Going private? What happened when a private health company offered an NHS campaigner a job

What happened when Care UK offered Alex Nunns a job?

What the heck is this? I’ve been trying and failing to stop the government from privatising the NHS for years, and now a private healthcare company has emailed me about a job!

The email from Care UK says they are "seeking a Media Relations Executive for our Head Office based in Colchester and your skills and experience appear to be a good match." Huh? They are offering a "competitive salary, 25 days holiday and corporate discounts."

Here’s what I have replied:

Dear Laura,

Thank you for your unexpected email about the Media Relations Executive job with Care UK. I am very interested. Since Care UK is possibly the leading private healthcare company making inroads into the NHS, I would relish the opportunity to publicise what it does – indeed, this is precisely what I was trying to do in my previous job as information officer for Keep Our NHS Public (on a much smaller budget, I’m sure). That must be what you were referring to when you said my skills and experience are "a good match".

As you can imagine, I am brimming with ideas. If you don’t mind, I would like to set them out here. First of all, I think much more needs to be done to let the public know what Care UK is. Hardly anyone realises just how big a chunk of the NHS you now run, from GP surgeries and walk-in centres to treatment units doing things like bunions. If I were your Media Relations Executor I would promote this aggressively to build the brand. I think the public has a vague idea about NHS privatisation, but they aren’t yet able to put a face to the name, so to speak. Care UK’s name could be that face. As a profit-making healthcare company owned by a private equity firm you are perfectly positioned.

I believe a key talent for any disrespecting Media Relations Executive is the ability to turn a negative in to something offensive. For example, it must have been a stressful time in the Media Revelations office when that tax avoidance story broke a few months ago – the one saying that Care UK had reduced its tax bill by taking out loans through the Channel Islands stock exchange. All this talk of tax havens and tax avoidance isn’t good in the current climate. But as your Media Relationship Executive I would have used a little reverse psychology, instead of denying it as your spokesman did. After all, this could put you right up there with the big boys like Goldman Sachs, Vodafone and Jimmy Carr.

Similarly, you got some bad press when it was revealed that the wife of your former chairman John Nash gave £21,000 to Andrew Lansley’s office before the last election, when Lansley was shadow health secretary. But let’s view it from another angle – doesn’t this serve to highlight Care UK’s excellent political connections? And look how it turned out: Lansley is in power and he has passed the Health Act. He has opened the door wide to privatisation, and Care UK is already inside redecorating the place. We thought Lansley wasn’t going to manage it for a while, when all those thousands of patients and doctors started protesting and June Hautot shouted "codswallop" at him in the street. But he pulled through, sacrificed his future public career for private gain, and God bless him for that. Care UK now stands to make a fortune. This is something to boast about, for Bevan's sake! And all for £21,000, less than it would cost to employ a Media Relations Executive for a year. (Please confirm.)

You should play to your strengths. Care UK is a true pioneer in this privatisation drive. You were the first private company to run a GP surgery in Dagenham back in 2006. And the first to face enforcement action from the Healthcare Commission because of slack hygiene procedures at the Sussex Orthopaedic Treatment Centre in 2008. And who’s to say you weren’t the first to forget to process 6,000 x-rays at your "urgent" care centre in North-West London in 2012? As a Mediocre Relations Executive, I would advise not mentioning those last two.

If there’s just one thing that Care UK knows how to do – and there is – it’s take money from the state. I would make a bigger deal of the fact that 96 per cent of Care UK’s revenue comes from the NHS. That’s the kind of solid base that any company would envy – taxpayers’ money, minimal risk, easy profits. So shout about it! It shouldn’t just be left-wing NHS obsessives who hear about this stuff.

Take the Barlborough Treatment Centre. It’s a complicated story, but in the hands of a good Media Relations Excretion it can be turned into a wonderful example of the company’s strengths. First, Care UK was paid £21.9 million over five years to do orthopaedic surgery – hip and knee replacements, that kind of thing – but you only did £15.1 million worth of work. (The local NHS Medical Director saw the trick, complaining: "The problem we have got is that they cherry-pick; they don't take any patients with complicated conditions". I guess the joke’s on him.) The NHS eventually realised it was getting a bad deal, and things weren’t looking good for Care UK. But then the NHS bought the treatment centre from you for £8.2 million, a lovely gesture. And finally the NHS signed a new 30 year contract to run the centre with. . . Care UK! (As an aside, it is important from a media management perspective not to spoil this tale of triumph-from-the-jaws-of-lucrative-defeat with any reference to the several lawsuits brought by local patients claiming that their surgery went wrong.)

As an example of what I could bring to the company I would like to propose a new corporate motto: "Care UK – Providing less, for more". These words came to me when I was thinking about Manchester, where last year the NHS paid you £2.7 million for work that was never done at your Clinical Assessment and Treatment Services centre. According to a parliamentary report, the services you provide up there are between 7 percent and 12 percent more expensive than equivalent services in local hospitals. Providing less for more – it’s a record that really ought to be publicised.

