Tony was talking about how he wound up getting paid to care less – less about his sick patients, less about the specialism that demanded years of study, less about the career he had spent decades practising. But all the talking proved something else: he still cares – a bit too much for his own good.

Remembering his 30-plus years as a pharmacist, he recalled, in a Midlands singsong, a man who once came in with a sore on his head that kept catching on his razor.

Tony had a look.

“I says, ‘Get to the doctor.’

“He says, ‘What, in a few weeks?’

‘No. Now.’”

It turned out to be a skin cancer that the doctor began treating straight away.

Then there was the woman who wanted more antibiotic eyedrops. Tony just knew something didn’t look right and refused to sell her anything. Instead he packed her off to the GP. And the doctor immediately flagged up a possible brain tumour.

“A hunch,” Tony shrugged. “Through years of experience you just develop an instinct.”

Such are the memories by which he measures out his life. No sprints down a hospital corridor, no anguished shouting in an operating theatre. His has been an unheroic career – but a life-changing, even life-saving, one.

“They’ve had cancer, marriage split-ups … men even talk about their impotence.” No wonder they bring these troubles to his counter: in his mid-50s, Tony emits the ready sympathy of a dad at the school gates at hometime.

How many of these patients guessed that their own chemist was sick? Over the past few years, depression has dug its claws into Tony. He is tired all the time. His weight, blood sugar and blood pressure have shot up.

The illness kicked in shortly after he began his latest job, in 2011. Tony is sure that that was the cause – sure that he is sick because of his employer, and what it is asking him to do. The cuts to staffing that have made him feel unable to serve patients properly, the business targets that he is expected to meet, the pressure to behave like a salesman as much as a medical professional – and he believes managers treat him as a disruptive threat for questioning these practices. Tony isn’t his real name and, along with all the pharmacists in this story, some details will be left vague to protect their anonymity.

From being “really confident” on joining, he has “been under virtually constant stress for the last three years”. He told me that “Every time more than two managers come to our store together I think, ‘What’s going on? Am I going to get dismissed?’”

Boots is to ­outpatient care what the high‑street banks are to the UK’s money system

The past few years have been spent on and off anti-depressants. When we met late last year, he had just started another course of pills and was back in the usual side‑effects cycle: sweating, waking too early, exhaustion, sexual dysfunction.

And the pharmacy chain that Tony blames for making him feel so bad?

Boots.

You know what rogue capitalism looks like. It is a pinstriped banker defending his bonus, a Silicon Valley executive explaining exotic tax practices to short-tempered MPs, a billionaire sportswear boss pouring more money into his pocket. It is zero-hours contracts and financial shadowplay, profits funnelled through offshore shell companies and giant warehouses teeming with temps on minimum wage.

What it is not is No 7 moisturisers, contact-lens solutions, angina pills. It is not the shop on the high street with the white-coated pharmacist who fills your gran’s prescription, the shop where your mum used to go for your cough medicine. What it is not, in other words, is Boots.

But Tony’s story isn’t about one man who can’t rub along with his bosses. It is about a radically changed business model that, in the eyes of many of the company’s own staff, appears to suck the care out of a caring profession, harming employees while enriching those right at the top.

This is the tale of how one of Britain’s oldest and biggest businesses went rogue – to the point where its own pharmacists claim their working conditions threaten the safety of patients, and experts warn that the management’s pursuit of demanding financial targets poses a risk to public health. (Boots denies this, saying that “offering care for our colleagues, customers and the communities which we serve…is an integral part of our strategy.”)

At the heart of this story is one of the most urgent debates in post-crash Britain: what large companies owe the rest of us – in taxes, in wages, and in standards of behaviour.

When David Cameron calls for a “responsible capitalism”, or the former Labour leader Ed Miliband decries “predator” corporations, what both men are grasping for is a way of describing how some of our biggest and best-known businesses no longer resemble the societies they operate in. Lawfully exploiting the opportunities afforded them by globalisation and new technology, they hand over as little tax as possible to the countries on whose infrastructure and protections they rely, squeeze pay and conditions for employees even while handing out lavish rewards to managers, and underinvest in staff so as to over-reward shareholders.

