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If we want a publicly-owned NHS, we have to ditch Brexit

The case for a People’s Vote and the reversal of Brexit couldn’t be clearer writes Dr Alex Ashman, Leader of the National Health Action Party, and Dr Louise Irvine, Secretary to the National Health Action Party

The recently published, ‘The Ideal U.S.-U.K. Free Trade Agreement’, written in partnership by the Cato Institute - an American neoliberal think-tank - and arch Brexiteer Daniel Hannan MEP’s, Initiative for Free Trade, hardly contains any surprises for those of us who’ve said from the start that Brexit poses a serious risk to the NHS.

The Conservatives won’t openly be calling for the privatisation of the NHS anytime soon. For now, they seem to understand this would be political suicide. But, Brexit, either in its Chequers form or as a hard-Brexit, will allow the Tories to push for privatisation by stealth.

The Health and Social Care Act 2012 already forces England’s NHS to put services out to tender to public and private providers. As a result, clinical and administrative contracts have increasingly been awarded to private providers. In the EU, the UK has the power to put an end to the purchaser-provider split, thereby renationalising the NHS. Outside of the EU, and having to negotiate free trade agreements with larger economies, this will be an impossibility.

For a start, the government has been clear that pursuing agreements with the US, Canada, Japan, Australia and New Zealand is a top priority during the transition period. Any agreement between the UK and these countries, like all free trade agreements, will be underpinned by Investor State Dispute Mechanisms (ISDM). These are private, corporate courts where businesses can sue governments for implementing policies which negatively affect their profits. They leave no room for appeal, and only the corporations can sue.

Unfortunately, there are still some who believe in a fantastical ‘Lexit’ where the UK, whose economy amounts to 3.85% of the world’s economy, can somehow dictate to the US whether we open the NHS up to private foreign investment. Whereas it appears in reality that it is the hardline Brexiteers who have a greater intuition of how our future trading relations will be shaped. Hannan and co. make this clear when they write:

“health services are an area where both sides would benefit from openness to foreign competition, although we recognize any changes to existing regulation will be extremely controversial. Perhaps, then, for other areas the initial focus should be on other fields such as education or legal services, where negotiators can test the waters and see what is possible. That said, we would envisage a swift, time-tabled implementation of recognition across all areas within 5 years.”

The future capacity of a progressive government to renationalise the NHS worsens once we also factor in the Conservatives continued push to rollout, without a vote, Integrated Care Providers (ICPs). Rightly denounced by the late Professor Stephen Hawking as nothing but a barefaced attempt to privatise the NHS, ICPs – previously known as Accountable Care Organisations - represent the apex of NHS fragmentation.

They allow for the unfettered ability of private companies to manage healthcare provision and budgets for entire regions of England for as long as 10-15 years. The increased scope for private sector involvement in the NHS that they represent, means the UK will be an attractive market for larger economies, such as the US or China, who will hold greater leverage in any one-to-one negotiations. You can be sure that any free trade agreement will be predicated upon the UK – especially if ICPs are already in place – ensuring that the purchaser-provider split stays exactly where it is.

The government has also made clear it will also be exploring signing up to the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) post-Brexit. Further undermining the future of the NHS as a tax payer funded, and universal health system.

If the UK joins the CPTPP it will inevitably have to align its regulations on goods and customs with those of fellow signatories. In turn this makes it impossible, as the EU continues to tell Theresa May, for the UK and EU to enter into, a la Chequers, a ‘common rulebook’ for goods. The government’s plan is unworkable, its intransigence is simply ratcheting up the risk of a no-deal Brexit.

If a no deal Brexit happens, and is presided over by a Tory government and a further £80bn per year black hole in the public finances, you can be sure it will be the NHS, those in need and our public services which will be attacked, and sold off, under the pretence – whilst corporation tax is cut and taxes for the wealthy are cut - of ‘balancing the budget’.

This can be avoided through holding a People’s Vote, held in light of the facts of what Brexit really means. Failure to do so will entrench austerity for years to come and abolish any hopes of bringing the NHS back under public control.


The National Health Action (NHA) Party was founded in 2012 to oppose the growing marketisation of the NHS.

The NHA Party stood against Jeremy Hunt in his SW Surrey constituency in the 2015 and 2017 General Elections, taking 12,093 votes in the latter: a 7.8% swing to NHA.

Dr Phil Hammond is the NHA’s latest parliamentary candidate and will be standing against Jacob Rees-Mogg at the next general election.

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