This article was updated at 2pm on Wednesday 28 May to reflect an error. It previously stated that there were 7.5 million patients on waiting lists. This was inaccurate. There are 7.42 million cases involving about 6.25 million people in England.
For over 75 years, the National Health Service (NHS) has been the bedrock of universal healthcare in the UK – a system where no one should die because they can’t afford care. But today, the NHS is on its knees, systematically dismantled by both Conservative and Labour governments over four decades, with private US healthcare companies poised to feast on the carcass. From Margaret Thatcher’s first cuts, to Wes Streeting’s latest manoeuvres, the NHS has been hollowed out for profit, against the will of the British public.
Now, a new nightmare looms: a Reform UK victory in the next general election, led by Nigel Farage, could obliterate the NHS in as little as 2–3 years, turning the UK into a patchwork of corporate sovereignties where democracy is replaced by a CEO-led ‘Sovereign Corporation’.
This isn’t a conspiracy: it’s a documented, deliberate, and devastating betrayal, turbocharged by the rise of the libertarian right.
Thatcher’s blueprint: the seeds of privatisation (1980s)
The assault on the NHS began under Margaret Thatcher in the 1980s. Her government introduced competitive tendering in 1983, outsourcing ancillary services like porters, kitchens, and cleaning to private firms. This wasn’t about efficiency – it was about profit.
Hospital-acquired infections spiked as private companies cut corners to maximise margins. Access to NHS opticians and dental care was slashed, with charges introduced to erode universality.
By 1988, Thatcher’s allies, including Oliver Letwin (a privatisation expert at NM Rothschild Bank) and MP John Redwood, published Britain’s Biggest Enterprise, a manual for privatising the NHS through stealth. The Adam Smith Institute’s The Health of Nations expanded on this, advocating for trusts, private companies, charges, profits, and health insurance – a blueprint that has guided the NHS’s destruction ever since.
PFI to PPP: A debt trap for profit (1990s-2020s)
The 1990s saw the introduction of Private Finance Initiatives (PFI) under John Major’s Conservative government, a mechanism to fund new hospitals without upfront public spending. It was a Trojan horse: private firms built and maintained NHS facilities, locking taxpayers into exorbitant repayment contracts. Tony Blair’s New Labour doubled down, funding 100 new hospitals at a cost of £12.7bn through PFI. The catch? Repayments ballooned to over £80bn, with the public never owning the hospitals even after the debts were paid.
As of May 2025, NHS trusts are still laden with these debts, forced to sell assets to cover costs, a covert bed closure program shrinking capacity for private gain.
The transition from PFI to Public-Private Partnerships (PPPs) in the 2000s and 2010s expanded this model. PPPs allowed private firms to take on broader roles, from building infrastructure to delivering services. By 2020, the NHS was spending £8bn annually on PPP contracts, a figure that rose to £12bn by 2025, according to Corporate Watch.
These deals enriched companies like Serco and Capita, while NHS trusts lost control over their own operations.
This debt trap wasn’t an accident. It was designed to justify hospital closures and pave the way for private sector land grabs, setting the stage for a full-scale privatisation push.
Labour’s Complicity: from Blair to Streeting (2000s-2025)
New Labour didn’t just inherit the Tories’ privatisation agenda – they amplified it. Blair’s government embraced PFI and PPPs, while the 2012 Health and Social Care Act (HSCA) under the Conservative-Lib Dem coalition removed the Secretary of State’s duty to provide universal healthcare, handing responsibility to quangos like NHS England (NHSE).
This opened NHS contracts up to private firms, accelerating corporate creep.
Simon Stevens, the NHS England’s chief executive from 2014 to 2021, was a former UnitedHealth executive who rolled out Sustainability and Transformation Plans (STPs) and Accountable Care Organisations (ACOs). These models were inspired by the US private insurance industry. His Five Year Forward View aimed to:
- Slash full A&E hospitals from 140 to 70-40.
- Reduce GP surgeries from 7,500 to 1,500 “superhubs”.
- Close smaller hospitals to cut costs for private firms.
- Shrink care for the sickest patients while outsourcing routine procedures.
Fast forward to 2025, and Labour’s Wes Streeting (who blocked me on X for taking him to task on donations) is continuing this legacy. Streeting, who has received £175,000 in donations from private health-linked firms like MPM Connect, oversaw the abolition of NHS England in March 2025, replacing it with a smaller body under tighter Department of Health and Social Care (DHSC) control.
This followed the ousting of NHSE’s chair Richard Meddings and CEO Amanda Pritchard, with Sir Jim Mackey appointed as a temporary replacement.
Streeting’s reforms are a facade for profit.
