Choice of Downing Street health adviser prompts fears that copayments may be on the agenda

BMJ 2013; 346 doi: (Published 21 May 2013) Cite this as: BMJ 2013;346:f3307
  1. Ingrid Torjesen
  1. 1London

Fears that the appointment of Nick Seddon as the new special adviser on health at Downing Street is a sign that the government is considering the introduction of copayments for NHS patients have been dismissed by senior health policy figures who know him well.

Before being invited to advise on health and social care as part of a new team led by Jo Johnson—the younger brother of London mayor Boris Johnson—Seddon was deputy director of the right wing think tank Reform, an organisation that promotes free market policies and small government.

Before joining Reform, Seddon—only in his mid-30s—was head of communications at Circle, the first private company to win a franchise to run an NHS hospital, Hinchingbrooke in Cambridgeshire.

Seddon has been reported to have argued that, based on international evidence, imposing charges for services such as seeing a general practitioner could be effective.1 He said this in 2012, when asked to comment by the BBC on a report from the Institute for Fiscal Studies. The report had concluded that the government needed to consider more radical steps because of rising demands on the NHS from the ageing population, such as introducing charging for some services, stopping low priority care, or raising taxes.2

Nick Bosanquet, professor of health policy at Imperial College London, and a member of Reform’s advisory board, said that fears about copayments were “quite misplaced.” “[Seddon] has said no more than Malcolm Grant [chair] of NHS England3—that at some point we may have to consider user charges—he didn’t say that that would be desirable or that it is going to happen soon, but realistically it may happen in the future,” he told the BMJ.

Seddon is an expert on innovation in health services and would bring some fresh and badly needed ideas for lowering costs, Bosanquet added. “He’s very keen on improving communication with patients and making it much easier for patients to get direct access to their [general practitioners] by telephone, email, and texting,” he said.

In an article for the Health Service Journal last year,4 Seddon wrote: “If we want the NHS to survive we will need to transform the relationship between the individual citizen and the state with personal technology aiding the exercise of personal power, control and accountability.” He added, “Services will need to be shaped around patients in a complete overhaul of the business model,” which included a reduced emphasis on hospital care, more care in community settings, use of new technology, personal budgets, and “helping services do more with less.” Part of this overhaul required workforce reforms, with local rather than national terms and conditions, and more skill mixed, team based working.5

Seddon has acknowledged that some hospitals need to close, but, as Bosanquet points out, he is not the first person to say this. The question is whether Seddon can drive the government into seeing this through where others have failed.

Paul Corrigan, a former special adviser to Tony Blair, said that the appointment was a good one. “His is a political appointment. This recognises that the prime minister needs political as well as policy advice on the NHS. Up until now, the position has been only one of policy advice, and in my experience this would limit the effectiveness of the position,” he said.

“Nick goes into this job knowing enough about real politics to recognise that he will never set government strategy for the NHS,” he added. “Those who say that his appointment will lead to a change in the fundamental funding principles of the NHS with more funding coming from copayments will be proved wrong. The Conservatives will go into the next election as they went into the last, pledging to maintain the basic funding principles of the NHS.”


Cite this as: BMJ 2013;346:f3307