This debate is not merely a moral abstraction, it is central to everyday life in Britain – from why the workforce is so unproductive to how your kids’ Sure Start centre got shut down.

As a case of rogue capitalism, Boots is sharply different and especially troubling. First, the online giants and investment banks that usually get blasted for bad behaviour by newspapers and select committees grew up in this new world of business. Boots, on the other hand, traces its origins back to the Methodist Nottingham of the 1840s. It has gone through dramatic changes to end up in this bracket.

Second, where the likes of Sports Direct and Amazon are criticised for their treatment of low-paid temporary workers, Tony and his colleagues are professionals. Their testimony shows how even “good jobs” are changing.

Finally, Britain relies on Boots – and Boots relies on Britons. It is by far the biggest pharmacy chain in the country. Healthcare professionals refer to the firm as an “essential component” of the NHS. It is to outpatient care what the high-street banks are to the UK’s money system: a massive private-sector firm delivering a vital public service.

And it takes a lot of public money to do so: around £2bn a year for prescriptions alone, according to independent financial analysis, or a third of Boots’s annual income in the UK. Then come the patient-care services paid for by the taxpayer, and the contracts Boots is now taking over from the NHS – to host GP surgeries in its stores, to run pharmacies in hospitals, to manage hearing test centres and specialist clinics monitoring drugs that prevent blood clots.

Boots gave Tony work experience in the 1980s while he was training to be a pharmacist. Back then, he said, it was a good employer, “a blue-chip, like Marks and Spencer”. But by the time he rejoined in 2011, it was under very different owners.

The transformation Tony was about to witness began in spring 2007, when Boots was bought for £11bn. This was the frenzied peak of the greatest financial bubble in history and each day’s papers brought news of more crazy deals. Still, this stood out: it was the biggest buyout ever seen in Europe.

The deal was backed by one of the world’s largest private equity groups, Kohlberg Kravis Roberts (KKR), the debt merchants synonymous with the excesses of 1980s Wall Street. But it was led by the billionaire Stefano Pessina. Barely a few months earlier, in July 2006, he had merged the wholesaling business he had created, AllianceUniChem, with the venerable British name. The result had been Alliance Boots, a Europe-wide pharmacy chain, of which he was a director. Now he was buying the entire business, whipping it off the FTSE 100 and into private ownership.

‘Stefano Pessina looked less like a typical FTSE bureaucrat and more like a continental football manager, here to save the ailing local side.’ Photograph: Micha Theiner/City AM/Rex

A near-unknown from the continent had just snapped up a high-street stalwart – and City newsrooms were agog. The guy even sounded exotic. He came from Italy, but had moved to Monaco, the principality famous for not levying income tax. He collected yachts and Italian old masters. Separated from his wife, he had got together with girlfriend Ornella Barra after buying her family’s business – then made her head of his wholesale operations. With his white hair and rimless glasses, Pessina looked less like a typical FTSE bureaucrat and more like a continental football manager, here to save the ailing local side.

“He confesses to living a peripatetic lifestyle, jetting between his home in Monaco, where he has to spend at least 90 nights a year to qualify for its low-tax regime, and his offices in Italy and in London,” reported the Telegraph in 2007. “The two mobiles and a BlackBerry laid in front of him are clearly more important than any office.”

After all, offices are not necessary when hunting for deals – and Pessina has a genius for making deals. By 2005, when he invited Boots executives for merger talks on his yacht off Sardinia, he had already bought more than 500 firms. Yet the press gave little consideration to the precise nature of this latest deal – and how that might change a business delivering a vital public service.

One man who was worried about Britain’s new king of medicine was Bill Scott. Until March 2015, Scott had been Scotland’s chief pharmaceutical officer for 22 years, leading policy-making on pharmacy. It was from that vantage point that he watched the takeover. “The feeling was that it would fundamentally change the ethos of Boots,” Scott told me. He and his colleagues had always regarded the company as “ethical” – because it was “very much driven by pharmacists themselves”. Now, with the money men in charge, it seemed the future was less certain.

