Robert Colvile: A Royal Commission would shine a light on the challenges faced by the NHS

Posted On: 
5th February 2018

As the NHS turns 70, a Royal Commission could be the only route to safeguarding its long-term future, says Robert Colvile 

Calling for a royal commission is not a covert attempt to privatise the NHS, writes Robert Colvile
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For any British government, maintaining the National Health Service is one of the most important political priorities. It is not only an area dear to voters’ hearts – one with which millions of them have the most intimate and pressing contact – but one that is responsible for an almighty proportion of government spending, which will over the coming decades grow more almighty still.

Asking the same government to effectively renounce control of the institution is therefore the kind of request that might be deemed, within the civil service, to be “courageous”. Especially when the recommendations that result from such a process might well result in a request for extra cash which the government may be hard pressed to find.

So why make such a “courageous” request? Because it is increasingly looking as though it is the only route to solving the NHS’s many problems – or at least many of the NHS’s many problems.

It is an article of faith in British politics that the NHS needs more cash. But it doesn’t need cash alone. Anyone who has worked in the health service, or studied it, or even just been through its doors, will know that there are things it could be doing better. The OECD has said that simply bringing it up to the standard of our nearest neighbours, in terms of efficiency, would result in gains worth 3% of GDP.

And even if cash alone were the solution, where is it going to come from? Over the next 50 years, the share of national income required by the NHS is – according to the Office for Budget Responsibility – set to rise from 6.9% of GDP to 12.6%. Even “non-demographic” pressures (ie medical price inflation rather than changes in the population’s size and age) will add the equivalent of two thirds of the current NHS bill.

There are, in other words, all manner of pressing questions hanging over the health service and its future. Even if you think it can just about survive the next few years, some very serious thinking still needs to be done about the next few decades. Yet politicians are barely trusted to do that thinking – especially in the wake of the last misbegotten round of NHS reform.

This is why Lord Saatchi, chairman of the Centre for Policy Studies, has proposed a royal commission. This would have the power to investigate the standards, structures, funding and future of the NHS, and to come up with solutions that put it on a sustainable footing for the coming decades. Not all of its suggestions would meet with unanimous agreement: the health service is far too hot a political potato for that. But it would at least bring the process of reform, and the key challenges that the NHS faces, into the light – and help to educate voters about those challenges, and the trade-offs that may need to be made.

Some have argued that calling for a royal commission represents a covert attempt to privatise the service. But it is difficult to see how. Our latest paper, setting out the remit for such a commission, is explicit that the founding principles of the NHS must be respected, and that whatever the commission’s conclusions on private sector involvement, or additional funding sources beyond general taxation, commercial interests must not be allowed to predominate.

Indeed, the focus of NHS reform must surely be on those who are worst served by its current problems – those who cannot afford an alternative. At the moment, health outcomes in this country vary enormously between rich and poor: those born in the affluent south-east can expect years, sometimes decades, more of healthy life than those in the worst-off areas.

The National Health Service is at the heart of British politics. It’s something the British people themselves are hugely attached to. But like so many 70-year-olds, it’s got its fair share of health problems. It’s past time for a proper check-up. 


Robert Colvile is director of the Centre for Policy Studies. ‘A Royal Commission on the NHS: The Remit’ is available at