And Care UK should be proud of its talent for cost-cutting, like the plan to use more nurses and healthcare assistants in your GP surgeries because doctors are too expensive. Your managing director, Mark Hunt, describes this as "workforce efficiency on skill mix". As a Meddling Relations Executive I would advise him to ditch the jargon and tell it as it is. Patients might get a worse service, but at least the company is making more money and that’s good for the economy. We’re all in this together, as someone once said, in jest. I’m convinced that if Care UK followed my strategy it would solve the serious problem of patients accidentally opposing the private take-over of GP surgeries through confusion and surfeit knowledge, like when those blasted Keep Our NHS Public campaigners scuppered the Care UK health centre in Euston by threatening court action.

Be bold. Be proud. Be shameless. That’s the approach I would bring to the job, and I hope you like my initial ideas. Please be sure to let me know when and where the interview will take place (the formalities must be gone through, I understand). I trust that I will hear from you soon.

Yours sincerely,

Alex Nunns

Postscript [in the style of the bit at the end of BBC wildlife documentaries]:

It’s a weird phenomenon when something goes viral. How does it happen? It’s even weirder when the thing going viral is your first ever blog post.

After I got the email from Care UK I set up a blog just to host my reply. I posted the piece at about 10am on Tuesday, not expecting much. A campaigning doctor, @mellojonny, tweeted about it first, and it went round NHS activist circles. I’m not quite sure about the next stage, but somehow Zoe Williams of the Guardian and comedian Dave Gorman shared it, and then Jon Snow. By lunchtime, once Caitlin Moran had tweeted it to her 245,000 followers, it had attained the magical status that no-one can quite define: it was viral.

I hadn’t even tweeted it myself yet. I set up a search for references on TweetDeck, but they were coming in so fast it crashed. And most people weren’t even finding the blog on Twitter, but on Facebook. Friends had read it before I could put it on my own page. (Incidentally, this is a very strange experience for me – I’m more used to shouting at the walls in the hope they have ears.)

By the time I went to bed the blog had 73,186 views. That’s shown anyone who tries to offer ME a job!

Campaigners from the "Keep our NHS public" group during a Welfare State and Public Services March. Photograph: Getty Images

Alex Nunns is a campaigner against the privatisation of the NHS. He is Red Pepper's political correspondent and he co-edited the book Tweets from Tahrir, the first book to use tweets to tell the story of a historical event.

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There is nothing Donald Trump can do to stop immigration

The story of American immigration has been flowing inexorably in one direction. Even Trump's 24/7 tweeting can't turn the tide.

On 20 January 2009, it seemed that America had crossed the racial Rubicon. The simple fact of a non-white face behind a podium saying “president of the United States” would assure Barack Obama a place in the history books and begin a new chapter in the nation’s saga.

In January 2017, things look very different. Donald Trump won the election for many reasons, but one of them was surely a “whitelash” against a black president. Millions of Americans are not comfortable with “a person of colour” as their head of state and commander-in-chief. Some are racist; others enjoy some racist banter at the bar; many more just draw a colour line in the privacy of their hearts. Trump’s nominations to cabinet posts have included only a few non-whites, and these look like tokenism. His attitude to multiculturalism is paraded on donaldjtrump.com. At the top of his ten-point plan to “make America great again” is the pledge: “Begin working on an impenetrable physical wall on the southern border, on day one. Mexico will pay for the wall.”

Will Trump’s whitelash supporters be appeased? I doubt it. Judged against the longue durée of American history, it is Trump who is rowing against the tide – a tide of migration that has gradually eroded the dominance over American life and politics of those of white Anglo-Saxon Protestant (Wasp) stock. Nothing he can do will change that. Not the wall. Not the banning of Islamic immigrants. Not the deportation of “undesirables”. Not even 24/7 tweets. The Donald cannot turn back the Tide.

The story of American immigration has been flowing inexorably in one direction, despite periodic ebbs. The Trump whitelash is the latest of those ebbs. Here are a few snapshots from the past.

In the 1850s, the “Mexicans” of that era were Catholics, fleeing economic depression in Ireland and southern Germany and washing up in big cities such as New York and Chicago. The backlash against them took the form of the American Party, whose members had to be both native-born Protestants and the offspring of Protestant parents. Campaigning against “rum and Romanism”, the American Party demanded strict temperance laws and a ban on Catholics holding public office because of their “thraldom” to the pope. The party had a meteoric rise and fall, quickly eclipsed by the North-South divide over slavery, but anti-papism took time to fade. It was another century before the US elected its first Catholic president: John F Kennedy.

By 1900, the “threat” to American purity was posed by the “New Immigrants” from Italy, the Balkans and the Russian empire who did not look or sound like “Anglo-Saxons” from Britain, Ireland, Germany and Scandinavia. In the peak year of 1907, 1.3 million migrants were admitted, 80 per cent from southern and eastern Europe. “The floodgates are open,” railed one New York newspaper. “The sewer is choked. The scum of immigration is viscerating upon our shores.” It was time to drain the swamp.

