David Lock: Is this the start of the wholesale privatisation process of NHS management?

The prime minister has picked a new health advisor, Nick Seddon, who poured cold water on the creation of clinical commissioning groups and appears to be focused on moving NHS management away from public bodies and into the private sector. Whatever the rhetoric might suggest, changing the NHS into a commercial insurance model appears to be the dominant thinking in No. 10.

In July 2010, Nick Seddon, who was then the deputy director of the right wing think tank, Reform, was fairly damming about the white paper which proposed the creation of clinical commissioning groups. He said:

We are constantly being told that the NHS is going to be radically reformed, yet nothing changes. We get radical disorganisation without long term progress. The most obvious concern about Mr Lansley’s plans is that we don’t know whether GPs will be better commissioners. There is no evidence to suggest that they 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. They certainly haven’t been given any training. And the vast majority of the GPs that I have spoken to say they don’t even want to do it.

There are many who might feel that Mr Seddon was right in his analysis of the government’s proposals even if his own proposals may have equal, if not greater difficulties. Having rubbished the white paper proposals, Mr Seddon then advocated a commercial solution, replacing government with insurers. He said:

The government could still move towards a mixed funding insurance model. The £80 billion budget could be allocated to insurers in professional alliances with GP groups, which would bring together clinical expertise with commercial intelligence.

Writing only last month in the Health Service Journal, Nick Seddon said:

Equally, commissioners need to be open to making big and bold risks, such as using prime contractor models. In Valencia in Spain, private companies have taken on the running of a fifth of the hospitals and primary care services over the past decade, saving 20 per cent while maintaining quality by integrating services, using advanced IT and changing staff terms and conditions.

It does seem a strange appointment for the government to make given that the whole scheme of the 2012 act was to remove responsibility for the delivery of the NHS from ministers and towards NHS England.  This does strongly suggest that the professed hands off approach from ministers who want to leave the running of the NHS to professionals may not be very convincing.  Perhaps this is just the start of the wholesale privatisation process of NHS management.  It will be interesting to see where it all goes.

David Lock is a barrister and QC, No5 chambers. He is a board member of of Brook Sexual Health, a member of the BMA Ethics Committee, and a Honorary Professor at University of Birmingham.

Competing interests: I am a member of the Labour Party and Chair the West Midlands Branch of the Labour Finance and Industry Group. I am due to become a non-executive Board Member of Heart of England NHS Foundation Trust which is due to commence on 1 June 2013. My wife is a doctor who is employed by Worcestershire Partnership NHS Trust.