‘Major leak from Brussels reveals NHS will be ‘KILLED OFF’ if Britain remains in the EU’ screams the headline.
Sounds terrifying, right? And may even sound beguilingly persuasive. I mean, the EU stands for free trade, and entitlements of private companies (and the shareholders that hold the power) to capitalise on the huge market of the EU. And we know, from for instance the World Health Organisation, that the US health system is utterly inefficient. Significant reliance on private enterprise is no way to run a national health system.
But let’s take this claim apart, and have a look at what is being said.
“Major leak”. That sounds like something is being kept secret, and it also sounds like it is new information. But actually what is being reported here is existing information, which is already in the public domain. And part of the reason is precisely because of the EU. The huge grassroots and civil society campaigns against TTIP have effectively deployed the EU’s legal rules on transparency, as well as the politics of the situation. The European Parliament, for instance, has done a great deal to make sure that we have unprecedented amounts of information about the negotiating texts of TTIP, compared to other trade agreements in the past. And the European Parliament has the power to reject the TTIP altogether.
“Killed off”. This is a myth that has been perpetuated throughout the campaign. The legal position is clear (though doesn’t make for interesting headlines). The legal competence (power) to make decisions about national health systems lies with governments of the EU Member States, not with the EU. This is true for the UK, and for all other EU countries. And let’s not forget that our own national analysis of the balance of competences between the EU and the Member States found that it’s about right, overall, and that specifically in this area it is the right balance. The EU is not about to take more power to decide on things like the NHS. It cannot do so legally – or politically for that matter.
So if there is any threat to the NHS, and many of us think so, it’s from our government, not from the EU. That’s the legal position. It’s also the politics of the situation. The EU institutions cannot legally – or politically – tell our government, or our NHS managers, or anyone else, how to organise our NHS, or how to fund it.
What’s more, even the bits of EU law that might affect small aspects of the NHS, where it is run on a market basis, have legal exceptions, and are interpreted in ways that respect shared European values about how to run health services.
But all that said, the stop-TTIP campaigners are right to be concerned about this and other things (for instance, the environment, labour rights). The TTIP negotiating text (remember, no agreement has been reached, and may never be) does cover investment of private US-based companies within the EU. The underlying idea of the TTIP is indeed to open up markets to that kind of investment. And the deal is likely to include some protection for that investment from governmental action, by making sure investors are compensated if governments take away their property. There’s nothing particularly sinister about that in principle – after all, if you invested in something and then government policy took away your expected benefits, you would expect some compensation. But there are ways in which it can be designed to give more, or less, power to governments as opposed to private capital.
So if we are concerned about the effects of TTIP on the NHS, the question is, what’s the best bet to make these concerns heard, and, ideally, have protections for the NHS put into the TTIP final text? Or you might be wondering what is the best way to stop TTIP altogether?
There’s much more detail on this here, and here. But in brief, the other EU countries have got ‘opt outs’ for their health systems within the EU TTIP text. It looks as if David Cameron may be forced to negotiate one for us too. It’s true that if we were to leave the EU, there would be no need for that. But the Leave campaign claims that we will have better trading relations – including with the US – outside of the EU. I would rather be within a context where there are pressures on our government to do what other governments have done to protect the European way of organising health systems. Remember that the Leave leaders are on record as pro-NHS privatisation.
Finally, why should you believe me? Why not believe the people cited in the Express article? I will be voting Remain, though I have been critical of the EU, and tried to argue for ways of using EU law to advance socially progressive agendas, for all of my career. My salary is not paid by the EU, although universities are indeed beneficiaries of EU funding. If I publish (including this blog) things that are demonstrably wrong, my professional reputation will suffer.
Contrast the Express – they can requote the same (small) number of health professionals and policy people (eg Louise Bours) without any lasting consequence for the paper or its editors. They can leave invisible the hundreds of health professionals and policy people who have put their names to Remain (including those who have publicly changed their minds, like Sarah Wollaston). Think about what those people have to lose by giving anything other than impartial advice – their very professionalism and professional identity.
I’m very happy to answer any more questions people have. On balance, my analysis, shared by many others in the health sector, is that the NHS is better off if we Remain in the EU.