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Free trade agreements must consider health and care impact

FTA negotiations must not compromise interests of patients in exchange for short-term commercial advantages

Louise Prime

Tuesday, 21 January 2020

Future free trade agreements (FTAs) have an important role in the UK’s health and care system and offer opportunities to capitalise on the UK’s reputation as a world leader, the NHS Confederation has reported. But it insisted that the interests of patients must not be compromised in exchange for short-term commercial advantages – and that negotiations must always consider the long-term impact on public health and population wellbeing, and never result in lowered standards or increased costs for patients and the health and social care system.

For its latest report*, NHS Confederation Wales investigated how FTAs negotiated at UK level might affect the NHS in Wales, and how national and devolved administrations might differ in terms of their “key asks”. Post-Brexit trade deals, it noted, have significant implications for a range of wider determinants of health for Wales such as environmental protection, food standards, alcohol and tobacco regulations and working conditions.

The report’s authors argued that although trade negotiations often fail even to include health matters on their agenda, or at least not prioritise them, they offer “an opportunity to promote the core principles of the Welsh NHS, including equality, prevention and the wellbeing of future generations”, as well as to “capitalise on the UK’s reputation as a world leader in clinical care and governance, healthcare education, medical and scientific research and the development of innovative treatments, products and services”. However, they warned, “FTAs must not come at the cost of decreased protection for patients and the public from provisions that could increase healthcare costs, lower standards or place additional burdens on already challenged services and budgets”.

They said:

  • The impact of FTAs should be assessed to ensure that commercial advantage is not prioritised at the expense of human and economic health. In order to guarantee equal or higher public safety, impact assessments should ensure robust co-ordination mechanisms on public health and wellbeing standards.
  • There should be public and political scrutiny of trade negotiations. Health is a devolved responsibility and Wales should be meaningfully included in future negotiations.
  • FTAs will not themselves change the fundamental principles of the NHS – free care provided to all based on need at the point of use and funded through general taxation – and FTAs should not weaken or undermine this principle.
  • While some competition is expected to continue when commissioning service provision in England, the Welsh NHS governance system emphasises integrated care, enabling Local Health Boards in Wales to commission their own services for their local population, including for public health.
  • Operating on World Trade Organisation terms will not force the NHS to open services to foreign providers: it will be for the UK government to decide what services to offer, or not, in any future deal.
  • An early priority should be for the UK government to negotiate a trade agreement with the EU. This will promote continuity, minimise potential disruption and costs, ensure shared access to data and preserve reciprocal healthcare arrangements.
  • While protecting the NHS across the UK when negotiating FTA, Wales should emphasise the need for the long-term impact on public health and population wellbeing to be considered, maintaining high regulatory standards, having shared access to data, protecting food quality, reducing health inequalities and providing the best possible quality of healthcare services for patients whilst ensuring value for money.

The Confederation concluded: “Any future trade deals should aim to create an economic climate that will support population health, by improving the wider determinants of mental and physical health such as employment, good housing, education and nutrition. This virtuous circle is not only desirable in itself but will also reduce costs in the longer term.

“The NHS Confederation argues strongly that trade agreements between the UK and third countries should protect patients and the public from provisions that could increase healthcare costs, lower standards, or place additional burdens on services and budgets in health and social care. Nor should such provisions inhibit the ability of future UK governments to promote population health and wellbeing, for example through regulation. The interests of patients should not be compromised in exchange for short-term commercial advantages and the long-term impact on public health and population wellbeing should always be considered during future trade negotiations.”


*The NHS and future free trade agreements: implications for health and social care in devolved nations. The Welsh NHS Confederation. Published online 17 January 2020.

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