Just before the general election, David Cameron declared his opposition to lobbying, saying “we all know how it works. The lunches, the hospitality, the quiet word in your ear, the ex-ministers and ex-advisors for hire... It arouses people’s worst fears and suspicions about how our political system works, with money buying power, power fishing for money and a cosy club at the top making decisions in their own interest...We can't go on like this.” 

Today, Nick Seddon enters 10 Downing Street, as Cameron's brand new health advisor.  Seddon’s last role was as deputy director of "Reform" - a free market think tank extensively funded by healthcare and insurance companies. He has openly called for an end to the NHS as we know it, and promoted the idea of an insurance-based system.  

Before joining Reform, Nick Seddon was head of communications at private healthcare company Circle - the first company to take over the running of a NHS hospital.  

His role during the passage of the Health and Social Care bill was to lobby key people to defend competition in the bill. His reward? A place in Cameron’s health policy unit, developing  policies for the 2015 general election. In David Cameron’s own words, “We can’t go on like this”.  

Private Policy Unit

 When work begins in the Number 10 Policy Unit, Seddon will find himself working under a team that has both financial connections to private healthcare interests, and a long standing ideological commitment to a system of private health insurance. He told the the Evening Standard “The exact work I do will be for Jo Johnson and the PM to clarify.”

Jo Johnson MP, brother of Boris, was recently appointed Parliamentary Secretary at the Cabinet Office to help devise the 2015 Tory manifesto. In July 2010, he received £6,000 to his constituency office from Robin Crispin Odey, investor in the aforementioned Circle Health.

 In turn Jo Johnson will be under the experienced hand of Conservative policy guru Oliver Letwin, who famously wrote a report for the Tory think tank Centre for Policy Studies titled "Britain’s Biggest Enterprise, ideas for radical reform of the NHS". The document, written when Letwin was an advisor on "privatisation to overseas government" asked:

"Might it not, rather, be possible to work slowly from the present system towards a national insurance scheme?  One could begin for example, with the establishment of the NHS as an independent trust, with increased joint ventures between the NHS and the private sector; move on next to the use of ‘credits’ to meet standard charges set by central NHS funding administration for independently managed hospitals or districts; and only at the last stage create a national health scheme separate from the tax system." 

Reform – Tory Think Tank

Nick Seddon’s transfer from Reform to the No10 policy unit is merely the latest example of close links between the supposedly ‘non-party’ think tank, and the Conservative Party. Reform is often used to trail Conservative policies. Seddon’s predecessor at Reform, Elizabeth Truss, went on to become a Conservative MP, as did its founder, Nick Herbert.  

Reform appears to exist principally as a way for companies to influence the policy agenda. It is part-funded by 35 corporate partners – nearly half of whom are involved in private healthcare, health insurance, and associated businesses - who each donate at least £8,000 annually to the charitable Reform Research Trust. In 2011, Reform received  the sum of £770,000 from its corporate partners and other sponsors. In return for the cash, they are involved in research reports, able to sponsor key events with policy-makers present and have their agenda represented in newspapers.

 Seddon's role in the Health & Social Care Act

At Reform, Seddon played a leading role in helping the government push through the Health & Social Care Act  2012. At the end of the so-called "listening pause" granted after massive outcry, David Worskett (director of  healthcare lobby group the NHS Partners Network), produced a memorandum for their members that was obtained by Social Investigations:

"the whole sequence of Telegraph articles and editorials on the importance of the Government not going soft on public service reform, including some strong pieces on health, is something I have been orchestrating and working with Reform to bring about."

 Two days earlier, Mr Seddon had appeared in the Telegraph criticizing Clegg for saying that "instead of having a duty to promote competition, Monitor's main duty should be explicitly to protect and promote the interests of patients".  Seddon claimed “the two are not in conflict and competition is actually in the best interests of patients."

Another Telegraph article by Seddon highlighted a Reform report, titled "It can be done", which praised the increased involvement of private companies in running hospitals in Spain and Germany. Seddon also criticized opponents of the "plan to compel hospitals to compete for patients and income". And he weighed in to ssupport the forthcoming conclusions of  Sir Stephen Bubb, the head of the Future Forum’s competition panel, and a long term advocate of competition.

Sir Stephen, meanwhile, had blogged about how he "met for lunch with the marvellous Nick Seddon" and received ‘lots of evidence and research on how competition extends choice and provides better value for the NHS"’ Later,  Sir Stephen revealed how fixed the "listening exercise" really was. "Just as I was signing off the competition panel’s report, I got sent a copy of the PM speech announcing he is accepting many of our key recommendations (although we haven't actually given him the report yet!)". 

A glimpse of the future?

So what policy ideas can we expect from Nick Seddon?  He is no fan of Clinical Commissioning Groups (CCGs). In another Telegraph article, which appeared the day after Andrew Lansley’s 2010 White Paper, he wrote "There is no evidence to suggest that they [GPs] have the skills needed, which makes it unlikely that they'll be any good at trying to make hospitals improve what they do and cut their costs…"

Such criticism may be surprisingly welcome to the ears of his new boss, Letwin, whose original post-election blueprint for the NHS did not include Clinical Commissioning Groups, according to Nicholas Timmins’ book on the battle over NHS reform.

Seddon’s article goes on to say that ‘all is not lost’, because CCGs could be used as the basis to  move towards a "mixed funding insurance model. The £80 billion budget could be allocated to insurers in professional alliances with GP groups…those who can afford to would be encouraged to contribute more towards their care packages".  

 Such a move would surely please the corporate partners of Reform, who include the Association of British Insurers and Aviva. A greater role for insurance seems to be Seddon’s key theme – last December he reportedly told the All Party Parliamentary Group on Primary Care and Public Health that the NHS could learn a great deal from insurers in other countries especially those in the private sector. 

He recommended too that the NHS should trial the U.S. system of Accountable Care Organisations (ACOs), which work together to reduce costs. Once services are fragmented, such  schemes could act as a way to bring them back together, but not under public control, rather, under the potential control of insurers.

In the U.S, the ACOs are funded by private health insurance, employer health schemes or the government.  According to a report by the leading journal of health policy in the U.S, ACOs have produced mixed results. High set up costs mean ACOs have experienced difficulty in balance the books. There have been concerns that a few ACOs will gain a "large share of the market, increasing their bargaining power with private payers and reducing the potential for savings."

Seddon’s appointment shows Cameron’s hand. It shows yet again the corporate interests driving the dismantling of the NHS, whether through lobbyings like Seddon and Reform, or through their extensive links with parliamentarians. Let us not forget, one in four Conservative Lords and 58 Conservative MPs have recent or present financial links to companies or individuals connected to private healthcare. Over thirty of the companies who are listed as corporate partners of Reform also have recent or present financial links to Lords and MPs.

 The voices calling for insurance schemes are no longer shouting from the wilderness, but are now at the forefront of Conservative party policy-making. The Health and Social Care Act was a façade. Behind it lay the legal mechanisms that will fragment services and see NHS providers lost forever as increased numbers of services and public resources move into private hands. Will these be the new organisations that make up the ACO system that Seddon wishes to promote?

 This article was co-published with Social Investigations