Sajid Javid’s medicine won’t save the NHS

Does the NHS need a royal commission? Sajid Javid, the former health secretary, thinks so. ‘It is abundantly clear the status quo cannot continue,’ he writes in the Times. He argues that ‘a dispassionate and honest assessment is required’ from an ‘institution that is above the political fray’. Javid suggests that a royal commission that is ‘set up correctly’ could perform this function.

Royal commissions sound august but don’t have a great track record of really helping governments make difficult decisions. They have become a byword in Westminster for kicking something not so much into the long grass as into a thick forest of delay. The Labour government set up one on social care in 1999, and rejected its most important proposals. The NHS has had the royal commission treatment, too: Harold Wilson set one up in the late 1970s to deal with the complaints from the medical world that healthcare was in crisis. It wasn’t really given much scope to think the unthinkable in terms of financing, both in terms of its structure and membership. Anyway, it reported in 1979 and made little difference to the policymaking of the Thatcher government, which set up its own internal reviews on what to do about the NHS.

Javid says his royal commission should ‘report back within one year after the next general election for the government of the day to respond’. At least that would prevent it from being something a new government could set up with a luxurious three-year remit in order to delay difficult decisions. But more widely than this, it’s not clear what a royal commission would tell us that we don’t already know about health. Javid himself argues this, saying that there is a private acceptance that the health service is unsustainable, but that politicians are too afraid to make this argument in public.

A royal commission is not going to lab-grow politicians their own cojones to suddenly say unpopular things. What it more likely is that it will merely reiterate what we already know about the levels of investment we have and the outcomes that these lead to, about how low capital spending is in the NHS, about the impact of a continued failure to reform social care despite commissions royal and otherwise examining this for the past three decades, and about the need to address an unhealthy population.

Could it possibly be that the problem isn’t that we don’t know what to do about the NHS, but that governments are just reluctant to get on with it? The only people who can change that are the politicians themselves.