No one could have predicted the scale of the change we have all experienced as a society in recent months as a result of the covid-19 pandemic, and still the future looks very much uncertain. One thing that has remained steadfast throughout, however, has been our National Health Service. At the height of the pandemic, the NHS became a bastion for all that is good in our country and its workers were deservedly exalted as the heroes at the forefront of the battle.

Yet, the preservation of our health service as we know it hangs in the balance. While the glare of the media and the health agenda has been focused elsewhere, trade negotiations have been quietly taking place between the UK and other nations.

The UK’s trade agreements with countries outside Europe have massive implications for the future of our health service and the general health of the population in Britain. The BMA has serious concerns as to how the health service, and indeed the wider health of the public, will be protected in any future trade agreement. A report by the Institute for Government notes that pressure to rush through deals without adequate regulation and scrutiny mechanisms in place has ultimately weakened the Government’s hand at the negotiating table and does little to assert public trust in the process; trust that has already been wearing thin. The public are rightly concerned about their health service which, according to Department for International Trade research on public attitudes, tops the list of their concerns around negotiating trade deals with protection of public services such as the NHS (34%) and maintaining current UK food standards (30%) among the key concerns.

Negotiations with powerful global economies such as the US, Australia, and Japan are already gathering significant pace. As the US and the UK enter their fourth round of negotiations this week, it is critical that the UK’s proposal is sufficiently detailed and binding to ensure meaningful protections for the health and social care sectors—particularly the NHS—and effectively protect food and agricultural standards. Currently, the UK is among those countries with the most rigorous product and food safety standards in the world. These standards, which essentially constitute the protection of human, animal, and environmental health, are at very real risk of coming second place to economic considerations if they are not afforded adequate protection. The increased use of pesticides and antibiotics in food could well be an unwanted aftertaste of trade deals with countries who have less stringent regulations that the UK. Analysis by the Alliance to Save our Antibiotics found that total antibiotic use in US farm animals is more than 5 times higher than in UK farm animals, and in US cattle it is 8-9 times higher compared to the UK. The UK has refused to confirm it will join the EU in banning group preventative treatment in cattle by 2022 and commit to an overall 50% reduction by 2030, which means the UK could have the weakest rules on antibiotics compared to their European counterparts.

The breadth of what the trade deal could mean for the delivery of healthcare is vast with another area of serious concern being its potential impact on drug pricing here in the UK. We must avoid at all costs a profit-driven market such as that in the US, where spending on medicines is 2.5 times higher per person than in the UK—a cost of £12 billion per year on the 20 most expensive medicines alone. We must ensure that a future trade agreement does not jeopardise the UK’s ability to afford lifesaving medicines that doctors and their patients need.

This year has truly exemplified how crucial it is that across all four nations, our health service can be publicly funded, publicly provided and publicly accountable. The decisions in the coming months will shape the trajectory of our health service for years, even decades, to come. While trade agreements do not require governments to privatise services, they make it extremely difficult to reverse privatisation, which already has a destabilising and fragmentary effect on NHS services in England and frequently represents poor value for money. It is imperative that health and social care are excluded from the scope of any trade deal, including sections on services and investment, to guard against locking in privatisation in England and potentially extending it to the devolved nations.

The BMA is clear that the health of the public both in the UK and globally is a priority. Ultimately, the only way we can ensure this is achieved is by putting protections into law. As the Trade Bill is debated in the House of Lords this week, this is a pivotal point to raise key issues, particularly following the disappointment of MPs voting against amendments to the Bill that would have gone some way to protecting the health service and public health. This must not be another missed opportunity.

With the end of the transition period drawing ever closer, the Government must not succumb to the temptation to rush through a trade deal for economic gain. The Government must not lose sight of their commitment to preserving our health service and the wider health of the British public at a time when we need it most.

David Wrigley is a GP in Carnforth, Lancashire and is BMA trade negotiations lead and deputy chair. 

Twitter: @davidgwrigley

Competing interests: DW is co-author of the books ‘NHS for Sale’ and ‘NHS SOS’