A French company supplies household electricity and a German conglomerate owns the water supply, while airports may be bought by a Spanish infrastructure firm. Swedes are big players in health service contracting, and a lot of public sector software is Dutch. And that's before listing the American-owned consultancies and information technology suppliers for which the UK has become a lucrative market.
In such a context, it would be odd if some public managers themselves weren't non-nationals. High-profile examples include Bob Kylie, recruited from New York by the mayor of London, Ken Livingstone, to run Transport for London, and Paul Evans, the Boston police chief at the Police Standards Unit in the Home Office. Kylie's appointment was consistent with long American involvement with London's transport. As Stephen Inwood points out in his wonderful history of late 19th-century London, City of Cities, without American drive and capital the deep tubes might never have been built.
Yet nationalism rules OK across most public management. It's hard to think of a town hall chief executive who isn't home-grown. Permanent secretaries have to be citizens, but Whitehall is prepared to be flexible, and scouts from the Department of Health (DoH) have been sizing up health systems managers on the west coast of the US, in Chicago and New York as they search for a new chief executive for the NHS.
There would be ructions if an American were appointed. The NHS, like the BBC, supplies elements of national identity - to be British is to believe in healthcare free at the point of use. To many, such an appointment would promise further and quicker movement down the road of contracting out provision.
That, indeed, is the point: the DoH wants someone to complete the transformation of the NHS into a commissioning agency, which is why the headhunters are looking to Kaiser Permanente and big American "health maintenance organisations", which purchase care but may not themselves run hospitals or general practice.
Money would be a problem. In London, Livingstone had to weather a storm over Kylie's package, and the health secretary, Patricia Hewitt, would have to dig deep to cover transfer fees. Fairly or unfairly, the appointment of an American would symbolise the Blair government's attachment to the US in foreign policy, and it is a mark of the desperation in top DoH offices after the sacking of Sir Nigel Crisp that the American option should have been pursued - and pursued, moreover, without Treasury backing.
But is the issue here really about a foreign appointment? It is noteworthy that the headhunters don't seem interested in French or Spanish candidates, even though health systems in those countries are versions of the commissioning model. It is the DoH's faith in what you might call leadership by syringe. Appoint a big cheese and they will lead "transformation" top down; the new chief executive will thump the table and the new heads of strategic health authorities will push primary care trusts relentlessly into payment by results, standing firm while hospitals close, moving midwives out into non-profit trusts, and so on.
Of course, the NHS has more command and control than other public services, but if the government wants change to stick, hearts will have to be won. The leadership books talk about the need for emotional intelligence, and in the NHS that surely implies some "political" understanding of the Bevan legacy and its, let's face it, quasi-socialist values. The books define leadership in terms of networks and persuasion. However talented, an import will lack networks and will have to rely on lieutenants, who, in time-honoured NHS fashion, will themselves be jostling for place and position. Who imagines that this recent reapportionment of seats in strategic health authorities will be the last?
No final decision has been taken, but it looks as if the twin roles of chief executive of the NHS and permanent secretary of the department - so unhappily held by Crisp in recent months - will be split. That means an incoming chief executive will have to mind his or her back, because the civil service and ministers will have an opportunity for shifting blame that now is entirely theirs.
British health managers - at least, those brought up in the system - know the score. The NHS will always be part of politics, and the decibel levels are going to rise as the Blairite agenda for change is pushed further. Some grounding in the art of public management in Britain is surely a prerequisite for survival.
· David Walker is editor of the Guardian's Public magazine.