Scott had encountered Pessina once before. The two had met in the summer of 2006 – just after Boots’s merger with Alliance Unichem, but a few months before the buyout. Pessina’s team had taken some of the top officials in Scottish pharmacy to the Balmoral in Edinburgh, a five-star hotel that still stations kilted doormen at the entrance.

Over what another attendee remembers as a “grand dinner”, the Boots team gathered intelligence about Holyrood’s plans for their industry. For his part, Scott wanted to know what Pessina had planned for Britain’s most important community pharmacist.

“The question I asked him was: ‘Are you going to stay in the health sector on the stock market?’” Each business on the FTSE (where Alliance Boots was then listed) is categorised in a particular sector, so Barclays can be found under “banks”, BAE Systems under “aerospace” and so on. Behind that innocently technical query lay a much bigger question – “I was asking: ‘Where’s your focus?’”

Pessina seemed to grasp Scott’s meaning. “He said, ‘Bill, this is a very good question and I understand why you’re asking it. But as well as pharmacy, there’s a bit of retailing – so we want to be in the retail sector.” It appeared that Pessina saw the future of Boots not as a healthcare business but alongside Marks and Spencer, Next and Carpetright. “I didn’t see him as someone with a clinical care,” Scott told me. “He’d just seen another market to get into to make money.”

Whether Bill Scott was right would determine life for Tony and his patients – and millions like them.

Prescription drugs, two packets of Beechams, a Shaper sandwich and some Brecon Carreg water. Over a century and a half, Boots had built up a business that serviced the most prosaic aspects of British life. Exciting, dynamic, a licence to print money? Nah. But at its core was a stability underwritten by government money, public goodwill and a solid reputation.

Outwardly, 2007 changed nothing. The pharmacists still wore white coats. The sign outside the shop was still the same blue and white cursive logo dating back to 1883. But behind the trusty facade was “the story of how one business model colonises another,” according to Colin Haslam, professor in accounting and finance at Queen Mary University of London. The everyday needs and ailments of communities across the UK had been reconfigured as thousands of little revenue streams for a small transnational elite of ultra-wealthy investors, whose fortunes depended on those streams getting bigger, and fast.

To see how that changed our medical services, I asked Haslam to examine the accounts of Boots UK, the main British subsidiary of the continental conglomerate Alliance Boots. The investors’ method, as Haslam describes it, was “stretch and extract”: stretch company finances and staff as far as they can go – then extract profits.

Stretching began immediately, by loading up the new asset with billions in debt. To buy Alliance Boots, Pessina and KKR had invested £2.5bn of their own money – but they borrowed almost £9bn from Barclays, the Royal Bank of Scotland, Citigroup, JP Morgan, and Merrill Lynch among other banks. The borrowed billions were then shoved onto the balance sheet of Boots UK Ltd – and those banks jumped to the front of the queue for repayment out of the profits made by the company.

Set in black ink on pink paper in the Companies and Markets section of the FT, these are no more than the technicalities of a company buyout. Yet they amount to a dramatic shift in power. Think about that previous paragraph again: a billionaire based in a tax haven, Pessina, and a small consortium of wealthy investors and funds, represented by KKR, pick up a 158-year-old company employing around 70,000 Britons. To do so, they borrow billions from a few global banks and dump most of these loans on the balance sheet of Boots in the UK – pushing it deep into debt, even though the debt has nothing to do with the actual business Boots does here. A firm that delivers an essential social service is now private, making it almost impossible for outsiders to see how it is changing. Finally, the profits made by Boots UK are used to repay the lenders faster and ultimately leave more profit for the investors.

In this way, British money – whether from customers or taxpayers – was siphoned offshore. The KKR funds that owned Alliance Boots were housed in the tax haven of the Cayman Islands, while the stakes held by Pessina were located in Luxembourg. A few months after going private, Alliance Boots shifted its headquarters from Nottingham to the low-tax canton of Zug in Switzerland.