In January 2025, Private Eye exposed how the NHS Cheshire and Merseyside Integrated Care Board awarded a £124m ‘Appointments and Patient Choice’ contract to divert NHS patients to private hospitals. Streeting has also brought in Camilla Cavendish, a former advocate for privatisation who oversaw the failed Circle Healthcare takeover of Hinchingbrooke Hospital in 2012, which collapsed in 2015 after care was rated “inadequate”.
US Healthcare’s corporate creep: UnitedHealth, Palantir, and Free Zones
US healthcare companies have been central to this privatisation push. UnitedHealth, where Simon Stevens worked, has influenced NHS policy through its global division, promoting ACOs (now rebranded as Integrated Care Systems, ICSs). Optum, a UnitedHealth subsidiary, has secured contracts for data management and patient care coordination, embedding itself in the NHS’s core.
Palantir, a US data analytics firm with a controversial history, has also won NHS contracts to manage patient data, raising privacy and profiteering concerns.
In 2024, the NHS spent a record £216m outsourcing X-ray examinations to private firms, many with US ties.
Peter Thiel (co-founder and the chairman of the board of Palantir) once said “The NHS makes people sick”. He also said:
I no longer believe that freedom and democracy are compatible.
You see where this is going? Thiel’s contempt for democracy, and for the welfare state, aligns with the Tories, Labour, and Reform UK’s neoliberal policy agendas. Thiel is a huge fan of free zones. Therefore, it is no coincidence that Palantir now has its tentacles not just in the NHS, but also the police, and the Ministry of Defence.
What are Deregulated SEZs and Freeports?
Deregulated Special Economic Zones (SEZs) are geographically defined areas where businesses operate under a special regulatory framework that differs from the rest of the country. These zones often have relaxed labour laws, reduced taxation, and fewer environmental or administrative regulations.
Freeports are a specific type of SEZ, typically located near ports or airports, where goods can be imported, processed, and re-exported without incurring standard customs duties or taxes until they enter the broader domestic market.
The rise of Freeports and Special Economic Zones (SEZs) – 86 in total, covering regions up to 75km in diameter, has turbocharged this corporate creep. These zones, backed by both the Tories and Labour, offer tax breaks and deregulatory frameworks, creating “corporate sovereignties” where businesses wield significant power.
By 2024, the government had spent £19.78bn on freeports and SEZs, with £64bn planned by 2046-2048, according to a May 2025 report.
Yet they’ve delivered only 22,067 new jobs, at a staggering cost of £896,246 per job, with 66%-96% of promised jobs displaced rather than created. Firms like BlackRock, owning 80% of shares in Harwich, Thamesport, and Felixstowe freeports, are positioned to profit, often at the expense of public services like the NHS.
Freeports and SEZs could become hubs for private healthcare firms, scaling up NHS outsourcing at an alarming rate. If US companies like Optum or Palantir establish operations in these zones, they could double or triple outsourcing spending by 2030, hollowing out the NHS faster than projected.
MPs and their dirty money: Streeting and beyond
Streeting isn’t alone in his ties to private health interests. A 2025 EveryDoctor report revealed that 67 MPs, including Streeting, have accepted donations linked to private healthcare firms since 2019.
Streeting’s £175,000 from MPM Connect, a shadowy company owned by Labour donor Peter Hearn, raises red flags. Other Labour MPs, like Dan Jarvis (£50,000) and Yvette Cooper (£75,000), also took MPM Connect cash, claiming it was properly declared.
Meanwhile, 24 Tory MPs have pocketed £138,000 from IX Wireless, a firm with ties to health tech investments.
As political campaigner Richard Murphy noted in 2023:
There is no reason we should let this degree of opacity cloud something which should require total transparency.
Unqualified Physician Associates: a deadly risk in the NHS
Streeting’s push to expand Physician Associates (PAs) is another nail in the NHS coffin. PAs, with just two years of training and no medical degree, are being deployed to fill gaps left by underfunded doctor training programs. The NHS aims for 10,000 PAs by 2036, but at what cost?
In February 2025, Surrey coroner Dr. Karen Henderson warned of the “unfettered use” of PAs after the death of Pamela Marking, 77, who was misdiagnosed by a PA as having a nosebleed when she had a severe bowel obstruction.
The Royal College of General Practitioners (RCGP) reported in 2024 that 81% of respondents see PAs as a threat to patient safety, yet Streeting presses on, placing cost-cutting over lives.
The 10-year NHS endgame: a gradual collapse
Without drastic change, the NHS as a public entity is on track to collapse within 10 years, by 2035. This projection is based on converging trends:
- Waiting lists: 7.5 million cases, up from 4.5 million in 2019.
- Hospital closures: 30% of A&E departments closed since 2013, with more planned under ICSs.
- Staff shortages: 121,000 vacancies, including 40,000 nurses and 10,000 doctors.
- Private profits: £12bn spent on outsourcing in 2025, a 140% increase since 2015.
