Yasaman Barzin is a junior doctor in the United Kingdom's National Health Service. She has worked in hospitals across England and is based in an emergency department in the southeast.
With each posting, her concerns have increased about the state of the NHS. As the U.K. heads towards a general election brought on by the stalemate of Brexit, she decided the best way she could contribute her voice to the debate about the NHS's future was to speak publicly to passengers on busy commuter trains.
"I'm here because the NHS is in crisis," Barzin told passengers recently. "In the last few years, we have had cuts. We are losing nurses. We are losing beds."
The British are not known to be chatty on public transport, but it didn't put Barzin off as she spoke out, explaining how her patients in the emergency department have had to wait more than 24 hours for a bed on a ward and how she has seen children under 16 wait three days for an emergency Mental Health Act assessment.
She has increased the number of these "train talks" as the U.K.'s Dec. 12 general election gets closer. So far, she has done more than eight and sees it as her duty to share her personal experience of the NHS, hoping to influence voters to think about the NHS and the political promises being made when they vote.
Fears of NHS being 'sold off' in U.S.-U.K. deal
With the NHS providing free health care and paid for from taxation, funding is always a key election issue.
But with Britain's planned departure from the European Union looming, it's even more central than usual in the political party campaigns, with opposition claims the NHS could be "sold off" as part of a future trade deal with the United States.
"When you're dealing in trade, everything is on the table. So, NHS or anything else," U.S. President Donald Trump said earlier this year.
However, Trump appeared to walk back that sentiment on Tuesday during a news conference with NATO secretary general Jens Stoltenberg in London. When asked if the NHS should be on the table during trade talks, Trump said: "No, not at all."
"We have absolutely nothing to do with it, and we wouldn't want to if you handed it to us on a silver platter," he said.
Barzin is fearful of any suggestion that the NHS could be broken up for profit. It's not what she went into medicine for, she said. She wants an NHS that is equal for all.
"When your patient comes in, you don't have to worry about asking them for insurance. You don't have to worry about asking if they can afford that. And you don't have to make difficult decisions with them about whether they want a treatment or not because of a financial basis."
She said her shifts are spent juggling emergency medical care and bed space.
"The NHS is becoming destroyed and these coming years I think will be a huge turning point … depending [on] what happens with Brexit," Barzin told CBC.
In 2004, the Labour government introduced a four-hour target for emergency room patients, with 95 per cent meant to be seen, transferred, admitted or discharged within that time. It's not been met since July 2015.
According to NHS England, the 18-week waiting time standard for planned elective care hasn't been met since February 2016.
Last Wednesday, the main opposition Labour Party presented what it said was a 451-page leaked dossier detailing exploratory trade talks between U.K. and U.S. officials.
Labour Party Leader Jeremy Corbyn said a secret deal is being hatched to carve up the NHS and hand it to "Big Pharma" to make billions from the misfortunes of British patients.
The ruling Conservative party, led by Prime Minister Boris Johnson, has rubbished that and called out Labour for diversionary tactics.
With less than two weeks to polling day, British voters have to decide who to believe.
Kerry Lakin, an early years educator from Coventry in the West Midlands, has an autoimmune disease and takes a daily "cocktail" of medication. She fears that any external buyout involving pharmaceuticals could see moderate drug pricing increase drastically.
"I could potentially need to choose which drug to drop to manage the cost." she told CBC, "My quality of life will diminish. I may not be able to work. I could realistically develop complications that could lead to a stroke or a heart attack."
The NHS is the world's fifth-largest employer, with at least 1.5 million people. It's eclipsed only by Walmart, McDonald's, China's People's Liberation Army and the U.S. State Department, according to the Nuffield Trust, a health think-tank, and the World Economic Forum.
Dan Wellings, a senior fellow at the London-based, health-focused Kings Fund think-tank, said the group's research indicated "one in two people say the NHS is the thing that makes them proudest to be British."
But austerity measures since the global financial crash in 2008 have hit hard.
A "prolonged funding squeeze on the NHS since 2010, together with growing demand for care and staffing shortages, has led to significant deterioration in performance across the board," says the Kings Fund analysis.
'From the cradle to the grave'
The NHS turned 70 last year. The Kings Fund research asked people if the original principles still stood — a health service that was free at the point of need and available to all "from the cradle to the grave."
"The vast majority of people still strongly support those principles," said Wellings.
But there are questions about how long the model can last — and if the promises being made by political parties vying for the keys to 10 Downing Street of extra funding, nurses and doctors are enough.
Private companies have always played a role in the NHS. A publication by the Kings Fund says "some services, such as dentistry, optical care and pharmacy, have been provided by the private sector for decades and most GP practices are private partnerships."
Data suggests that around 25 per cent of NHS spending goes to the private sector, such as GPs, pharmacy, optical and dental services and outsourcing elective hospital treatment, partly to help hit waiting list targets.
U.S. companies can already bid for those private contracts to provide clinical services in England.
Labour fears any post-Brexit trade deal could open the door to U.S. pharmaceutical companies exploiting the market and leading to an increase in drug prices, hitting the poorest and those most in need hardest.
The Tories have denied the NHS will in any way be up for sale as part of a trade deal.
A 'very real' threat
Dr. John Lister, a health policy specialist and secretary of a pressure group, Keep our NHS Public, said he doesn't believe U.S. health insurers or hospitals will see any real profits from working with a relatively under-funded NHS.
But the earlier threat from Trump, he warned, must not be dismissed, particularly if the U.K. crashes out of the EU without a good deal — or worse, none at all — before the December 2020 negotiating deadline.
"I think the threat on pharmaceutical prices is very real and that a Johnson government, especially after a no-deal Brexit, would be a soft target," he told CBC.
"Other U.S. health corporations could also see the possibilities of exploiting the extent to which the NHS is already open to the private sector."
The only way to prevent the NHS being broken up and sold off in bits to private U.S. companies would be through legislation, reversing wide-ranging reforms brought in seven years ago and making the NHS a "fully public service without contracting," Lister said.
With Labour arguing that the NHS is up for sale under a Conservative government and the Conservatives saying no, it's not, the question for voters now is who do they believe?