There is nothing illegal about these arrangements, and a spokesman insisted at the time that the move to Zug was absolutely not for tax purposes: “We have chosen to locate the overall stewardship of the group in Switzerland as we believe it enhances the position of Alliance Boots as a leading international pharmacy-led health and beauty group.” Yet when Richard Brooks, a former tax inspector, visited Alliance Boots GmbH in 2012, he found that its “headquarters” in Zug was “one of around 50 unrelated companies dealt with by a local business service company, the proprietors of which were none too pleased with the visit.” And, he reported, no Boots employees were present.

All very complicated, yet perhaps rather lucrative for Pessina and KKR. In 2013, a report published by War on Want, Unite and the US campaign group Change to Win, claimed that Alliance Boots had legally avoided paying over £1bn in taxes to the UK since going private. Yet around 40% of the revenues for its British business come straight from the NHS. The campaigners complained to the OECD, the rich-nations’ thinktank, about what they saw as a violation of UK tax laws, although the OECD rejected the claim.

A Boots spokesperson categorically rejected the tax campaigners’ claims, describing their calculations as factually inaccurate, “heavily biased” and “defamatory”. The spokesperson stated: “We organise our tax affairs strictly in compliance with all applicable laws in each jurisdiction.” In the financial year from 2013 to 2014, Boots paid “around £577m in tax in the UK”. The company refused to give any further details, apart from to say that the sum includes business rates and national insurance. Yet business rates and national insurance are the cost any firm must bear to run shops and employ staff. A family is not granted a lower council tax bill because it has already shelled out for the electric and water.

If Nottinghamshire heritage could be junked in the new regime, financial stability didn’t count for much, either. Before the takeover, Boots UK bore a modest 50p-worth of loans for every £1 of equity, or net assets. Immediately after the takeover, that ratio shot up five-fold. It was as if a house worth only £100,000 suddenly had a giant mortgage of £250,000. Haslam, who is a former corporate financier, believes that balancing such huge debt on comparatively little equity would be judged by an auditor as “high risk”.

‘Boots says self-checking – where pharmacists monitor their own work – must be done only as a last resort’. Photograph: Alamy

This is not an academic point, but a matter for public interest. To pocket Boots, Pessina and KKR had to outbid another private-equity baron, Guy Hands. His outfit, Terra Firma, went on to buy Four Seasons Health Care, the biggest care home operator in the UK. It shares certain similarities with Boots: both private-sector providers of public services; both weighed down by the expense of running old-fashioned bricks and mortar, both controlled by tax exiles (Hands uses Guernsey as his base). Four Seasons, too, was landed with outsize debt – and over the last few months, the group has gone into meltdown: struggling to pay the interest on its loans, castigated by government inspectors for providing “inadequate” care in 125 of its homes, forced to sell some properties and overhaul others.

Four Seasons is now a prime example of what happens when private equity – big borrowing, hard charging – goes wrong, with results that may be paid for by its residents and families and even taxpayers over the coming months and years.

This is not likely to happen to Boots. But Haslam sees the same conflict between outsize profit-seeking and public interest, claiming: “Boots is now about immuring tax, squeezing labour costs and taking out the dividends rather than reinvesting in the business.”

Whether as residents or patients, relatives or members of the public, we need our care homes and pharmacies to be reliably dull. When financiers get excited over such sectors, the rest of us should worry. Yet Pessina came to Boots promising double-digit growth. “There’s so much to do – the products are fantastic, the spirit of the people is fantastic,” he fizzed in a 2008 interview. “The important thing now is to motivate them and to convince them they can succeed.”

Late last year, I went to the Midlands to meet Tony and hear his views on how his working conditions had changed. He took me on a tour of a branch of Boots very like his own, a large, relatively new shop in an out-of-town retail park.

