by Denis Lyons
London, 13 May 2024 - The Prime Minister today announced the sale of Britain’s National Health Service to the American healthcare giant, American Medical Services, hailing the deal as “a historic leap forward for British healthcare” and “a triumphant marriage of compassionate conservatism and fiscal responsibility.”
Flanked by his Health and Treasury ministers and by Paula Baxter, the charismatic CEO of the giant American Medical Corporation headquartered in Los Angeles, the PM beamed ecstatically as he surveyed the reporters in the Downing Street press briefing room. “Our new partner, AMC,” the PM continued, with a dazzling smile in Paula’s direction, “will assume full operational control of the NHS as soon as the enabling legislation is approved.”
In answer to somewhat sceptical questions, particularly from the BBC and the Guardian, the PM responded briskly, “Passing this legislation will not be a problem.” Pausing briefly, he added, “If we can get the Rwanda Bill through, we can certainly get this one through.”
The NHS-AMC deal, if approved, will be one of the biggest and most unusual deals of its kind in history, not least because the sale of an entire government-run healthcare system of this size to a publicly-quoted corporation is believed to be a first.
In terms of staffing alone, the NHS is the biggest government-run healthcare system in the world, with a total UK workforce of about 1.8 million people and total annual UK expenditures running at about £220 billion. It is not only Britain’s biggest employer but also one of the world’s largest: while the UK’s NHS workforce is smaller than the US, Chinese and Indian armies, it is 10 times larger than the combined British armed forces, slightly smaller than Walmart and similar in size to Amazon.
AMC is the biggest and one of the most respected international private healthcare companies, with 200 hospitals, 2,000 medical facilities and over 300,000 employees worldwide.
Commenting on the deal which has been the subject of febrile market rumours over the past 24 hours, the PM said, “For many years the British public have been yearning for our brave but under-resourced NHS to be brought up to date. Previous governments have shied away from tackling this critical problem but this government will not shy away. I am proud that my government has been courageous enough to deliver this bold 21st century solution to a 21st-century problem.”
The PM was referring to mounting evidence that, despite its world-class healthcare professionals, the NHS is at breaking point. Years of cuts, staffing shortages, pay disputes and long waiting times for medical procedures have led to several recent strikes over pay and conditions by tens of thousands of nurses, consultant doctors, junior doctors and ambulance workers, despite the NHS’s almost sacred status as a revered national institution.
“Under the terms of the agreement AMC will assume full responsibility for running the National Health Service in England, Scotland, Wales and Northern Ireland, with the UK government retaining a 51% interest in this vibrant new partnership“, the PM said. “This will enable the merged NHS and AMC organisations to achieve enormous efficiencies and will guarantee enhanced free medical services to all who need them, as well as excellent private healthcare services for those who prefer them.”
Striking a less than convincing Churchillian pose behind his podium, the PM continued, “Free healthcare services and freedom of choice - this is what we have promised the British people and this is what we are delivering.”
In confident mood, the PM decided to risk a question from Gary Hardcastle, The Morning Star’s loquacious scourge of the privileged classes. “PM isn’t this the most epic betrayal of the British people’s trust? This trashes Nye Bevan’s legacy. Hard-working people up and down the country…”
“If I can stop you there, Gary,” the PM was now in full campaign mode, “this actually leverages Nye’s legacy“. The PM liked the word “leveraging” which he had discovered during his time in Silicon Valley. “Leveraging, Gary, that’s the key. With AMC‘s AI skills and its technological expertise in achieving operating efficiencies we can actually put even more resources into free health services. Everyone wins, Gary.”
The PM knew he was on a roll – he could tell from their open-mouthed expressions that the press corps was impressed. He decided to extend his winning streak and invited a question from the Daily Mirror’s Gwen Delaney, a commanding presence in horn-rimmed spectacles.
“Mine is for Paula Baxter. What does an American company know about our complicated British health system?” Paula had been ready for this one long before she had even left Los Angeles.
“Well, Gwyneth….”
“Gwen, actually,” she adjusted her horn rims reproachfully.
“I’m sorry, Gwen. Well, Gwen, we at AMC know quite a lot about the British system actually. Did you know, for example, that, like a number of US healthcare companies, AMC has been present in the UK for 30 years? That we already operate 85 various types of medical facilities throughout the country? That we own and operate a network of top quality private hospitals in the UK? That we already have major working partnerships with several of your most famous NHS hospitals? That we provide services in key areas like cardiac surgery, cancer care and neurosurgery, and that we are the largest provider of robotic surgery in the independent sector?”
Gwen did her best to look like she did indeed know all this.
“We also have the most rapidly expanding network of GP practices in the country,” Paula went on, “and, if you’re concerned about quality….well, as you know, whoever owns these practices - British or American - they all work under contract to the NHS and they must be able to meet the strict standards and regulations that apply to all NHS providers.”
