As the referendum debate enters its final furlong, the issue of the future of the NHS in Scotland is being highlighted by both the Yes and No campaigns. 

As brickbats are hurled back and forth over whether Scotland can continue to resist privatisation with or without independence, it is worrying that both sides appear oblivious to the implications of a possible EU-US trade agreement for the future shape and form of Scotland’s public services.

The Trans-Atlantic Trade and Investment Partnership (TTIP) is being negotiated in secret by US government officials and representatives of the EU Commission. 

While it would seek to reduce tariff barriers, these are already minimal between the EU and the US and therefore its primary objective is to remove other regulations which are viewed by the negotiators and private businesses as “barriers to trade.” 

Given the current focus on the increase of private interests in the NHS, there is real concern that an agreement on TTIP could further accelerate the involvement of private business, including the large US health insurance companies, in tendering for NHS services. 

It is clear that TTIP, which involves the establishment of an investor-state dispute settlement (ISDS) based on courts operated by corporate lawyers, would allow companies to sue governments should they decide to restore previously privatised services, including any in the NHS, to public ownership. 

An ISDS system has already been applied in other international and bilateral trade agreements involving the US. Examples of its application include US tobacco company Philip Morris suing the Australian government over the introduction of plain packaging for cigarettes, Argentina being asked to pay $500 million following its decision to unpeg its currency from the dollar and Ecuador being pursued for billions of dollars by oil companies which were sued by the Ecuadorian government following damage to the Amazon rainforest.

In recent weeks the EU Commission has issued statements designed to reassure that TTIP will not force the tendering of health services across Europe. 

While such assurances are open to question — as is its definition of what constitutes a “health” service, given that many of the services already privatised in the sector are in “support” services such as cleaning and catering — the fact that such statements are now emerging is evidence of the growing pressure to exempt health from the coverage of TTIP. 

It should encourage campaigners to continue to press governments and the EU for further commitments on health exemption.

However, while it is to be welcomed that the opposition to the potential effect of TTIP on health services is increasing, it should remain a concern that many people, including elected politicians, appear unaware of the fact that TTIP, through the ISDS system, could still affect health services even if these are deemed to be exempt from the body of the agreement.

Moreover, it would continue to directly affect other sectors, including major areas of the public sector. 

While public services such as the judiciary, border controls and air traffic control are exempt from the scope of TTIP, it will cover areas such as education and local government. 

It will also seek to remove or reduce regulatory “barriers” in areas such as food safety, postal services, the environment, banking, data protection and employment rights. 

Although the detail of how TTIP will address these issues is patchy — given the secret nature of the negotiations — the US record in these areas makes it clear that people across Europe and beyond should be deeply perturbed.

In relation to food safety, for example, it has been reported that 70 per cent of food in US supermarkets contains GM products and there are claims that 40 per cent of US food would currently be restricted for importation to the EU under regulations governing the use of beef bovine hormone growth treatments, chlorine treatment in poultry and pesticide levels in fruit and vegetables.

We also know, in relation to employment rights, that the US has signed up to only 14 of the International Labour Organisation’s 190 conventions and many US states — most infamously Wisconsin — have brought in laws attacking trade union rights.

Proponents of TTIP here tell us that a trade agreement with the US would be good for job creation and job security. 

However, in its own TTIP “impact” report, the European Commission refers to the resultant “prolonged and sustained dislocation of European workers” and the experience of other US trade agreements shows that promised job creation was not forthcoming. 

Indeed, in the major  North American Free Trade Agreement deal involving the US, Canada and Mexico, the overall result was an estimated loss of over one million jobs.

While TTIP as an international agreement would clearly affect countries across Europe and beyond, it should be recognised that it would have particular implications for Scotland, given the stated anti-privatisation position of both of Scotland’s main political parties and the fact that the scope of TTIP would directly impact on areas under the Scottish Parliament’s jurisdiction — such as food safety, the environment, local government and health. 

For example, TTIP could force privatisation of health services and would certainly act as a barrier to taking health services back into public ownership — under penalty of the Scottish government being sued in the ISDS — irrespective of the outcome of the referendum on Thursday. 

Given this situation, both sides in the referendum debate should be demanding an input by the Scottish Parliament into the TTIP debate and joining the growing opposition to its current direction. 

In the mid-1990s, political activists and campaigners in Scotland played a role in the defeat of the proposed Multi-Lateral Agreement on Investment which threatened to place more power in the hands of the richest transnational companies to the detriment of the developing world. 

Much of the agreement’s worst characteristics — the secret discussions, the use of the ISDS system and the link between investment and deregulation — are mirrored in the TTIP process. 

We successfully opposed such moves then. Both the Yes and No campaigns should resolve to oppose TTIP now.

Jackson Cullinane is political officer of Unite Scotland.