Here, the chemist’s counter had a full complement of staff. So had Tony’s – when he began in 2011. But by then, four years into the buyout, job cuts were well under way, both in his store and across the country. Now for hours each day, he said, it was only him manning the counter and the pill dispensary while taking care of the shop’s photo business, too. With no other colleagues around to make sure he was giving out the right drugs at the right dosage, Tony had to monitor his own work. Pharmacists call this “self-checking”, and it leaves patients at greater risk of getting the wrong medication. In its own standard operating procedure, Boots says self-checking must be done only “as a last resort”. Yet Tony claims he was self-checking on a daily basis. (Asked for comment on this practice, Boots would say nothing on the record.)

Working by himself, Tony explained he also had to hand out vouchers for money off makeup. “We try to get the patient to redeem that voucher straight away. We have to: they monitor that kind of thing.” He added: “That commercial focus in pharmacy – 10 years ago it would have been unheard of.”.

But that was the least of Tony’s worries. It was the medicine-use reviews (MURs) that really bothered him. Patients came to his consulting room and discussed their diet and health problems, while he took them through a chunky list of questions and advised them on what their medicines were meant to do and how best to take them. Free for the customer, a way of keeping a patient out of a GP’s waiting room, and for each one the NHS pays the company £28. To prevent the system from being abused, every pharmacy in the country is limited to 400 MURs a year. Except Tony’s managers took that number as a target for his store to hit.

“Miss it and they get on your back,” said Tony. He adopted a manager’s whine: “You’ve done three MURs less than you should have done this week.”

A Boots pharmacist from another region described to me a recent staff awayday at which he and his colleagues were told: “400 MURs is an expectation now. We don’t need to tell you that.”

I have seen a 2008 email from a Boots area manager in yet another part of the country that states:

I personally don’t want colleagues to feel ‘brow-beaten’, but we do need to deliver our targets of 400 MCUs [medicine check-ups – another name for MURs] per store this financial year for two reasons: 1. Delivering 400 MCUs is a measure of Excellent Patient Care 2. The company can make £28 profit for each MCU, so each one we don’t deliver is a lost £28.

So keen was Tony’s store to make that profit, he claims it did reviews on anyone, no matter how unsuitable. Tony himself was told to have one – and to give one to a patient with severe dementia. His manager came in for one – no sooner had it begun than she walked out, but it still went towards the total. All so the shop could earn that extra £11,200 from a scheme intended to help the sick. (Asked to comment, Boots said: “We make it clear to our colleagues that these services should not be undertaken inappropriately.”)

Assuming each pharmacy churns out 400 MURs a year, that one NHS programme is worth an annual £30m to the company

These forms of outpatient care are a good earner for Boots. Assuming each of its pharmacies churns out 400 MURs a year, that one NHS programme is worth an annual £30m to the company. Stack alongside that the new medicine service (NMS) for patients on heavy-duty drugs, worth at least £25 a time, NHS flu jabs at up to £17 a pop, stop-smoking clinics, and a lot of public money is being sent to private companies to look after our health.

As far back as 2010, the NHS’s own research warned that MURs were being used to cream off public money and could be “of limited benefit and cursory in nature”. In 2013, the Pharmaceutical Journal noted that “some pharmacists face penalties for not meeting the targets, such as no pay rise or a possible loss of a bonus”.

Yet though it has tweaked the criteria for MURs, the cash-strapped NHS has no plans to scrap the system. A few chemists even falsify MURs. Those caught go in front of the regulator, the General Pharmaceutical Council, which publishes its determinations online. Sift through them and a pattern emerges.

From the hearing of a Boots pharmacist in the West Midlands, April 2012: “He said the pressure to meet targets was relentless … Area managers ringing him on a daily basis, asking how many [MURs] he had done and what he was going to do about them … He was told continuously that he was letting the store down …”

A Boots pharmacist in Nottingham, August 2012: “… She had felt under enormous pressure to carry out an unrealistic number of MURs …”

A Boots pharmacist in Cornwall, May 2014: “The only way he benefited personally was in not coming under pressure for failing to fulfil his MUR targets.”

