It’s time for a royal commission to review the NHS

29 Jan 18

To keep the NHS sustainable for the long term, the starting point should be a review by a royal commission, taking it outside politics, says Robert Colvile, director of the Centre for Policy Studies.

Pressure on the NHS has dominated the headlines this winter. But it’s only when you look to the horizon that you appreciate the true scale of its problems.

According to the Office for Budget Responsibility, health spending will rise from 6.9% of GDP to 12.6% over the next 50 years. Just keeping pace with “non-demographic cost pressures” will need an extra £88bn in today’s money, equal to roughly 60% of NHS England’s current budget.

Everyone from Jeremy Hunt to the humblest hospital porter accepts that the NHS needs more money. But it’s not just about money. The NHS, like many 70-year-olds, suffers from multiple long-term conditions – an ageing, expanding population, bias towards acute over primary and preventive care, the split between health and social care and the health gap between rich and poor.

Some of this may be fixed by more money, but not all. In 2015, we ranked 19th out of 31 European countries for stroke deaths and in the bottom third for heart attack deaths. In terms of cancer survival after diagnosis, we are bobbing along in the rankings alongside countries like Chile and Poland. An OECD study a few years ago argued that just by improving the efficiency of our health system to match that of similar nations in Europe, we could gain the equivalent of 3% of GDP – without spending an extra penny.

The trouble is that, while the NHS needs change, change has become politically toxic. Following the Andrew Lansley reforms, voters no longer trust the Tories to have big ideas about the NHS. Labour, meanwhile, howls about cuts and privatisation without putting forward constructive suggestions.

It is an age-old political cliché that the NHS needs to be “taken out of politics”. But sometimes it is true. The NHS is too important for the current situation to endure, where cash is funnelled into patch-up jobs that solve an immediate crisis without addressing the underlying symptoms.

That is why Lord Saatchi, the Centre for Policy Studies chair, last year called for the government to set up a royal commission to examine the NHS’s future. A paper the centre published in January provides a remit for such a commission: to examine the structure, funding and organisation of the NHS in order to set it on a sustainable course for the coming decades.

The advantages to a royal commission are many. It could bring together independent, authoritative voices and draw opinion from across party lines. Ideally, it would be able to: summon witnesses to testify under oath; offer protection for whistleblowers; draw evidence from all corners of the health service; and to inspect NHS operations as its members saw fit. All its recommendations would be fully costed – and it would be asked to investigate options for raising funding from beyond general taxation.

In addition, this would educate the public about the problems the NHS faces. For example, a royal commission would be able to examine the merits (or otherwise) of private provision in the NHS, and whether this should be expanded or curtailed, without knee-jerk cries of “privatisation”. More broadly, it would highlight the absurd alphabet soup of agencies and bureaucracies that hospitals and doctors have to wrestle with, and how layer after layer of incentives and targets have distorted the health service’s work.

There is no silver bullet – and no royal commission can produce a blueprint that will win universal support. But, if we do not take bold action, it is hard to see the current system lasting another 70 years, let alone spending them in rude health.


A Royal Commission on the NHS: The Remit by Maurice Saatchi and Dominic Nutt can be read here

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