Labour is right to protect the NHS, but it must focus on other issues too if Corbyn wants to win this election

Dealing with the US – and particularly Donald Trump – over a trade deal will be tough, so Labour is right to set red lines. But other issues like the economy now need their attention

Which Donald Trump to believe? (If any.)

There is the present-moment Trump, for example. As if carefully scripted by Conservative central headquarters, the US president now tells the media that America is not interested in the National Health Service even if it was “handed on a silver platter”.

In the summer, however, a seeming eternity ago, when he was hosted by Theresa May and might not have received the same level of intensive briefing and coaching as recently, he made it perfectly clear that in a trade deal “everything” is on the table – and he said so in direct response to a question specifically about the NHS.

We also have the ugly track record of Mr Trump’s trade relations with Canada, Mexico, China, Japan, Korea, the EU, and Brazil… in which there is a constant pattern of harassment and punishment, all in the name of instinctive protectionism and the famous Trump catchphrase – “America First”. According to one chronicler of the Trump White House, the president once wrote in capitals on a draft text of a speech on economics the words: “TRADE IS BAD”.

These are not encouraging auguries.

Perhaps the interested observer could look elsewhere for evidence of American intentions? That would include the 451-page document recently leaked to, and released by, the Labour Party. The dossier detailed discussion between Britain and American officials about pharmaceutical prices, and stressed that “the US approach was that everything in services should be open unless there was a very good reason”. Whether causing political embarrassment to a British government counts as “a very good reason” is a matter for some speculation.

Of course, if the US did agree to leave the NHS, drug pricing and other sensitive matters out of trade talks, then that could simply mean that, in the spirit of all such bargains, the US would be looking for rather more concession in other areas to compensate for being kept away from the health sector.

So, for example, the US could demand greater access to food markets – the emblematic chlorinated chicken being imported freely to the UK, to be sold in shops without any discriminatory labelling that would create an unfair disadvantage for the American producers. Much the same might go for genetically-modified crops, and the foodstuffs made from them, and hormone-treated meat. None would be welcomed by even this government; but the views of the Conservative Party are not the deciding factor in US trade policy.

Or the US might try to maintain tariffs, albeit lower, on such products as scotch, or cars, or steel. In other words, depriving American companies of the opportunity to tender for NHS contracts would mean a far more dramatic incursion into other areas of British national life. The US trade representatives might, say, ask for access to contracts from the state education sector, or local authorities or any number of state agencies. That American-tinged version of privatisation might or might not commend itself to the British public.

Size matters in trade deals, and the brutal fact remains that both the US and the EU are, roughly, about 10 times the size of the UK in economic terms. The British, in other words, as a great trading nation, need them rather more than they need the relatively small British market.

Under such conditions, there are limits to the amount of things the British can refuse to talk about with each of these potential trade partners; and a corresponding lack of clout when it comes to making demands of the Europeans and the Americans. The British will also face some novel tough choices of their own. Across whole sectors of trade and the economy, the UK will have to choose whether to align itself with US rules and regulations; or those of the EU customs union and single market. The British will have to learn all over again that they cannot have their cake and eat it.

When the time comes for Liz Truss and her team to open up talks with China and India, they might also find their design for a “points-based system” of immigration control will need to be amended to take account of the wishes of Beijing and Delhi. This, it is fair to say, is not much mentioned by the relevant ministers. Absolute political sovereignty sits badly with economic globalisation.

Finally, were it not such a hazardous path, a concerned voter might also take a glance at the Conservative manifesto, and what that says about the NHS: “When we are negotiating trade deals, the NHS will not be on the table. The price the NHS pays for drugs will not be on the table. The services the NHS provides will not be on the table”.

This seems clear enough, but it leaves a great deal of scope for further involvement in the private sector – including the private sector based in the United States. There is nothing, for example, to prevent US firms tendering to run a hospital or health clinic. There is nothing to prevent US-owned hospitals setting up in the UK and having the NHS refer operations and other procedures to them, just as it does now with private facilities. There is nothing to stop a US-based firm being given a contract to recruit staff, or provide catering or cleaning services – all areas routinely sent out for tender today. The US trade representatives have also suggested that the National Institute for Health and Care Excellence drugs watchdog unfairly restricts the variety of drugs available to patients on the grounds of price – and that precise point is also not covered in the Conservative manifesto, even though it could cost the NHS a great deal of money.

“Our NHS is not for sale” is a powerful slogan that has been much used by Labour and, according to the polls, has helped the party pick up a little support in recent weeks, as the campaign has pivoted from Brexit to public services. Yet, if anything, it is one of the more misleading claims Labour could make, because, in literal terms, the British system of taxpayer-funded health provision free at the point of use is not something that can simply be “bought” like a conventional corporation or piece of real estate, say. The incursion of the US private sector in the provision of ancillary services is not so very different to the present situation, where British or European based companies are competing for business.

The NHS is the only major policy area that the Labour Party has enjoyed a consistent and healthy opinion poll lead on since the foundation of the service in 1948. But it does not win elections for Labour, and the party has no need to exaggerate the very real risks that a US trade deal would hold by implying that some Trump look-a-like is about to take control of every bedpan and packet of aspirins in every NHS hospital clinic and GP surgery in the land. Labour has done the job it needed to do in driving the debate onto the NHS, and picked up support as a result – but it needs to make much more progress on issues such as the economy more widely, and the credibility of policies such as the four-day week. And time is short.