A Boots pharmacist in Stafford, November 2015: “This Committee has experience of otherwise competent and honest pharmacists feeling themselves under pressure to pretend to have completed medicine use reviews …”

On the one hand, you have an NHS looking to move more of its patient care into the private sector. On the other, you have giant chains such as Boots chasing lucrative new business. And in the middle, you have the humble pharmacist, responsible for diagnosing ailments and dispensing medicines – and personally liable for errors. Yet under intense managerial pressure, they are being stripped of their professional discretion – and some feel they are being turned against their own patients.

A Boots pharmacist based in the north-west told me a few of the targets he was set: “MURs, NMS, items [drugs dispensed] ... There’s an over-the-counter target for sales, as well … We have a texting service – the patient is texted when their medicine is ready. Then we started getting targeted on how many we signed up to the service and how many we actually text. And if you’re behind on dispensing, because of staff cuts, then people are coming in before their medicines are ready – so you’re not texting them.” He added: “If you miss any target, they want to know to the nth degree why you haven’t done it.”

He joined Boots out of university nearly 30 years ago. Then he had considered it a “family-run professional firm”. And now? “Big Brother, a giant profit-seeking monster.” The gold-plated final-salary pension scheme had been shut, resources cut. “There’s such a culture of fear.”

That fear comes wrapped in the corporate language of empowerment. Targets are “non-negotiable”, and staff who beat them get graded as “legendary”. A chemist advising a customer – “You know, like I’ve done my entire career,” as one Boots lifer puts it – is now having a “Great Conversation”. If the satisfied customer then compliments the chemist that is now a “Feel Good Moment” (although in performance plans they are unfortunately referred to as FGMs – so a chemist must notch up, say, five FGMs a week).

This is pure Apprentice-speak, an attempt to turn pharmacists into estate agents, career pedants with a duty of care into hustlers in labcoats. Tony played the game at first, but struggled to cope as the staff numbers in his section halved. When he complained, the manager classed him a “non-performer” and asked if he would move stores. His pay was frozen and he was subjected to regular performance reviews. (A spokesman from Boots stated: “the health and wellbeing of all our colleagues is, and always has been, a priority for the business.”)

“There are a huge number of very good pharmacists at Boots,” said Bill Scott, the former chief pharmaceutical officer for Scotland. “But if my bonus is dependent on the business targets I’ve been set, you are taking away from me my ability to practice my profession for the patient. And that’s got to be wrong.” And, he remarked, the sheer size of Boots meant that where it went, the other pharmacy chains and independents would follow.

I half-wondered if these were just a handful of malcontents – until I saw a poll that the trade union, the Pharmacists’ Defence Association (PDA) recently conducted of its members. The survey of working conditions, shared exclusively with the Guardian, is the first of its scale and kind the PDA has commissioned – and it says something deeply worrying about the profession Britons rely upon for their medicines.

Open to all chemists in the PDA, whatever chain they worked for, the survey attracted 1,988 responses, of which 624 were from Boots employees – more than one in 10 of all its chemists. The survey suggests that morale across the profession is low, but that Boots pharmacists feel more pressured than those employed by Lloyds, Asda and the rest. Like Tony, many routinely dispense medicines without anyone else checking their work. But their responses to two questions stand out. Asked how often “commercial incentives or targets have compromised the health, safety or wellbeing of patients and the public, or the professional judgment of staff”, more than 60% of Boots pharmacists said that was the case half the time or more. That compares to 52% of chemists at other chains.

Asked “how often do you believe financial cutbacks imposed by your main employer have directly impacted upon patient safety”, 56% of Boots chemists said that was true “around half” or “most” of the time. A further 20% said it was the case “all the time”. Taken together, these numbers outstrip by 10 percentage points their counterparts at other chains, and should cause particular alarm given Boots’s position as Britain’s biggest pharmacy.

