EU Referendum

Reality Check: Could private companies buy NHS hospitals?

Vicci asking: "Could private companies 'buy' NHS hospitals if the EU-EU trade deal goes ahead?"

The question: Vicci emailed Reality Check to ask: "Could staying in the EU lead to the possibility of companies purchasing NHS hospitals?"

The answer: The EU is negotiating the TTIP trade deal with the US. Negotiations are still ongoing and until the wording of it has been agreed, it is impossible to say what impact this deal would have on the NHS. But the chief executive of NHS England has accepted assurances from the European Commission that it would not undermine the UK's ability to run a publicly-funded health service.

The European Union is negotiating a trade deal with the United States. It is known as the Transatlantic Trade and Investment Partnership, or TTIP.

Tariffs between the EU and the US are already relatively low. The aim of the TTIP deal is to remove non-tariff barriers by introducing common standards and regulation, and new measures to protect investors. There are also plans to prevent discrimination on the basis of a company's nationality.

Campaigners fear US companies could use TTIP to pressure the UK government to let them compete for contracts within the NHS. They say this could lead to greater privatisation.

While US companies might not be able to force a change in policy, campaigners fear that the prospect of a lawsuit might influence government decision-making. The rules could also prevent the UK government from reversing privatisation in the future if they are afraid of getting sued by US companies that provide goods and services to the NHS.

Under domestic law, NHS commissioners in England can already open clinical services to competition if they wish. In 2012, a private company took over the running of the Cambridgeshire NHS hospital, Hinchingbrooke. It later had to be taken back in house after poor performance.

Both the European Commission and UK government say public health services will not be affected because of an exemption which allows governments to manage their public services as they see fit. This means they can allow monopolies, grant exclusive rights to selected providers and reverse privatisation.

The Department of Health reiterated this by saying: "The European Commission has explicitly ruled out public services from the scope of any market liberalisation in the TTIP."

"The agreement will not require participating EU members to open up their national health systems to private providers."

Member states will also be free to change their policies and bring back outsourced services to the public sector whenever they choose.

But we won't know how any of this will play out until we have the final agreement and it has been tested in practice.

Some are worried there will be loopholes. For example, the Unison trade union said the practice of "negative listing" - a requirement to explicitly list services for exemption from TTIP- could mean new services developed in the future won't be protected.

The European Commission says the difference between positive and negative listing is "strictly technical".

The NHS Confederation flagged concerns that commercial confidentiality could be abused to bury or ignore unsatisfactory clinical trial results and that the US's more stringent intellectual property rights could extend the use of patent protection, limiting patient access to innovative treatment and cheaper generic drugs.

However, in a document setting out the pros and cons of TTIP, the membership body for commissioners and providers concluded the EU's negotiating proposal to the US contained strong safeguards for the NHS.

NHS England chief executive Simon Stevens told the Andrew Marr show that, following assurances from the European Commission, his concerns that any trade agreement would undermine the ability to run a publicly-funded health service had been appeased.

Negotiations are still ongoing and until the wording of the trade pact has been agreed, it is impossible to predict the exact impact on the NHS. But the final deal will likely have to be agreed by all member states, giving the UK the power to delay and veto it.

Read more: The facts behind claims in the EU debate

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