Why it’s time for a Royal Commission on the NHS

The health service is plunging deeper into winter crisis—time for an honest review into what works, with party politics taken out of the equation

January 12, 2018
Photo: Peter Byrne/PA Wire/PA Images
Photo: Peter Byrne/PA Wire/PA Images

When he set up the NHS, Nye Bevan is reported to have said that “when a bedpan is dropped on a hospital floor, its noise should resound in the Palace of Westminster.” Today, it is alarm bells that are ringing—at ever-increasing volume.

The NHS is in the middle of another winter crisis, that most distressing of seasonal repeats. Ambulances are stacking up outside hospitals. A&E departments are running out of corridor space, let alone beds. Tens of thousands of non-emergency operations have been cancelled or postponed to cope with the flood of patients. Blockages are present throughout the system.

The prognosis, both short- and long-term, is grim. By the end of September 2017, 83 per cent of acute hospital trusts in England were in deficit. Demand for treatment is growing, thanks to an ageing and expanding population with more complex conditions—and the cost of treatment is also rising, thanks to the inflationary pressure of medical innovation.

Between 2021/22 and 2066/67, the Office for Budget Responsibility predicts that health spending will rise from 6.9 per cent of GDP to 12.6 per cent. Just keeping pace with “non-demographic cost pressures” (such as medical price inflation) will take extra spending of £88 billion per year in today’s money. Yet the period between 2010 and 2021 will see the biggest drop in NHS spending as a share of GDP since the service was founded.

Everyone from Jeremy Hunt, the Health Secretary, to the average punter accepts that the NHS needs more money. But it’s not just about cash. As it marks its 70th anniversary, it is becoming increasingly clear that the NHS is—like so many elderly patients—suffering from multiple debilitating conditions.

“By 2066/67, the NHS will need an extra £88 billion in funding per year”
In 2015, it was ranked 19th out of 31 European countries for stroke deaths, and in the bottom third of countries for heart attack deaths. In terms of cancer survival, we are 20th out of 23 for breast and bowel cancer survival, and 21st for cervical cancer: our overall peers for survival following a diagnosis are Chile and Poland. Health care isn’t joined up with social care. The rich have dramatically higher healthy life expectancy than the poor. We can’t decide whether private sector involvement in the health system is good or bad, and seem allergic to many of the revenue-raising approaches that are standard practice in Europe.

It doesn’t have to be this way. A recent report by the OECD argued that Britain could enormously improve the efficiency with which it delivers healthcare, to the tune of 3 per cent of GDP. Yet ministers, scarred by the experience of the Andrew Lansley reforms, feel unable to suggest radical changes—and would struggle to get public backing even if they did.

It is one of the hoariest political cliches that an issue needs to be “taken out of politics.” But sometimes, it is true. This is why we at the Centre for Policy Studies have called for a Royal Commission on the NHS—an idea set out in a paper last year by our chairman, Maurice Saatchi, and fleshed out in a new paper outlining its remit.

This Commission would have the power to summon witnesses—under oath—to get to the bottom of what’s ailing the NHS, and what needs to be done to its structures and funding to put it in a position to deliver the best outcomes on a basis that is sustainable over decades.
“Britain could enormously improve the efficiency with which it delivers healthcare, to the tune of 3 per cent of GDP"
Contrary to the suspicion of some (Polly Toynbee in the Guardian accused us of leading a “sinister phalanx” bent on the NHS’s destruction) this Commission would be charged with preserving the NHS’s founding principles, which command near-universal support—a publicly owned service, free at the point of use, which provides care for all. There would be no “privatisation by stealth”—just a willingness to look at all the options in terms of what would make the NHS work better, and how to fund it. The Commission would also take account of the NHS’s existing five-year plan, which has considerable merits, as well as the OECD’s suggestions for how to bring our healthcare standards up to those of our neighbours.

The other big idea that is doing the rounds—beyond just muddling through—is that of a dedicated NHS tax. Conservative MP Nick Boles and Nick Macpherson, former head of the Treasury, have suggested that National Insurance could serve this purpose. But this proposal—the Nicks’ NICs—is flawed in two ways.

First, hypothecated taxation is always a con: even Nick Macpherson admits that his NHS tax would be a “smoke and mirrors” disguise for an increase in general taxation. Second, it makes it seem as if the problem is money alone. Yet it is as intellectually dishonest to say that the NHS needs more cash and more cash only as it is to say that it needs more reform and more reform only.

British politics appears to be grinding towards a long-overdue acceptance that the NHS needs a full check-up, and a prescription that will put it back on its feet. It has been heartening to see support for a Royal Commission—or something very much like it—coming from all sides of politics, including many former ministers. If ministers have the courage to grasp the nettle, we might just be able to put Bevan’s creation on the road back to health.