‘Asked what dangers cuts might pose to patients, the PDA identified overworked chemists giving out either the wrong medicine or the right medicines at the wrong dosages.’ Photograph: Alamy

Three in every four of responding Boots pharmacists believe that the cuts imposed by their employer, whether the drop in staff numbers or increased workloads, threaten patient safety at least half the time or more. In response, Boots points out that it now employs more than 6,000 pharmacists in the UK, up from about 4,500 before the buyout. However, that rise tracks the increase in its number of stores, up from 1,400 in 2005 to around 2,400 today. I asked Boots what had happened to the number of dedicated pharmacy support staff, the dispensers and assistants that Boots chemists reported they were having to do without. The company did not respond.

Asked what dangers these cuts might pose to patients, John Murphy, general secretary of the PDA, identified overworked chemists giving out either the wrong medicine or the right medicines at the wrong dosages. He listed cases of medicine-related fatalities: a woman in a Chesterfield care home given six times her prescribed dose of morphine by a Boots pharmacy; a similar story in Weston-super-Mare; an 86-year-old widower in Felixstowe given the wrong drugs.

Boots rightly pointed out that such cases are very rare, stating that “patient safety is at the heart of what we do … Whenever [such cases] happen our priority is always to the family … and working with the relevant investigators to seek to understand what happened”.

Yet these incidents evidently play on the minds of Boots pharmacists. Below are a few of the many comments from those surveyed:

“All the company cares about is profit, figures, services. They are not interested in patient safety, appropriate staffing levels, training time for staff, appropriate breaks etc. Each day I am worried about making a mistake due to the enormous amount of pressure I am constantly under.”

“Efficiency has a limit, beyond which patient safety is compromised.”

“I am considering changing profession due to these working conditions … I would rather change profession than risk others.”

Boots is part of a dwindling band of high-street chains that bears a family name, rather than one created in some marketing lab. The man who built the firm, Jesse Boot, grew up in the Nottingham of the 1830s, in one of the thousands of back-to-back terraces that housed the city’s lace workers. He inherited a tiny shop. Between 1883 and 1920, he turned it into a chain of more than 660 shops, employing more than 14,000 people. As he got richer, he and his tough-minded wife Florence became more interested in the welfare of their staff and society. Jesse Boot was not content with providing workrooms, records his biographer Stanley Chapman, instead he commissioned “industrial palaces”. Welfare workers were recruited to improve the health of employees. He took staff on day trips and set up sports club after sports club: athletics, football, cricket, boxing, gymnastics …

An early 20th-century branch of Boots. Photograph: Science & Society Picture Library/Getty Images

Some of these still endure. And to wander around Nottingham University today is to walk on Bootland – literally. Boot donated 35 acres to the campus and built the white-stoned Trent building with its clocktower and Oxbridge-aping quads. He gave Nottingham its first women’s halls of residence and fretted over what kind of wastepaper baskets it would have. Downhill from the campus is a bust of Jesse Boot, facing his company’s sprawling Beeston complex of factories and offices that lie just over University Boulevard. The inscription reads: “Before him lies a monument to his Industry. Behind an everlasting monument to his benevolence.”

Jesse Boot was steeped in a culture that expected much more of its leading businessmen

In 1919, in the first issue of the company newsletter, the Beacon, Boot wrote to his staff: “Fellowship in recreation, fellowship in ideals, common hope, common sympathies, and common humanity bind us together; and whatever fosters this happy union is valuable.”

Today we know to smile at this as paternalism. Yet we have no popular term to describe the worldview of business leaders such as Pessina. A Yiddish joke has it that to a worm in horseradish the whole world is horseradish. When it comes to the culture of modern business, we are that worm.

You hear it when the BBC and the press treat the economy as it were merely a synonym for business – and business as if it were just a synonym for finance. You hear it when the term “entrepreneur” is applied to a carpetbagger with a good PR, or when chief executives defend corporate tax-dodging as being their duty to shareholders.

