Dr. James Noyes is a policy advisor, and an Associate at ResPublica.
Lord Saatchi was right. The NHS turns 70 this year and is showing its old age. It needs a full check-up if it is going to live beyond this year’s birthday, not just pills to treat the pain.
In January, Saatchi published a paper for the Centre for Policy Studies arguing that the best way to achieve this check-up would be with a Royal Commission: the ultimate option for policy change.
Britain was once a country of Royal Commissions, even if they have recently fallen out of fashion. They are formally appointed by the Crown and are made up of a high-level committee tasked with working in a non-partisan way on a question of national importance. There have been past Royal Commissions on child labour, the railways, the defence of the realm and the freedom of the press. Harold Wilson set one up on the NHS in 1975.
The political sting must be taken out of our healthcare debate. In a non-partisan setting, conflicting ideas over privatisation, taxation and automation would be given serious review rather than soundbites. This approach is essential for an NHS that has been politicised to the point where consensus has become impossible. For too long, questions of healthcare spending, structure and leadership have been weaponised by political parties in their struggle for ideological supremacy.
It is therefore encouraging to see a range of ex-health ministers from all parties support the call for a Royal Commission, including Stephen Dorrell, Alan Milburn and Norman Lamb.
Crucially, a Royal Commission would also be an opportunity to address wider factors of social inequality that underpin the poor health of too many Britons today. People from all sides of the political spectrum share the same outrage that a child born in Blackpool has a lower life expectancy than a child born in Kensington. The same goes for the sharp rise of deadly conditions like dementia and diabetes, which statistically hit the poorest among us the hardest.
The Prime Minister has made social inequality a Government priority. If she wants to leave a positive legacy on this issue, and not just be remembered for Brexit, a Royal Commission on the NHS would be the practicable way to do it.
To make this happen, the Royal Commission should set out a future of public health that speaks for local communities as much as it advocates for innovative technology. Key to this will be resolving long-standing imbalances of access. As I recently argued in a report for the ResPublica think tank, it makes no sense to build Amazon-style automated NHS services or to place the burden of a seven-day week on overstretched GPs when we have 11,000 clinically-trained community pharmacists on almost every high street in the country, including in our most deprived neighbourhoods.
There are critics who say that the process of a Royal Commission takes so long, that it is inevitably dead on delivery. The Commission launched by Harold Wilson took four years and was only completed when Thatcher was Prime Minister, by which time the landscape of government had changed.
This is a reasonable concern, but it forgets the words of Walt Whitman: the future is no more uncertain than the present. Political uncertainty is the hallmark of our age. Who among us can guess the spectrum of possibility that might face us leading up to a general election in 2022? In these uncertain times, a Royal Commission would give us precisely the kind of stability that the country – and the NHS – so desperately needs.
Crucially, a Royal Commission launched this year would be able to respond to three flagship initiatives presently taking shape. The first of these flagships is Brexit. The second is the Industrial Strategy, launched last year by the Government with four ‘Grand Challenges’ for the country. The third is NHS England’s Five-Year Forward View, due to conclude in 2019. In policy terms, the stars are aligning.
A Royal Commission held between now and 2022 would be an ideal opportunity to put our healthcare at the heart of this historic moment of social and economic change. As with Brexit and the Industrial Strategy, the legacy of the Government will be defined by how it captures the moment.