One of the great arguments by those who support the NHS is that it is “fair”; a millionaire at a GP or an NHS hospital will get exactly the same treatment as someone on the lowest income.
At least, supposedly.
A recent report from the ONS shows that if you live in a smart area you will on average have 19 more healthy life years at birth than if you are born in the worst areas. A boy growing up in Blackpool has a life expectancy of just 75 while another born in Kensington could expect to live for at least another decade. While some of this staggering discrepancy is due to external factors (poor housing, unhealthy lifestyle choices and so on), a significant part must be laid at the door of the NHS. It is failing to treat the less well-off adequately and is failing to provide effective preventative care to those who need it most. It is not a National Health Service. It is a Wealth-determined Illness Lottery.
This is just one of the many crises facing the NHS. We might all disagree on the importance and urgency of the individual problems that it faces. But it is hard to think that we can just soldier on as we are now for the next 20 years.
The UK now sits in the middle order or lower tail of European countries for A&E wait-times, cancer survival rates, decrease of stroke deaths, and infant mortality. In 2015, it was ranked 19th of 31 countries for stroke deaths, 20th of 23 for both breast and bowel cancer survival, and 21st of 23 for cervical cancer survival. It was in the bottom third of countries for heart attack deaths, and our closest peers for survival after a cancer diagnosis are Chile and Poland. These are hardly non-critical indicators.
And the challenges are only going to intensify: an ageing population, the future of social care, the perennial funding crises, the growth in financially draining chronic disease, the impact of Brexit on labour supply, the cost (and opportunities) of medical innovation, the problems with mental health. The gravity of one or more we can argue about. Taken together, it is clear that a failure to consider fundamental reform of the NHS would be irresponsible.
But the NHS has become a political football. There is little agreement over the scale of the problems its faces and their causes, let alone possible solutions. That is why we need an honest broker, a peacemaker: we need a royal commission on the NHS.
Royal commissions are public inquiries at the highest level, called to look into matters of utmost importance; and few issues are more important to the future of our country than the health and wellbeing of our citizens.
Their many advantages include the ability to secure vital, cross-party support needed to embed lasting changes, to encourage a public debate on what needs to be done and to detoxify reforms that otherwise may be too politically dangerous to pursue. And royal commissions are independent — governments cannot interfere once they have started — and therefore sit outside of politics. They are also powerful and can compel people to produce documents and other evidence in their inquiry.
And we will need the power to ask difficult questions of experts from all sections of society. We must think beyond the structures and institutions of the last century.
Is the NHS no longer fit for purpose? If so, what is that purpose? Is the crisis really as simple as a lack of funding? Or are citizens bringing it to breaking point through our lifestyle choices?
If a political party were to pledge that it would set up a royal commission on the future of the NHS, it would not only be morally right, it would also be immensely popular. Recent ComRes polling has found that, 61 per cent said that they supported a royal commission, while only 6 per cent said that the NHS should continue as it is. Voters of all parties support a royal commission; 68 per cent of Conservative voters and 61 per cent of Labour voters support the proposal, with Liberal Democrat voters being most supportive at 75 per cent in favour.
The prime minister has rightly said that tackling unfairness and injustice are her top priorities. We all want an NHS that is accessible, fair, and sustainable. Only a royal commission can examine forensically what that means today for healthcare, for citizens, and for society — and take the politics out of health reform.
This piece was originally published by the Times Red Box on Monday 1 May 2017.