Intended for healthcare professionals


Is the NHS really “off the table” in post-Brexit talks with the US?

BMJ 2019; 367 doi: (Published 10 December 2019) Cite this as: BMJ 2019;367:l6898
  1. Johanna Hanefeld, associate professor of health policy and systems1,
  2. Richard Smith, professor of health economics 2
  1. 1London School of Hygeine and Tropical Medicine, London, UK
  2. 2College of Medicine and Health, University of Exeter, Exeter, UK
  1. Correspondence to: J Hanefeld Johanna.Hanefeld{at}

No, the UK risks losing control over critical elements of NHS policy

Since leaked minutes of US-UK trade talks were made public on 25 November, a predictable war of words has been ongoing between the political parties and the media. But what do these revelations actually tell us about the possible impact of a post-Brexit US trade deal on the NHS? We have examined six sets of minutes1 and find two clear messages.

Firstly, these documents make clear the extent and form of US interest in the NHS, and it seems unlikely that factors affecting the provision of health services would be excluded from trade agreement negotiations. The NHS as a whole may not technically “be on the table,” but depending how negotiations are concluded, there is real potential for an agreement that greatly undermines the UK’s sovereignty over policy decisions in this space and the government’s ability to determine spending on …

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