Professor John Robertson OBA
Thanks once more to Dottie for alerting us to this.
From The Lowdown, 2 September 2025, the above and:
In late August the release of a report by US senator Chris Murphy (D-Conn) on the destruction of hospitals in his home state of Connecticut, and across the US by private equity companies highlights once again the negative effect of this form of investment.
The report documented what happened when three Connecticut hospitals—Waterbury Hospital, Rockville General, and Manchester Memorial—were bought by Prospect Medical Holdings, a company that since 2010 had been owned by private equity firm Leonard Green & Partners.
Extensive employee testimony in the report told of how Prospect went to extreme lengths to avoid spending money, including delaying and stopping paying suppliers leading to a lack of equipment and disposables for treatment and surgery, and even a lack of food for patients, maintenance of buildings was neglected, which in two instances led to ceilings collapsing.
The deterioration of patient care at Waterbury became obvious by 2019, when the report noted that it “recorded the highest rates of patient readmission in the state.”
These reports are from the USA, but private equity’s interest in healthcare is global, including the UK.
A backgrounder on private equity – how it works and its involvement in public services in the UK – can be found on our NHSforsale site, but in short private equity is the very worst of capitalism. It has no long-term interest in companies, their employees, clients or the communities where they are based. Private equity operates only to make as much money as possible in as short a time as possible, usually 5-7 years. It burdens the companies it invests in with massive, usually unsustainable debt, and siphons off as much money for investors (and the private equity managers) in as short a time as possible.
Is Scotland at risk equally?
No. From Grok AI:
Predicted Impact on NHS Scotland
NHS Scotland faces far less PE exposure, with 2025 forecasts showing minimal growth in these due to a public-centric model.
Key factors:
- Policy Resistance: Scotland’s integrated system (14 regional boards, no trusts) emphasizes collaboration over competition, rejecting England’s market-based reforms. Private practice is “much less common,” and outsourcing is rare—limited to overflow cases (e.g., ~0.5% of operations in 2021, or ~1,500 procedures annually). The Scottish Government prioritizes prevention and equity, with frameworks like the 2025 Population Health Framework focusing on social determinants rather than PPPs.
- Limited PE Activity: No major PE deals specific to NHS Scotland in 2025 searches. General Scottish PE interest rose 35.6% in 2024, but healthcare remains niche. Legacy PFI/non-profit distributing (NPD) contracts exist (e.g., expiring in 2025), but successors avoid heavy private involvement. Funding is ~20–25% higher per head than England (£12 billion in 2024/25), supporting public capacity without privatization incentives.
- Performance Edge: Scotland maintains better metrics (e.g., fewer long A&E waits, higher doctor/nurse ratios), shielding it from England’s backlog-driven PE reliance. Cross-border care adds complexity, but devolution enables resistance to Westminster trends.
Projections suggest PE’s share of Scottish NHS spending stays under 2%, with focus on public investment amid budget pressures.
Comparison: Will PE Affect NHS Scotland as Much?
No, private equity is unlikely to impact NHS Scotland to the same degree as predicted for NHS England. Here’s a structured comparison:
| Aspect | NHS England | NHS Scotland |
|---|---|---|
| Policy Stance | Pro-PPPs; 10-year plan boosts private finance for infrastructure and waiting lists. | Anti-privatization; integrated, collaborative model prioritizes public delivery. |
| PE Deal Volume (2021–2025) | 150+ UK-wide, ~50% of 2025 M&A; major assets like Assura acquired. | Negligible; no healthcare-specific PE surges reported. |
| Private Sector Share | ~6% of revenue; 30%+ mental health beds; rising to 10% by 2026. | <1–2%; overflow only, no systemic outsourcing. |
| Funding/Pressures | 3% growth but flat capital; 7.5M waiting list drives private reliance. | 20–25% higher per head; better capacity reduces need for PE. |
| Risks/Predictions | High: Debt, fragmentation, equity erosion (e.g., Unison warnings). | Low: Protected by devolution; focus on prevention. |
| 2025 Outlook | Surge in PE-backed contracts (e.g., ophthalmology, diagnostics). | Stable public model; PE limited to general economy. |
Key Differences: England’s competitive, underfunded system invites PE as a “quick fix,” while Scotland’s devolved, generous funding enables a “collectivist” approach with less private penetration. Recent X discussions echo this, framing Scotland’s NHS as a bulwark against “austerity” and privatization. If Westminster policies intensify (e.g., more off-balance-sheet deals), Scotland’s independence could further insulate it, but current trajectories suggest divergence, not convergence. This assessment draws from 2025 analyses; ongoing monitoring of budgets and elections will refine predictions.
Sources:
https://www.england.nhs.uk/long-term-plan/
https://www.england.nhs.uk/publication/nhs-england-operating-plan-2025-26/ https://www.gov.scot/publications/nhs-recovery-plan/ https://www.gov.scot/publications/population-health-wellbeing-framework/ https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00123-4
You can still support Talking-up Scotland at any time at: https://www.crowdfunder.co.uk/checkout/help-talking-up-scotland-tell-truth-about-scotland/payment/nBQxjVzq/details or by direct bank transfer method - Bernadette/John Robertson, Sort code 08-91-04, Account 12266421
Talking-up Scotland 'Albatraz' 
The example of private equity involvement from the US state of Connecticut exemplifies the legal imperative in the law regarding such companies. THEY MUST MAXIMISE SHAREHOLDER DIVIDENDS.
Written in to the law for private equity companies is that they must MAXIMISE SHAREHOLDER RETURN. This is the priority – not quality of service or pay and conditions of employees.
Maximising is achieved by ‘driving down costs’ – a phrase beloved by economics and business journalists because it implies cutting out waste and being EFFICIENT, because, we are told mendaciously, that the ‘bracing winds of competition result in better services, because, otherwise customers would go elsewhere’.
The quality of service has little to do with it. It is about making as much profit as possible by using the cheapest materials, paying staff as little as they can, providing the bare minimum of working conditions, delaying repairs, etc.
This is the Thatcherite legacy and Mrs Thatcher claimed that ‘new’ Labour of Blair, Brown and Mandelson was her true legacy. The LibDems, in coalition with Cameron were as enthusiastic as Osborne in pursuing this policy. Labour under Starmer is continuing. Blair and Brown could actually present a vision, which was plausible and which, to their credit, they fulfilled to some extent. Starmer’s Labour has no vision, is peopled by incompetents and is cosying up to private equity, whose members form a majority of government departmental advisory boards.
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