19 February 2018

Lucy Campbell argues that government must consider all of its options to address the funding challenges of health and social care.

The NHS has endured a challenging winter: cancelled operations; ambulances queueing for hours outside A&E; and patients consigned to trolleys in their wait for treatment. No wonder, with health and social care a dominant topic in the 2017 election campaign, that Jeremy Hunt, the Health and Social Care Secretary, wants to “find a consensus for the next phase” of NHS funding that looks beyond political cycles. 

But is a royal commission – favoured recently by politicians, think tanks and even former civil servants – the right solution? There is room for doubt.

A royal commission could take too long

Royal commissions are not quick: in the words of Harold Wilson, they “take minutes and waste years”. Typically constituted with a panel of 12 to 16 eminent experts and other senior figures, and intent on deep analysis, they routinely take years to produce their findings. The shadow health secretary, Jonathan Ashworth, argues that a royal commission on the crisis of health and social care would “kick the problem into the long grass”’.

A royal commission may not have impact

There is also no guarantee that the findings of a royal commission would have a real impact. The two most recent commissions have looked at long-term care for the elderly (Sutherland, 1997-1999) and reforming the House of Lords (Wakeham, 1999-2000).

Political and public concern with spending meant that the recommendations of the Sutherland Commission were never accepted by the Government (although they were adopted in part in Scotland). Meanwhile the proposals made by the Wakeham Commission are no closer to being implemented than when they were published 18 years ago.

There are other forms of commission that can address the challenges in health and social care

Royal commissions, with a 900-year pedigree, are one of the UK’s oldest political institutions. However, their use peaked in the 1800s and there have been none in the past 18 years. Instead, alternative forms of commission have been used for difficult policy questions, for example between 2002 and 2006 the Turner Commission reformed pensions. In 2012 the Houses of Parliament broke new ground by appointing their own commission, Andrew Tyrie’s Parliamentary Commission on Banking Standards, to address the financial questions arising from the Financial Crisis.

Clearly there can be more than one template for addressing today’s issues with health and social care. A new Institute for Government project will publish a report in the summer exploring different approaches to making policy on contentious issues.  


The last Royal Commission not mentioned, nor the Wanless Enquiry, which looked into the funding of the NHS. These confirmed existing approaches. The current proposal, therefore, is merely an attempt to delay action, both funding (for the NHS) and sturdy prevention (eg obesity prevention) where the government in thrawl to the food industry lobby.

Although I am in favour of a Royal Commission, I am not in favour of it taking ages, so I agree with you that other types of Commission be set up to examine health and social care. The Government, opposition and the NHS itself cannot come up with a solution, so we need to hear from every citizen of what is really required and how it should be funded. The Government needs to get this Commission set up very soon, before there is a complete breakdown. The Commission needs to look at recruitment, use of non-UK nationals, qualifications, accident and emergency, research, use of buildings and land, transport access, care standards for homes and hospitals, training of doctors and other medical staff, etc, etc.

Wanless was not a royal commission but a review. And Jenkins did a similar independent commission on electoral reform.