Nick Seddon, David Cameron's former health advisor (Photo by altogetherfool)
Theresa May didn't rule out offering up the NHS to even more privatisation by American corporations in her let's-make-a-deal meeting with Donald Trump last week. It took until Wednesday for the government to say that no, the NHS could never be part of such a deal. Meanwhile Labour were still warning that a US trade deal could be "a Trojan horse for NHS privatisation".
The prospect of further privatisation will remain a tantalising one for the health companies already making fat profits from NHS contracts. And at the top of one such firm is none other than David Cameron's former Special Advisor for Health.
Nick Seddon was Cameron's health advisor until July of 2016. According to transparency documents released just before Christmas by 10 Downing Street, Seddon became an Executive Vice President of Optum in November last year, just four months after he left his post with the Conservative Party.
Optum is a division of US private health giant UnitedHealth, and has been bidding for NHS contracts for years. A potential trade deal with Trump that includes trade health services could be a boon for them, so it seems like a good time to have a look at its record.
Last July, Optum paid an $18 million fine in the US to settle allegations they put non-terminal patients into their hospices that were supposed to care for people with terminal illnesses.
This was alleged by whistle-blowing Optum managers who filed a lawsuit. The whistle-blowers said Optum "targeted for admission ineligible elderly patients with conditions like debility, dementia, Alzheimer's and cardiac or pulmonary irregularities that, while serious, were not likely to lead to the death of the patient within six months, thus allowing the defendants to keep these types of patients on their hospice census for more than six months, if not several years". That way, the firm could make more cash from America's very limited public health system, Medicare.
The US Justice Department said the whistle-blowers showed Optum claimed money from Medicare, the US public health service, "for hospice care for patients who were not eligible for such care because they were not terminally ill".
The Justice Department said the prosecution and settlement showed its "continuing efforts to combat health care fraud and protect the nation's elderly and most vulnerable citizens".
VICE asked Optum if this hospice scandal meant they were a bad choice to run care for the terminally ill NHS patients. They did not respond to this question.
The firm has had other fines. In January of this year, the New York Attorney General fined UnitedHealth $100,000 and banned them from "uncompetitive practices". He said the firm was unfairly forcing nursing homes to buy extra insurance from them in return for business from the company. UnitedHealth settled out of court without admitting or denying any wrongdoing.
In 2014, California's Insurance Commissioner fined UnitedHealth a massive $173 million for violations under the "Unfair Business Practices Act" relating to health insurance. In 2004, United Healthcare agreed to pay $3.5 million to the US Department of Justice to settle allegations of fraud on Medicare.
And now they've got the former PM's ex-health advisor on board, maybe we can look forward to seeing even more of these guys in the UK.
Even more, because United already has a strong foothold in the NHS. It's on the NHS England "Commissioner Support Lead Provider Framework". That makes it a recommended "lead provider" to help local NHS "Clinical Commissioning Groups" buy health services. It is deeply entrenched in the NHS internal market.
UnitedHealth already had an advantage in the UK even before it employed Cameron's former aide. Simon Stevens, the head of NHS England, was a UnitedHealth executive from 2006 to 2014.
As Cameron's health advisor from 2013 to 2016, Nick Seddon was seen as one of the leading enthusiasts for NHS privatisation in the government. From 2008 to 2010 he was top spin-doctor for Circle Health, a UK health privatiser.
From 2010 to 2013 Seddon was a director at Reform, an economically liberal think-tank funded by leading outsourcing corporations. While at Reform, Seddon argued the NHS should be replaced by an insurance system. He envisaged "healthcare largely funded by government" but "organised outside of government, by insurance companies and other organisations".
In a major 2010 speech Cameron said the "ex-advisors for hire, helping big business find the right way to get its way" was part of the "next big scandal waiting to happen" of "corporate lobbying". But his government made it easier for Seddon to take this job.
Up until 2014, Seddon's new job would have been vetted for possible conflict of interest by the semi-independent Advisory Committee on Business Appointments (ACOBA). However, thanks to a change introduced by Cameron's government in 2014, Seddon only needed to get approval from his own department, the Cabinet Office, for the move to the private sector. They approved the job but imposed two conditions.
The cabinet office transparency document said, "Nick should not draw on privileged information available to him as a Crown servant, including information relating to unannounced Government Policy," and that "for two years from Nick's last paid day of service, Nick should not become personally involved in lobbying the UK Government on behalf of United Health/Optum".
There is no legislative enforcement mechanism to police these rules. Optum's spokesperson said Seddon was an "executive in residence" at Optum's American HQ in Eden Prairie, Minnesota, USA, and "was not engaged in any matters related to Optum in the UK". Given Seddon's close involvement in UK government health policy over the past eight years it's hard to imagine Optum don't want him to help them with UK work once he's able to.
Optum is currently bidding for NHS contracts. It bid for the £535 million Staffordshire "End of Life" contract looking after terminally ill patients in the Midlands. The NHS opened the competition to find a "service integrator" to manage all services looking after terminal patients in Staffordshire in 2016. NHS England imposed a "pause" on the Staffordshire deal last May because the collapse of a similar huge NHS privatisation in Cambridgeshire made health bosses worry these contracts might be unstable.
The "pause" was lifted, and this January NHS commissioners announced they would re-start the deal.
When VICE contacted Optum it tried to steer us away from the story, saying it is "not actively looking" at the deal.
NHS Commissioners told VICE that Optum had submitted a bid before the "pause" in the contract, and had not withdrawn the bid. As far as NHS bosses are concerned, Optum is bidding for this work. The NHS Commissioners said they intended to evaluate Optum's bid, along with the two other bidders – Virgin Health and Interserve – in the spring, and announce a winner in the summer.
Even when told that the NHS believed they were still a bidder, Optum stuck to its "not actively looking" guns. Since the NHS is not evaluating the bid until later this year, "not actively looking" at the contract doesn't mean it's not a bidder.
As Donald Trump would say, the privatisation of the NHS is going to be fantastic, terrific, beautiful…
This article was updated on 3rd February to include the fact that on Wednesday 1st February the government ruled out the NHS being part of a trade deal with the US.