For Britain and the NHS, this could be Donald Trump’s most important visit yet

The US president’s previous trips have been higher profile, but our election and our future are now intertwined with his reputation.

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It was only in June that Donald Trump claimed the thousands of Brits protesting against him during his state visit were actually “cheering”. And now he’s coming back for more – this time to attend the Nato summit in Watford.

His state visit in early summer was defined by demonstrations, with the now-iconic Trump Baby blimp and other spectacles echoing protests that took place on his first visit to the UK as president in 2018.

During both those trips, the US president made headlines with his comments about our domestic politics.

In July 2018, amid the aftermath of the Chequers agreement that triggered cabinet resignations, Trump gave an interview to the Sun warning that Theresa May’s Brexit plan would “kill” any future trade deal with the US, accusing her of ignoring his advice and saying Boris Johnson would make “a great prime minister”.

During his state visit in June 2019, during the Tory leadership election, Trump was outspoken about the race for the next prime minister, speaking to then contenders Jeremy Hunt, Michael Gove and Boris Johnson, and making his preference clear (“I know Boris, I like him, I’ve liked him for a long time, I think he’d do a very good job”).

He also raised eyebrows by hosting an informal meeting with Brexiteers like Nigel Farage, Iain Duncan Smith and Owen Paterson.

Yet the greatest political stir he caused was when he said the NHS would form part of trade negotiations: “When you’re dealing in trade, everything is on the table. So NHS or anything else, a lot more than that, but everything will be on the table, absolutely.”

Although he later rowed back on these comments, the damage was done – opposition politicians were mentioning it at anti-Trump rallies and cabinet ministers were forced to do damage control.

On paper, Trump’s visit this time round should be lower-key than before. He’s here for Nato rather than the specific matter of UK-US relations, and the novelty of protesting against his presence has been wearing off over the years (fewer people took to the streets during the state visit than in 2018, for example).

A bilateral meeting with Boris Johnson is conspicuously absent from his diary, according to a report by the New York Times, despite meetings lined up with Emmanuel Macron and Angela Merkel and a reception at Buckingham Palace hosted by the Queen.

During a radio interview with LBC last week, the Prime Minister as good as told Trump not to interfere with Britain’s electoral politics this time round:

“What we don’t do traditionally as loving allies and friends, what we don’t do traditionally, is get involved in each other’s election campaigns,” he said. “The best [thing] when you have close friends and allies like the US and the UK is for neither side to get involved in each other’s election.”

This new arms-length rhetoric was also clear in the jarring accounts of a phone call between Trump and Johnson in early November, as observed by the New York Times – White House officials talked up a “robust bilateral free trade agreement”, whereas No 10 emphasised Johnson’s urge for the US to drop tariffs on Scotch whisky.

A key aspect of Labour’s election campaign has been to tie Johnson to Trump, and define him as a “friend” of the unpopular US president (who only has an 18 per cent positive opinion rating in the UK, according to current YouGov polling).

This message was compounded by Jeremy Corbyn’s release of official documents last week revealing that the NHS featured in pre-trade deal exploratory talks with Washington. His line is that Johnson is putting the NHS “up for sale”, cosily carving up our health service with his close pal Trump.

The Conservatives insist both in interviews and in their election manifesto that the NHS will not be opened up to US markets:

“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.”

Yet as both my colleagues Stephen and Ailbhe have already argued (and you can hear more from the whole team on our podcast about this issue), access to the NHS and related markets and services would be crucial to any meaningful trade deal from the US's point of view.

The NHS is the world’s largest health institution, and the most significant procurer of healthcare products. This makes it a huge attraction for US corporate interests, including pharmaceutical and medical technology companies. Pharmaceuticals and healthcare industries in the US spend more on lobbying the US government than any other sector, according to Dr Charles Clift, a senior consulting fellow at the Centre on Global Health Security at Chatham House.

In reality, the “full market access” and “competitive pricing” mentioned in the transcripts of talks released by Corbyn mean “US companies would expect the NHS to treat all eligible patients with their new drugs, at prices set within free-market conditions”, according to Andrew Hill, a senior visiting research fellow in translational medicine at Liverpool University.

“The UK is the weaker partner in this trade deal and might have to decide between accepting higher drug prices or risk not signing a new US trade deal at all.”

Although Corbyn’s documents are not proof of the government secretly selling off the NHS, they do show that the US expects the NHS and drug patent regime to feature in discussions.

The Labour leader has also made a speech during this campaign warning that Johnson will sacrifice our food standards for a trade deal with the US: “They’ll slash food standards to match those of the US, where what are called ‘acceptable levels’ of rat hairs in paprika and maggots in orange juice are allowed.”

Again, although the Tories insist there would be no lowering of food standards, it’s clear US trade negotiators would need the UK to do away with EU regulatory standards for any kind of meaningful new arrangement.

Indeed, a memo leaked from the Department for Environment, Food and Rural Affairs (Defra) in October warned of pressure to drop agri-food standards as part of a free trade deal with the US.

When I interviewed the environment minister Zac Goldsmith that same month, he insisted Brexit was an “opportunity” to “improve our animal welfare and environmental standards” and reiterated the government’s commitment not to drop standards. Yet even he caveated this with the threat of falling standards in post-Brexit Britain: “Will future governments be tempted to water things down? Possibly, but then it is for parliament and for people to apply pressure, but that won’t be necessary with this government.”

Tying Johnson to Trump is a key attack line for Corbyn, which touches on many subjects the British public holds dear, including the NHS, animal welfare and food standards. It could be tough for Downing Street to keep Trump out of the election conversation during his visit. After all, two days after the election was called, Trump phoned in to Farage’s LBC show with some comments on Johnson’s Brexit deal: “To be honest with you, this deal, under certain aspects of the deal, you can’t do it, you can’t trade, we can’t make a trade deal with the UK… Under certain ways, we’re precluded, which would be ridiculous.”

And Johnson’s reputation as untrustworthy (he has been laughed at twice during TV debates when asked about telling the truth) is exacerbated when presented in the same light as a decidedly post-truth leader like Trump.

The question this week is whether Johnson will be able to avoid the association with Trump. That will very much depend on Trump breaking the habit of a presidential lifetime, and keeping quiet about the UK’s affairs.

Anoosh Chakelian is the New Statesman’s Britain editor.