of that "sale".
    – Jontia
    Nov 28, 2019 at 14:29
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    @Jontia removing the centralised purchasing system of the NHS doesn't scream "NHS is for sale" or even that any part of the NHS is "on the table", but it would increase costs by removing controls certainly. Difficult one.
    – user16741
    Nov 28, 2019 at 22:48
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    @Moo as the comments on the initial question mention, as a policy position 'NHS for sale' is all about the small steps that remove its ability to function as a coherent whole.
    – Jontia
    Nov 29, 2019 at 7:37
  • @Jontia it’s never been a coherent whole, or at least not for many many years - Trusts and CCGs have long broken up the NHS into segments, and in addition you have things like primary care (GP surgeries) who are private companies with NHS contracts...
    – user16741
    Nov 29, 2019 at 7:40
  • @Moo it could definitely be better.
    – Jontia
    Nov 29, 2019 at 13:19
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I think this question cannot be answered yet because there is no trade deal or even proper negotiations about one. It seems very plausible that:

a) Boris Johnson and his government want a trade deal with the US that excludes the NHS and the health industry.

b) The US government wants a trade deal that does include the health industry.

The two sides are talking to each other but have not agreed on this point yet. BJ has to claim he will only consider a deal under a) both for negotiation reasons as well as how he is perceived in the UK with an upcoming election.

If there is a Brexit, then GB will need the trade deal a lot more then the US will, so how an actual trade deal would look like only time will tell.

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  • Thanks for this, but it doesn't quite answer my question. I'm asking if there is anything in this dossier specifically that indicates that the NHS would be on the table in a future trade agreement, as Labour have claimed - not if there will be a future trade deal that includes the NHS, or what such a trade deal would look like. If, as you mention, the dossier indicates that the two sides have not agreed on this point; this would seem to show that Labour have fibbed a bit - negotiations are still under way, and this dossier doesn't prove anything. Would that be a valid conclusion?
    – CDJB ♦
    Nov 28, 2019 at 13:20
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Is the dossier released by Labour proof that the NHS is for sale?

No, Not Literally. There is nothing in the dossier to suggest that Theresa May's government was amenable to US private businesses purchasing the NHS including its hospitals and taking over its roughly 1.5 million employees.

Neither is there anything in the dossier to suggest Theresa May's government was considering selling off any unit of the NHS.

I believe the dossier contains a note that the US government would like the UK to adopt the same expiry time for patents as the US does. The US wants to encourage US businesses to invest money in developing new medicines and believes that they will only do so if it makes economic sense for them to do so. That means the duration of their patents should provide those companies with sufficient time to recover their costs and provide some return to their investors. The US and UK currently have different ideas about how long this needs to be. So far as I know, the dossier does not indicate that Theresa May's government were willing to concede this, it just records something that it was likely the US would want to discuss in a future trade agreement.

does the dossier contain any proof that the NHS will be negatively impacted in order to serve American interests in a trade deal?

That's a slightly different question.

No it does not contain proof that the NHS will be negatively impacted.

It contains evidence that there are aspects of the US initial position which, if accepted by a UK government, would mean the NHS might be affected in that it couldn't buy cheaper knock-off copies of patented medicines developed in the US before those patents had expired in the US.

Describing this as "proof" of "selling off the NHS" is hyperbole.

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