Never mind the insults to Sadiq Khan, Mayor of London. Or the refusal to accept Jeremy Corbyn’s suggestion of a meeting. Or the deliberate breach of protocol in commenting on the candidates to succeed Theresa May as leader of the Conservative Party and therefore Prime Minister.
These were within the bounds of Trumpery as the world has come to know it. The US President has said much the same before, albeit from the other side of the Atlantic. This visit was never going to deal with what was substantial, given that Theresa May will step down as leader of her party on Friday (and as Prime Minister as soon as her successor is picked). The timing rendered the visit all but meaningless.
The President did make one substantial point, so immediately provocative that it brought Tory leadership candidates out in instant retaliation. Smiling broadly, saying that the US and UK were heading for a “phenomenal” trade deal, he made clear that access for American companies into the NHS would be up for negotiation. “Everything will be on the table – the NHS, everything,” he declared at the joint press conference with Theresa May. Matt Hancock, Secretary of State for Health and Social Care and a contender to succeed her, was first out of the traps to retort via Twitter: “Dear Mr President. The NHS isn’t on the table in trade talks – and never will be. Not on my watch.”
The next morning, Trump appeared to backtrack, telling ITV’s Good Morning Britain that “I don’t see it being on the table” as the health service was “not something I would see as being part of trade.” But his first remarks – presaged by identical statements from Woody Johnson, US Ambassador to the UK – stand as a warning to the next prime minister of the pressure of entering into trade talks with the US. No prime minister – or prime ministerial candidate – can afford to suggest the NHS is in play, given its totemic standing in Britain and how powerful any suggestions of opening it to the competitive, private American market for healthcare would be in any context.
Were the politics not so emotive, there might be more room for a fudge. Politicians have insisted that the NHS is entirely a state system in that it is free at the point of use, available to all, and funded by general taxation. But around 11% of the Department of Health and Social Care’s revenue budget is spent on health care services from non-NHS suppliers which include commercial companies as well as local authorities, charities and social enterprises. The proportion going to private sector companies for services is just over 7%. There has, too, been enormous growth in private provision of social care, albeit commissioned by local authorities. Already, some of the private companies selling the NHS services are American (notably in some areas of mental health).
But even this limited level of provision is controversial, with critics arguing that it is changing the NHS’s values. Nor does it resemble what President Trump and his ambassador probably have in mind – a much more extensive opening up of the NHS’s supplies and services to US providers. Whatever the merits of some of these deals in theory, they would immediately provoke accusations that the NHS was becoming like American healthcare (with its high charges for patients) or being run “for profit”. Any politician venturing into this space risks a violent backlash.
Even if that point is defended, it illustrates how hard it will be for the UK to hold out for what it wants in trade negotiations with the US. Food standards – the now infamous chlorinated chicken – will be an even harder battle. For all ministers’ protestations, the UK will face a binary choice of whether to stay close to the EU in its standards, or the US. Then there is Huawei, where US indignation at Britain’s willingness to deal with the Chinese technology giant in building 5G capacity could become a real problem. It strikes at the heart of the intelligence sharing relationship, the most solid part of the “special relationship”, now sharply diminished whatever protestations this week’s D-Day commemorations bring forth.
Had this been a conventional visit with a prime minister who had more than hours left in her post, the two sides might have managed more substantial discussions on real points of disagreement. Chinese trade is one; the Iran nuclear deal is another, and the provocation of the US moving its embassy in Israel to Jerusalem a third.
The President went out of his way to be courteous to Theresa May’s efforts on Brexit (although he has disparaged them previously). But however cordial he chose to be yesterday, his remarks should be a warning. In trade talks with the US, the UK will be challenged to surrender all kinds of points it regards as unshakeable principle. It should expect to get a deal only if it gives up some of them. The unhappy political decision will be to work out which come at least cost.