Published: 7:45 PM June 5, 2019 Updated: 6:12 PM September 17, 2020

Tens of thousands of protesters march on Downing Street against privatisation of the NHS. Photograph: See Li/PA. - Credit: PA Images

ANDREW ADONIS says Donald Trump's visit to the UK has destroyed any illusions that remain that a trade deal with America would replicate what we have with the EU.

The NHS - the most successful welfare institution in the world - was always going to be at the heart of a national convulsion like Brexit because it is such an integral part of Britain.

Nigel Lawson, godfather of Brexit and climate change scepticism, called the NHS "the closest thing the English people have to a religion". He meant this not in admiration but despair. As Thatcher's privatiser-in-chief, Lawson was forced to accept the NHS as a collectivist institution strong enough to vanquish even peak Thatcher.

This was not lost on Dominic Cummings, as director of Vote Leave. Long before the 2016 referendum, he was crafting what became the infamous "£350 million a week for the NHS" red bus. When Cummings defeated Nick Clegg's plan to change to the Alternative Vote (AV) electoral system in the first of the Cameron referendums, in 2011, it was with posters of crying babies who "need a maternity unit not £250 million on AV".

The message went straight for Britain's political heartstrings. Areas with worse health statistics and longer NHS waiting times were significantly more likely to vote Leave. As Cummings put it: "Would we have won without £350m for the NHS? All our research and the close result strongly suggests no."

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But the NHS will be the end of Brexit as well as its beginning.

Brexit drives three stakes into the NHS. First, it starves it of vital EU staff. The Farage and Johnson anti-immigrant rhetoric, and fear of a restrictive immigration regime after Brexit, has caused an exodus. Some 5,000 nurses and midwives from other EU countries have quit the NHS in the last two years, and new recruits have dried up, fuelling a staff shortage of over 40,000.

The public have noticed. In the space of three years public opinion in Britain has gone from being one of the most negative to most positive in Europe about immigration. The main reason given for switching views, according to a leading pollster, is that "discussions since the vote to Leave have highlighted how much immigrants contribute".

Second, Brexit decimates economic activity, which means less money for the NHS. Before Brexit, Britain was one of the fastest-growing advanced economies, as it recovered from severe austerity. It has slumped to bottom of the pack as business investment collapses and Japanese firms like Honda flee the country.

Then there is the money spent on executing Brexit, while the NHS and social care suffer huge funding shortfalls. The £1.9 billion wasted on no-deal planning could have put 200 nurses into every local community in the UK. As Cummings might say, "our older people need more care homes, not Grayling's imaginary ferries".

Trump's visit has also destroyed the idea - always farcical - that 'Global Britain' can magically replace EU trade by a quick trade deal with the US.

Standing next to a grimacing Theresa May, Trump announced this week that the NHS would be "on the table" in a trade deal.

Tory leadership candidates are falling over themselves to deny this, and Trump's remarks have since been 'clarified'. But we all know what he means. America First. It's his trade policy with Mexico, Canada and China, and obviously he would do the same with a weak and vulnerable Britain.

NHS services and drugs, alongside agricultural produce, would be key to any trade negotiation, which means they will take years and probably get nowhere - like the EU's trade negotiations with the US over the last decade.

The NHS is the alpha and omega of Brexit.

It was there at the birth on a bus, and it is now organising the funeral.