Why I believe this is the only thing that can cure our NHS
From a major political voice, a cri de coeur that MPs of all parties MUST heed
THE NHS is the ultimate post-truth world – fake news and alternative facts. When he created the National Health Service, its founder Nye Bevan, explained what he was doing very simply: ‘When a bedpan falls in Tredegar (his constituency in Wales), the echo will be heard in Whitehall.’ What he meant is that when you are in trouble in the NHS, we will feel your pain in the corridors of power.
Times change. What that now means is that the NHS is the third rail of politics – touch it and die. Apparently, the NHS is now so complicated that it is beyond the judgment and understanding of the human mind to comprehend all its variables.
The problem is not whether the NHS is ‘good or bad’. It is that no one agrees on anything.
Even those most closely involved cannot agree on whether there is a problem, or, if there is, what it is; or what the solution might be. And that’s before we even start on ‘the patients’, that’s you and me.
While the recent ‘Winter crisis’ saw patients suffering in hospital corridors, critical operations cancelled and endless queues in casualty, some studies still suggest we have one of the best healthcare systems in the world.
So is the NHS close to meltdown, or was this just a statistical winter blip? Where does the truth lie? And who can we believe?
Today’s new buzzphrase is ‘alternative facts’. And the conundrum of ‘alternative facts’ goes to the heart of the problem with the NHS. These aren’t lies. It is just that there are so many different ways of looking at the same thing that rational discussion has become next to impossible.
AFEW examples. Is health spending up, as some say, or is it falling as a percentage of GDP and the lowest in the G7? Are doctors overworked and underpaid, or are too many people milking the system with bloated salaries?
Are performance levels getting worse, or are we carrying out record numbers of treatments providing safer, more effective care than ever before?
Is immigration a problem, or does the NHS’s survival depend on foreign doctors and nurses? Is the NHS a national treasure – or, like Stonehenge, an outdated relic? Does the NHS need more money – or more efficiency?
All these alternatives are true to some people and all were given as answers to the NHS’s ongoing problems during many fascinating meetings I have had with health professionals, politicians and administrators over the last year.
Some brilliant surgeons and professors think that everything is more or less manageable. Other equally brilliant surgeons and professors think the NHS is doomed. And those in the second camp couldn’t begin to agree about what should be done.
It has long been recognised that discussions, particularly party political ones, about the NHS produce more heat than light. So the time has come to ditch the dogma and face one central, undeniable truth.
That truth is that we as a nation need to have a proper, grown-up talk about the NHS. What we can expect of it, how we should fund it and how we can shape it to tackle the enormous challenges that lie ahead: a rising – and ageing – population; the extraordinary – but often extraordinarily expensive – advances in medical innovation; how to integrate social care, to name but a few.
The future of the NHS is a huge, looming problem that affects us all. It’s so central to our lives and our national identity that the very idea of change has become politically toxic – which is exactly why the discussion should be taken out of the hands of the politicians.
That is why, as I explain in a Centre for Policy Studies report published today, I am asking the Government to set up a Royal Commission into the future of the NHS.
I hear you groan and I understand why. Official inquiries have had a patchy record of late. The Chilcot Inquiry into the Iraq War, for example, took seven years and was widely seen as a convenient, and very expensive, way of kicking a thorny political problem into the long grass.
But if properly set up and directed, a Royal Commission can be a very different beast. With a tightly defined remit and length, it can be a hugely effective mechanism for identifying and analysing the enormous longterm challenges the NHS faces.
A Commission’s investigatory powers and capacity to provide solutions free from the political cycle can be a game changer. Its recommendations can carry a unique legitimacy and show a way forward that allows the NHS to meet the challenges of the future and sustain us all for decades to come.
To avoid accusations that the Commission is merely a vehicle for introducing politically difficult reforms, it should be invited to research a range of options and present a menu of fully investigated options and recommendations.
These could be rigorously examined and costed alongside more mainstream solutions with an aim of giving any future Government a range of options. It would also provide the opportunity to find consensus among health professionals and politicians on some of the most serious problems the NHS faces.
The Commission should look at the way we run the health service and how much we should reasonably pay to give it the best chance of relieving the growing pressures on the system.
The Commission should be asked to investigate how deteriorating clinical outcomes should be improved, how barriers to equal access should be eliminated and how the NHS should be future-proofed.
IT CAN also be asked to make recommendations on innovations that could provide cost-effective improvements and to outline best practice. The timing has never been better. We have the finest medical minds in the world. If they really believed it was Her Majesty’s wish that they would all sit down together to bring forward a good plan for the nation’s health, it would happen.
It will not be hard. All the Commission has to do is to find out what people expect and give it to them. All it needs is a blank sheet of paper and a pencil.
Lord Saatchi was the driving force behind the Access To Medical Treatments (Innovation) Act, designed to free the medical profession from the fear of litigation when using innovative treatments. His paper, An NHS Royal Commission – From Fighting Fires To A Lasting Settlement is available at www.cps.org.uk.
A Royal Commission can future- proof healthcare