It is little wonder that the NHS takes centre stage in election campaign after election campaign: it commands an extraordinary level of public support. We are more proud of the NHS than the armed forces or the royal family. Nine in 10 support the founding principles of the NHS: free to all on the basis of need, not ability to pay. And if the NHS is the closest thing the British have to a religion, voters tend to look unfavourably on politicians seen to embody a credible threat to it.
This is why Jeremy Corbyn launched his campaign with a stark warning about the threat of a US trade deal struck by a Conservative government, declaring the NHS is “not for sale”. The Conservatives promptly hit back; the health secretary, Matt Hancock, called it one of Labour’s “pathetic scare stories”. Even Donald Trump weighed in, saying: “It’s not for us to have anything to do with your healthcare system… we’re just talking about trade.” It would be politically foolish for any Conservative government to try to unpick the fundamental underpinnings of the NHS; to pave the way for large-scale privatisation, to introduce an insurance-style system or to bring in significant user charges. But Labour is right that the Conservatives pose a more insidious threat, by starving it of the resources it needs, and introducing the means for powerful private-sector suppliers, such as the big pharma companies, to extract more profit at the expense of the taxpayer.
The Conservative record since 2010 speaks for itself. Like every other public service, the NHS has come under severe strain as a result of public spending cuts imposed by Tory chancellors, even as they have doled out generous tax cuts costing billions of pounds a year that have disproportionately benefited more affluent families. This last decade has represented the tightest funding settlement the NHS has received since its founding. Funding has not kept pace with rising demand as a result of an ageing population and advances in medical technology, despite the fact that spending on healthcare is significantly lower than among many of our international competitors.
The verdict of the independent King’s Fund is that the NHS is “clearly under-resourced”. This is why, winter after winter, the NHS has struggled to meet need. Last winter, it took the unprecedented step of cancelling all non-urgent surgery, against a backdrop of increasing waiting lists, understaffing and bed occupancy rates consistently above the levels that permit safe care. Meanwhile, Conservative ministers have sought to misrepresent the figures: they have consistently claimed that the NHS is getting more money than it actually is.
So the Conservatives have already put the NHS at risk in order to fulfil their objective of cutting back public spending in order to pay for expensive and unnecessary tax cuts. There is no reason to believe they will not do so again. A US trade deal is a cherished objective of the hard Eurosceptic right that now dominates the Conservative party and it poses serious risks to the NHS.
It could open the door to rising NHS drug costs to the tune of billions of pounds a year. The NHS is one of the world’s biggest drugs purchasers and exerts a significant downward pressure on prices. Most pharmaceutical companies take part in a voluntary pricing and access scheme that caps the total price the NHS pays for drugs manufactured under patent. The NHS also has a world-leading system for assessing drugs, not just for safety and effectiveness but value for money. Together, these mechanisms mean pharmaceutical companies wanting to sell to the NHS have to offer their drugs many times cheaper than in the under-regulated American market. The price the NHS pays influences pricing across much of the rest of the world.
The US pharmaceutical industry has thus long had the NHS in its sights and in Trump they have found a sympathetic ear. He has taken aim at “freeloading” foreign countries that regulate drug prices, blaming them for high US prices. The US government’s desire to liberalise access to international drug markets has shaped the trade deals it has struck with other countries and it has stated it is an objective in any trade talks with the UK. As revealed by Channel 4’s Dispatches last week, it has already been the subject of several meetings between US and UK trade negotiators.
The hardline Tory right is desperate for a US trade deal that would align the UK’s regulatory standards more closely to that of the free-market US; it is one of the reasons why it has always wanted to leave the EU. And the US is an economic powerhouse that will expect most of its objectives to be met in such a deal, particularly under an America-first president.
After the economic fallout of a Boris Johnson hard Brexit, the UK would hardly be in a place to make exacting demands. A Johnson government could sign up the UK to measures in an international treaty that would bind the hand of future governments and turn Britain into a true rule-taker from the US. It makes an ultimate irony of the argument advanced by Brexiters that we should leave the EU, an institution over whose laws and rules we have a democratic say, in order to “take back control”.
The ideological right has taken over the Conservative party. It has already shown through its determination to pursue a hard Brexit that it will sacrifice the country’s economic wellbeing in order to get the version of the future it wants. Think it will exclude the NHS? Think again. The old adage has perhaps never been more right. You can’t trust the Tories with the NHS.
