How might TTIP affect the NHS?

Many believe that public services in Europe will be among the biggest prizes that TTIP will provide for US based corporations that are looking to expand. Although thrown into doubt now by the UK referendum decision to leave the EU, the NHS was considered the biggest prize of all. In 2011, for example, a coalition of US healthcare businesses, the Alliance for Healthcare Competitiveness (AHC) proposed that America’s battered economy could be rebuilt by selling the country’s health system internationally. It claimed that the scale of the US healthcare industry – “as large as the national economies of major European powers” – could provide the leverage for international expansion and so pushed the US government to build its foreign free trade policy around the health care industry (

With the EU the site of nearly one third of world health spending, TTIP will create new markets for the private sector by opening up public services and government spending to unrestricted competition from wholly or partly US-owned, profit-driven corporations.  In the UK, the fear has been that, if agreed, TTIP would change the whole emphasis of NHS health care: the priority would become the rights of transnational corporations rather than the care of patients.

Over the past year or two, the NHS became a focus for public opposition to TTIP. In response, there have been repeated assurances from the European Commission (among others) that, under TTIP, EU member states like the UK would retain the right to manage their health systems as they wished. This was true – up to a point. What was not mentioned were the possible consequences should the UK chose to exercise this right. Some consequences may remain relevant even after the UK leaves the EU, if TTIP is signed before this.

If TTIP is signed while the UK is still an EU member state, it appears that the provisions of TTIP will continue to apply to the UK for as long as 20 years (see – long enough to do irreparable damage to the NHS .

Investor protection measures like ICS and the NHS

Take the example of investor protection measure, namely Investor-State Dispute Settlement (ISDS) or the Investment Court System (ICS). (The EU is under pressure to use ICS for TTIP but the US wants ISDS.) With either measure, TTIP will give US based investors the right to claim massive compensation if a member state government introduces policy initiatives that could potentially reduce those investors’ profits. Plus, like CETA, TTIP includes a ‘stabilisation’ clause to ensure that ICS (or ISDS) will remain in force to protect investors’  profits for 20 years after a member state leaves the agreement. Some countries, such as Finland, have found that using private companies for providing state-funded health services has led to increased costs and poorer service, and so have returned the provision of services to the state. However, the inclusion of a stabilisation clause suggests that, if TTIP is signed before the UK leaves the EU, very little could be done in time by future UK governments wishing to reverse the growing privatisation of the NHS by US based corporations – at least without facing huge compensation costs.

Similarly, the fear of being sued for huge compensation may inhibit any future government from ending the contracts that many NHS Trusts have entered into with US based private investors under the Private Finance Initiative. These contracts can be for as long as 60 or more years and often mean that NHS Trusts are repaying debt for new buildings or infrastructure at usurious rates of interest.

Because of fears of being sued under ICS or ISDS, the UK government’s right to regulate would be restricted. It would be fearful, for example, of introducing new public health regulation, or health protection and health promotion policy measures that might affect Us based companies’ future investment or profit opportunities. Evidence for safer or more effective treatments, or advances in clinical knowledge, could not be put into practice (at least without the risk of being sued) if this affected the anticipated profits of existing providers.

In addition, the harmonisation of health and safety regulations that TTIP would usher in would probably mean the downgrading of EU public health measures that govern the use of food labeling, pesticides, chemicals, the presence of hormones in meat production and so on. The EU generally has higher standards of health and safety regulation than the US because of different methods of deciding safety standards: the EU uses the ‘precautionary principle’ (where tests must prove substances are not harmful) while the US approach is to assume that something is safe unless proved otherwise. ‘Harmonisation’ is likely to mean that the standards currently set by the EU will have to be lowered to be closer to those of the US. It is unclear how the UK’s public health measures will be affected, given the vote to leave the EU.  But, at the very least, we shouldn’t lose sight of the problems posed by  ‘harmonisation’ if a new treaty is being negotiated between the UK and US.

See also our page on whether the NHS is exempt from TTIP

For a detailed article on the question of whether the NHS is subject to competition law, see

How public services are at risk from FTAs – and

For more details of the Trans-Pacific Partnership FTA see

 Further reading on TTIP and the NHS:

updated June 2016

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