Jesse Boot reminds us that this was not always so. He would surely have recognised some of himself in Stefano Pessina: the wheeler-dealing, the gusto for marketing, the tireless expansionism. But Boot was steeped in a culture that expected much more of its leading businessmen. The point about Pessina is not that he is uniquely bad, but that he operates in a milieu that asks so little of its capitalists – even when they are reliant on public money.

Five years after taking Alliance Boots private, Pessina and KKR began selling the firm to America’s biggest pharmacy chain, Walgreens – a process that was completed at the end of 2014.

The turnaround that Pessina promised never materialised: Colin Haslam from Queen Mary University points out that by 2014, operating profit margins for Boots UK – a key way of working out how much it actually makes on each pound going through its tills – were stuck at around the levels of 15 years earlier. Meanwhile, the model of stretch and extract – loading Boots with debt, then pulling out as much as possible for investors without reinvesting in the business – “has left its underlying financial structure hollowed out”. Asked about this, Boots replied that it had put money into both the employee pension funds and its chain of stores. Haslam points out that all firms are required to meet their pension-fund obligations.

But there have been some big winners from Boots. By 2012, Pessina was already claiming to have tripled the value of KKR’s investment in the company. He himself has not done too shabbily, either. In 2006, the year he merged his wholesale business with Boots, Forbes magazine ranked Pessina as the 428th richest man in the world. By 2015, he had shot up to 99th place. He has also gained a notably high vantage point in British public life. In 2010, David Cameron and George Osborne – both of whom describe tax avoidance as “morally repugnant” – took Pessina as part of their entourage to China. In the run-up to the general election of 2015, Pessina claimed that a Labour government under Ed Miliband would be a “catastrophe”. This warning from a Monaco citizen, who once said he would never buy a home in Britain “because if I have a home here I have to run it”, was considered grave enough by the Sunday Telegraph to be treated as one of its major stories of the day.

He is now both chief executive of and the single largest shareholder in the all-new entity Walgreens Boots Alliance, which has also shifted headquarters from Switzerland. Its new home, Delaware, is described by Alex Cobham of the Tax Justice Network as “the longstanding leader among US states in providing opaque corporate structures”.

Last year, the new entity announced plans to buy the US chain Rite Aid, a deal that will make it the largest pharmacist either side of the Atlantic – with 73-year-old Pessina at its head.

Just how much Pessina made personally out of Boots is hard to say, as many details are not in the public domain. But going by the public information and assuming that Pessina sunk £1.25bn of his own capital into the 2007 deal, Haslam calculates that he emerged with 214m shares in Walgreen, worth £11.5bn. In seven years he turned that £1.25bn into an estimated net gain of around £10bn. Asked for a response, neither Boots nor Pessina had anything to say on the record.

Driving back to his house, Tony had taken me on a tour of his Midlands hometown. He had pointed out the comprehensive where he was one of only two boys in his year to do A-level biology. Back then, the school churned out pupils as “fodder for the metal bashing industries” – far rarer was the “academic type” like him.

Now Tony saw his workplace as a factory. “It’s a profit factory where we’re doing piecework,” he said. All these decades after university, his working life was suddenly dictated by people who had little respect for his education or his profession. “The standard of education of these managers … some of them can’t even spell prescription; they put ‘quiet’ when they mean quite.”

Tony was raised in Thatcher’s era; he had drunk in her values. “I thought people should work hard, they shouldn’t claim benefits, they should be responsible for their own destiny. That was the politics in the household: that you work hard and get your just rewards.”

For a long time that story rang true: first in the family to head off to university, a profession, a neat house and a car. Then came this job: the cuts, the crack-ups, the half-decade of unhappiness. The old faith had deserted him. “Boots are showing me that you can work hard but you still won’t get your just rewards.”

I looked around his small living room: the messages on the wall reading “If You Believe In Yourself Anything Is Possible” and “Live Every Moment, Laugh Every Day”, the framed pharmacy certificate among all the family photos, the drugs manuals stacked up by the CD rack. That male mingling of personal with professional pride. Tony had a question.

“How can Boots call itself a healthcare company when it’s done this to me?”

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