- Freeports and SEZs: 86 zones costing £19.78bn, diverting funds from the NHS while enabling corporate creep.
Political resistance and systemic inertia slow this timeline.
Outright privatisation within one to five years would likely trigger massive protests, as seen with the 2012 HSCA backlash. The NHS’s size – 1.3 million employees, £182bn annual budget – requires time to fully dismantle. However, freeports and SEZs could accelerate this, potentially collapsing the NHS by 2030 if corporate creep intensifies.
The Farage nightmare: a two-to-three year disaster scenario
The 10-year timeline assumes a continuation of current Labour-Tory policies. But a Reform UK victory in the next general election – potentially in 2029 – could slash this to two to three years, plunging the UK into a dystopian nightmare.
Nigel Farage has long advocated for replacing the NHS with a private healthcare insurance system. In a 2012 speech, Farage argued that the marketplace could deliver better value, suggesting an insurance-based model over the NHS’s “cradle to grave” system.
With Reform UK polling at 25% in early 2025, alongside Labour and the Conservatives, their first-past-the-post advantage could propel them to power, especially after topping 200,000 members and a new constitution making Farage’s leadership unassailable for five years.
Reform UK isn’t just a party- it’s a private company majority-controlled by Farage, designed to operate like a business, not a democratic entity. Farage’s affiliations with Donald Trump, who has pushed for healthcare privatisation in the US, signal a shared ideology.
At a 2024 Mayfair fundraiser, Farage aped Trump, singing along to YMCA with Tory donors like Bassim Haidar and Mohamed Amersi, who paid £25,000 a head to attend. This transatlantic alliance could see US healthcare giants like UnitedHealth flood the UK, backed by Trump’s political influence.
Freeports and SEZs supercharging the NHS privatisation agenda
Reform UK’s support for freeports and SEZs would supercharge this agenda. These zones are primed for corporate political governance under “localised freedoms.” A Farage-led government could implement corporate governance models in these zones. This would carve the UK into feudal enclaves – patchworks of corporate sovereignties where firms like BlackRock, already dominant in freeports, call the shots.
Under this disaster scenario, the NHS could be dismantled by 2031–2032:
- Rapid Privatisation: Farage could abolish the NHS’s public funding model within his first year, replacing it with an insurance-based system. US firms like UnitedHealth and Palantir, already embedded in the NHS, could scale up operations in freeports, doubling outsourcing to £24bn by 2030.
- Corporate Governance: Freeports and SEZs could become testing grounds for corporate-led healthcare, with private firms managing entire regions. The NHS’s infrastructure – hospitals, clinics – could be sold off to private entities, especially in zones like the Thames Freeport, where BlackRock holds sway.
- Sovereign Corporation: Farage would run the UK like a business, positioning himself as a CEO rather than a Prime Minister. Reform UK’s structure as a private company, combined with Farage’s unassailable leadership, would erode democratic accountability. The country could become a ‘Sovereign Corporation’, where public services are privatised, and citizens are treated as consumers, not constituents.
This isn’t a fringe fantasy – it’s the logical endpoint of the libertarian right’s vision, once dismissed as wild and outlandish, but now terrifyingly plausible. Farage’s popularity, Reform UK’s corporate structure, and its alignment with Trump’s America, make this a serious game-changer for the fabric of the nation-state. Democracy in the UK could be replaced by corporate rule, with free zones as the blueprint for a new feudal order.
Public opposition ignored: no one voted for this
The British public has never voted for NHS privatisation. A 2024 YouGov survey found 78% oppose further privatisation, and the 2023 British Social Attitudes survey showed 91% support for free-at-point-of-use care. No major party in recent elections ran on privatising the NHS, yet policies like the HSCA, PFI debts, and ICSs have continued.
A Farage victory would be the ultimate betrayal: imposing a private insurance system without a mandate, accelerated by free zones that prioritise corporate profits over public good.
The NHS isn’t just struggling- it’s being deliberately dismantled. From Thatcher’s outsourcing to Streeting’s power grabs, the goal has been to hand the NHS to private interests, particularly US healthcare giants. Freeports and SEZs are like stealth killers accelerating this process, and a Farage victory could be the final blow, turning the UK into a corporate dystopia where the NHS – and democracy – are relics of the past.
The NHS on its last legs and Farage could finish it: a call to action
We can’t let this happen. Hold MPs like Wes Streeting accountable for their private health donations. Demand transparency and an end to Freeports and SEZs that enrich corporations at our expense.
Support campaigns by EveryDoctor and Keep Our NHS Public to stop privatisation. If Farage wins, the fight becomes existential: mobilise, protest, and vote to save the NHS and our democracy.
The NHS belongs to us, not to US corporations, Farage, or his far-right libertarian allies. Act now, or lose it all by 2031.
Featured image via the Canary
