BMJ 2014;349:g5880 doi: 10.1136/bmj.g5880 (Published 25 September 2014)

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NEWS Experts warn that EU trade treaty with US puts NHS at risk Matthew Limb London

US corporations would use a “highly secretive” new trade deal with Europe to sue future UK governments that ran the NHS against the corporations’ interests, experts have warned. John Hilary, director of War on Want, urged MPs and the public to campaign against the Transatlantic Trade and Investment Partnership (TTIP), which he described as undemocratic and “deadly toxic.”

still be at risk because of a proposed dispute or arbitration process in the deal that businesses would be able to exploit. He said that the so called investor-state dispute settlement mechanism lacked transparency and would operate as a “parallel justice system” beyond the scrutiny of regular courts.

“Everybody is agreed it is perfectly possible that if a future UK government wanted to take back the NHS into public hands it could be clobbered by any number of US corporations suing them over a loss of profits,” he said.

Dearden said of the deal, “It very clearly changes the balance within our society between us as ordinary citizens, us as equals, and the power of big business, which is already huge and responsible for a lot of erosion of democracy.”

Negotiations are under way between the United States and the European Union over what would become the world’s biggest trade deal if successfully concluded. But Hilary said that the deal would give foreign investors “special privileges” that endangered vital public services, including the NHS, while key documentation would stay inaccessible to scrutiny under a 30 year ban.

“What it could mean is a whole raft of cases being brought under arbitration against a future government for doing things like trying to reverse the Health and Social Care Act, if American companies were invested in the health system of this country at this time,” said Dearden. He added that corporations such as Philip Morris had brought cases using similar arbitration schemes to sue countries that wanted to introduce plain cigarette packaging. “This is not an abstract fear—it’s something that is going on,” he said.

The TTIP’s potential impact was debated in London on 23 September in a lecture at the Royal Society of Medicine hosted by RSM Global Health, Medact, and the UK Faculty of Public Health. The UK government has backed the trade deal, claiming that it would reduce unnecessary bureaucracy, boost jobs and economic growth, and cut prices for consumers.

In April the campaigning group 38 Degrees called on the UK government to exempt the NHS from the treaty. But the Department of Health responded by saying that the agreement had the “potential to benefit patients through promoting collaboration across the pharmaceutical and life science sectors.”1

But Gabriel Siles-Brügge, a politics lecturer at the University of Manchester, said that the potential benefits were being “mis-sold” and exaggerated to the public, while the negative effects were being hidden. The debate focused on concerns that the deal would pave the way for further privatisation in the NHS and would harm public health. Hilary said that the treaty rang alarm bells because its clear purpose was to loosen any regulations that US businesses, such as drug companies, had said were a barrier to maximising profits when they traded or invested across the Atlantic. Nick Dearden, director of the World Development Movement, said that UK ministers had been “gung-ho” about wanting medical and drug services brought under the scope of the deal. Ministers recognised potential gains from the United Kingdom exporting to the US “without seemingly realising the US might want to do exactly [the] same thing to Europe,” he said. Dearden added that the UK government had failed to enter the appropriate clauses, restrictions, or limitations that would exempt or protect health services from US competition. But even if they were to do that, he noted, public services would For personal use only: See rights and reprints http://www.bmj.com/permissions

Hilary said that perhaps the most “chilling” thing about the deal was that it could prevent states from “even daring” to bring in legislative changes in the first place for fear of litigation, noting that the new investor rights under TTIP applied “even if you haven’t already made an investment yet.” He said that even ministers had admitted that the figures projecting economic gains were “made up,” and he added that it would actually lead to net job losses and reduced standards of protection in areas such as the environment and workers’ rights. Hilary also warned that seeking exemptions under the deal was not the answer. “We should use the NHS as a really good example of what could happen, but let’s call for the whole agreement to go,” he said.

John Middleton, vice president of the UK Faculty of Public Health, said that potential measures to improve health among the UK public seemed to be “highly at risk.” He said, “If the country decides to introduce a minimum unit price for alcohol, will Diageo want to sue us for so doing? If we go into a sugar tax, likewise will Kraft (part of Philip Morris) want to sue us?”

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BMJ 2014;349:g5880 doi: 10.1136/bmj.g5880 (Published 25 September 2014)

Page 2 of 2

NEWS

Siles-Brügge noted a clear “bias” in the agreement “towards liberalisation,” even if this might not necessarily lead to the wholesale privatisation of public services.

Dennis Novy, economist at the University of Warwick and an adviser to the House of Lords, said that the drugs industry was one of those predicted to gain most. But he disagreed with the other speakers on the threat to public services.

“There is no reason to fear either for the NHS as it stands today or for changes to the NHS in future as a result of TTIP. The

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current NHS commissioning model was decided by the UK government, not by the EU’s rules on public procurement, and TTIP would not change that,” he said. 1

O’Dowd A. NHS should be exempt from EU-US free trade treaty, campaigners say. BMJ 2014;348:g2876.

Cite this as: BMJ 2014;349:g5880 © BMJ Publishing Group Ltd 2014

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Experts warn that EU trade treaty with US puts NHS at risk.

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