19. TTIP agreement

RCN Inner South East London Branch

(R) That this meeting of RCN Congress urges Council to lobby against the inclusion of health services in the Transatlantic Trade and Investment Partnership (TTIP)


The resolution was passed.

For: 97.16% (461)
Against: 2.84% (13)
Abstain: (14)

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Debate report

The Transatlantic Trade and Investment Partnership (TTIP) is a new threat to the existence of the NHS, Congress heard. 

“If health is not excluded, then it could be traded in the same way as baked beans or energy,” said Gay Lee, of the Inner South East London branch, proposing the resolution. Explaining that TTIP is a trade agreement currently being negotiated between the European Union and the United States, Gay said: “The NHS is not about making money but about putting patients first. That’s what we all love about it.”

John Hill of the Scunthorpe branch said: “I would suggest that a couple of months ago the vast majority of you would never have heard of TTIP. But this is one of the biggest threats to the NHS that there has been in years.”

Calling for increased openness in the way TTIP is being negotiated, RCN Deputy President Cecilia Anim said: “This needs to be done in an open and transparent way with full public engagement. There have to be red lines that can’t be crossed - and the NHS is one of those red lines.  TTIP will have wider irreversible implications for all of us in our working lives. We’re being kept in the dark and we have to stop it. EU commissioners open those doors and let us in – because we want to know what’s going on.”

The resolution was carried by 445 votes to 13 against, with 14 abstentions.


The Transatlantic Trade and Investment Partnership (TTIP) is a trade agreement that is being negotiated between the European Union and the United States. The stated aims of TTIP are to remove trade barriers to make it easier to buy and sell goods and services between the EU and the US. If health services were not exempted from TTIP, it would cause them to be traded in much the same way.

There are widespread concerns that TTIP is being negotiated in secret, with a purely economic focus and with little attention to the impact on public services. As part of TTIP, public service standards between the US and EU will be harmonised, with a lowest common denominator approach to make trading between the two easier. There is very real concern that this will adversely affect patient care and members’ terms and conditions of work, and could potentially lower the overall standards of care.

TTIP would further open up the NHS to American private businesses, who would be legally able to tender for public service contracts. There is concern that this could lead to further privatisation within the NHS.

Another area of concern with TTIP is the Investor-state dispute settlement (ISDS), which would allow an unelected tribunal to pass judgement on member state legislation in relation to compatibility with TTIP.

The Labour party is concerned that under ISDS a future government would be unable to repeal the competition and privatisation elements of the Health and Social Care Act as they propose to do. The undemocratic nature of this process has caused further alarm about the potential impacts of TTIP.

In the House of Commons, TTIP has been the subject of two parliamentary debates. The first in July 2013 when TTIP discussions amongst negotiators first started and more recently in February 2014. In the more recent debate a number of MPs raised their objections to the NHS being part of TTIP and called for its exemption. Jonathan Edwards MP raised issues relating to Wales during this debate. A House of Lords committee has also been established to look at the impact of TTIP. It is unclear if the Government have been seeking to exempt health care in negotiations. Negotiations on TTIP could conclude as early as the end of 2014.

The RCN has called on Members of the European Parliament (MEPs) in the European election 2014 manifesto to hold the European Commission and member states to account on the impact of economic measures and trade agreements on access to health services.

References and further reading

House of Commons (2013) Daily Hansard: 18 July 2013: EU-US Trade and Investment Agreement London: Parliament Available at: www.publications.parliament.uk (Accessed 13 May 2014)

House of Commons (2014) Daily Hansard: 25 February 2014: Transatlantic Trade and Investment Partnership London: Parliament [online] Available at: www.publications.parliament.uk (Accessed 13 May 2014)

Royal College of Nursing (2014) European election manifesto London: RCN [online] Available at: www.rcn.org.uk (Accessed 13 May 2014)