Gwen nodded meekly. “So, Gwen, I hope that answers your question?” Paula asked rhetorically as she turned away and pointed to Tim Caxton-Bailey of the Financial Times, easily identified by his signature stubble cut and snowy white Jermyn Street cuffs.
“Isn’t this just a rerun of private equity firms moving in for a quick profit and effectively privatising the NHS by stealth?” Caxton-Bailey asked with studied languor. Referring to his notes, he went on, “A recent BMJ review said that private equity ownership was ‘most consistently associated with increases in costs to patients or payers’ and was ‘associated with mixed to harmful impacts on quality’ and that there were ‘no consistently beneficial impacts of private equity ownership’.”
“But…,” Paula glanced at her prompt sheet, “…...Tim, with great respect, we are not a private equity company. We don’t just invest in health care – we actually deliver health care. This is not a high-speed financial shell game. This is a long-term operational relationship. This is a marriage of equal partners.”
The initial shock of the announcement was wearing off, but even the usually unruffled Hugo McIntosh from The Times found his voice rising as he asked the PM, “Doesn’t this mean that the government is simply abdicating its responsibility and auctioning off the NHS to the highest bidder?”
“Not at all, Hugo. The New NHS, as it will be called, is structured so that, as I said, Britain retains a 51% interest in the merged companies in order to guarantee that the British public will benefit from the improved free health care delivery which AMC will be incentivised to provide.”
With well-modulated incredulity, the Daily Telegraph’s entertainingly acerbic Malcolm Kennedy, patiently took his turn. “PM, over the past 20 years we have watched the NHS deteriorate inexorably from holy cow to sacred relic. Why would a profit-making company – and an American one at that - want to go anywhere near it?”
“I think this one’s for me, Prime Minister,” Baxter intervened smoothly. “There are no great models for free healthcare systems, Malcolm, and, let’s face it, even NHS fans are not too happy about yours. The old model was great, maybe, when it was founded in 1948. But the old model just doesn't work any more. Right?” Suddenly there were no dissenters in the press briefing room.
“All the evidence points in the same direction. Public satisfaction in the NHS is at its lowest ebb in 40 years. And you all know the reasons why – years of cuts, political neglect, staff shortages, dilapidated facilities, lack of beds, scanners, long waiting times for GP appointments, for medical procedures, or for being seen in an emergency department. You know the story. The doctors and nurses are great, but the system is under stress. If you don’t adapt the system to the world as it is now, the world will change it for you.”
Malcolm was not convinced. “But surely this proposal sets up a two-tier system which the British public will never tolerate?”
“Will never tolerate? But Malcolm, that’s exactly what it’s doing right now!” Now it was Paula who was on a roll.
“About 15% in a recent British poll said that they typically or always pay for private health services. Did you know that 10% of all elective procedures were already being outsourced to private medical facilities in England for the first time during 2023? It’s as high at 20% in some areas of the UK. And change is happening fast – predictably, as is often the case - among the younger generation. Last year over 40% of 18-24 year olds polled said they had used private healthcare.”
“You have about 900 NHS hospitals in the UK, Malcolm, but there are also over 200 private hospitals, some of them ours. And many of the private hospitals and clinics are foreign-owned – and not just by American companies.”
“So you see, Malcolm, this doesn’t establish a two-tier system – you already have a two-tier system or, as many of your compatriots prefer to say, a freedom of choice system.”
It was The New Statesman’s renowned columnist, Desmond Campbell – “Dogged Des” to his colleagues - who returned to the raw nerve issue. “PM, your critics will immediately say that this is the inevitable final act in the privatisation of the NHS which has been in the making for many years. They will say that it is a cynical move to line your cronies’ pockets. They will also say that you are desperately trying to distract attention from the government’s drubbing in this month’s local elections and the prospect of inevitable, ignominious defeat in the upcoming general election. What do you say to those critics?”
“Quite simply, Desmond, that this deal will reinforce the NHS’s founding principles, particularly the pledge to provide healthcare which will remain free at the point of delivery. The NHS already has partnerships with private health organisations where the private entity invests a share of its profits back into the NHS. This deal enables The New NHS to adopt the same approach on a much bigger scale for the benefit of all. In addition to generating this entirely new funding to update and expand free NHS services, the deal also entitles the NHS to share in the profits made by AMC’s private facilities. It’s win-win, Desmond.”
Turning to go, the PM added, “This is a great day for Britain. Thank you everyone.” He had almost reached the door when Gary Hardcastle shouted after him, “Does this mean that you will be able to give up your private healthcare, Prime Minister?” The PM rewarded Gary with a gleaming, if enigmatic smile.
Following today’s Downing Street announcement of the NHS-AMC deal, the British Pound jumped to its highest level for three years against the US Dollar, while AMC’s stock fell 10% on the NYSE.
The Make Britain’s NHS Great Again Bill is scheduled for its formal introduction and first reading in the House of Commons tomorrow.
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