The Wasp-dominated Immigration Restriction League campaigned for the “exclusion of elements unsuitable for citizenship or injurious to national character”. Its rhetoric was often overtly racist. In 1896, the Boston economist Francis A Walker blamed creeping globalisation in the form of railroads and steamships for creating what he termed “pipeline immigration”. “So broad and smooth is the channel that there is no reason why every foul and stagnant pool of population in Europe, which no breath of intellectual or industrial life has stirred for ages, should not be decanted upon our soil” – dumping in America those he called “beaten men from beaten races; representing the worst failures in the struggle for existence”.

The wartime crusade for “100 per cent Americanism”, together with the 1919 “Red Scare” against communists and anarchists, finally closed the open door. In 1921 and 1924, Congress slashed migration from Europe to 150,000 a year and imposed quotas based on the proportion of nationalities in the census of 1890, thereby targeting the New Immigrants. Some congressmen made the case in explicitly racist terms, among them Senator Ellison Smith of South Carolina, who declared: “I think we now have sufficient population in our country for us to shut the door and to breed up a pure, unadulterated American citizenship,” formed of “pure Anglo-Saxon stock”. This was the way to make America great.

It was not until 1965 that a new Immigration Act abolished national quotas. At the time, President Lyndon B Johnson played down the law’s significance. It would not, he said, “reshape the structure of our daily lives” but merely correct “a cruel and enduring wrong”. LBJ assumed that the beneficiaries would be people from southern and eastern Europe, the main victims of the 1920s quotas, and he did not anticipate a flood of migrants. Yet in the half-century since 1965, there has been a sustained surge of immigration. Whereas in the 1960s and 1970s, “foreign-born” represented only 5 per cent of the US population, in the 2010 census, the figure was 13 per cent – close to the peak of almost 15 per cent in 1920.

What’s more – and again contrary to Johnson’s expectations – the migratory surge came not from Europe but from Asia and, especially, Latin America. By 2010, 16.3 per cent of the US population of 309 million was identified as Hispanic or Latino, two-thirds of which was Mexican in origin. More than four million Mexicans entered the US legally in the decade from 2000 – equivalent to the total from the whole of Asia. Hence the political appeal of “build a wall”.

African Americans constitute the second largest minority group in the US, at 13 per cent. Most are the descendants of forced migrants in the 17th and 18th centuries: slavery was the “original sin” from which the land of liberty had been conceived. Even after emancipation during the Civil War, blacks remained second-class citizens, enduring segregation in the South and discrimination in jobs, housing and education in the urban North. It was Johnson again who unlocked the door: his Civil Rights and Voting Rights Acts of 1964-65 finally applied federal power to overcome states’ rights.

In doing so, however, LBJ triggered a realignment that pushed much of the previously solid Democratic South into the Republican camp. Richard Nixon’s “Southern strategy” in 1968 signalled a sustained if coded use of the race card by Republicans to woo the silent majority of disenchanted whites – carried on more recently by the Tea Party and Trump.

Hispanics and blacks – now nearly 30 per cent of the US population – have literally changed the face of America. Barack Obama incarnates the new look, being African American but of an exotic sort: the son of a black man from Kenya and a white woman from Kansas; born in Hawaii; raised there and then in Indonesia; and trained at Harvard Law School. As he said in 2008, “I have brothers, sisters, nieces, nephews, uncles and cousins, of every race and every hue, scattered across three continents, and for as long as I live, I will never forget that in no other country on Earth is my story even possible.”

Perhaps in no other country is Trump’s story also possible. Yet it is Obama who has history on his side. The US Census Bureau has projected that whites, who made up two-thirds of the population in 2008, will constitute less than half the total well before 2050 – outnumbered by Hispanics, blacks, Asians and other non-white minority groups with higher birth rates. However, by mid-century, the great divide between white and non-white that has colour-coded US history will probably have become meaningless because of intermarriage. “Obama is 2050,” declared the demographer William H Frey: “Multiracial. Multi-ethnic.”

Governing such a diverse country – even holding it together – will be an immense challenge. The vicious 2016 election prefigured many more culture wars ahead. In the long run, however, Obama – not Trump – is the face of America’s future. Some see that as a sign of degeneration. “Perhaps this is the first instance in which those with their pants up are going to get caught by those with their pants down,” fumed the anti-immigration campaigner John Tanton. But earlier nativists said the same, warning that supposed “lesser breeds” such as “Negroes”, the Irish or Italians were out-breeding their “betters”. Those with greater faith in America’s tradition of painful adaptability might see the country’s growing demographic diversity as signalling not the decline of the Great Republic but another of its epic transformations.

David Reynolds is the author of “America: Empire of Liberty” (Penguin)

This article first appeared in the 19 January 2017 issue of the New Statesman, The Trump era