The lost worlds of royal commissions in the NHS: The unaccountable in pursuit of the unanswerable?
| Published date | 01 July 2019 |
| Author | Martin Powell |
| DOI | 10.1177/0144739419830449 |
| Date | 01 July 2019 |
| Subject Matter | Articles |
Article
The lost worlds of royal
commissions in the NHS:
The unaccountable
in pursuit
of the unanswerable?
Martin Powell
Health Services Management Centre, University of Birmingham, Birmingham, UK
Abstract
There have been recent calls for a royal commission (RC) on the British National Health
Service (NHS). This article focuses on the impact of RCs and similar advisory bodies,
particularly on finance recommendations, of three inquiries with broad remits across the
whole of the NHS from very different periods: Guillebaud (1956); Royal Commission on
the National Health Service (1979); and House of Lords Select Committee on the Long-
term Sustainability of the NHS (2017). These inquiries appear to have had rather limited
impacts, especially on NHS funding. First, there appears to be some hesitancy in sug-
gesting precise figures for NHS expenditure. Second, the reports are advisory, and
governments can ignore their conclusions. Third, governments have ignored their
conclusions. In the 1950s and the 1980s, contrary to the recommendations of the
inquiries, NHS expenditure subsequently grew only slowly, and charges were increased.
In short, asking an independent RC to provide answers on NHS expenditure is perhaps
the unaccountable in pursuit of the unanswerable.
Keywords
Royal commission, inquiry, National Health Service (NHS), UK
Introduction
There have been recent calls for a royal commission (RC) on the British National Health
Service (NHS) (e.g. Saatchi, 2017; Saatchi and Nutt, 2018). Saatchi and Nutt (2018) state
Corresponding author:
Martin Powell, Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park
Road, Birmingham B15 2RT, UK.
Email: m.powell@bham.ac.uk; Telephone: 0121 414 4462
Teaching Public Administration
2019, Vol. 37(2) 199–217
ªThe Author(s) 2019
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0144739419830449
journals.sagepub.com/home/tpa
that there has been a groundswell of support – including recent editorials in the Tele-
graph,Sun and Daily Mail – for a RC. Saatchi et al. (2017) state that ‘never has there
been a better time or a more compelling reason’ for a RC on the NHS. They claim that
the public supports a RC (CPS, 2017), continuing that former health secretaries Norman
Fowler (Conservative), Stephen Dorrell (Conservative) and Alan Milburn (Labour) have
said that they support this approach, as has the current Liberal Democrat health
spokesperson and former Minister of Health, Norman Lamb. The Saatchi paper was cited
by Dr Andrew Murrison, who also pushed for a RC in a Prime Minister’s Question
(PMQ) on 10 January 2018. An ‘exclusive’ article for the Sun (Hawkes, 2018) stated that
as a result of lobbying by ‘dozens’ of Conservative MPs, Health Secretary Jeremy Hunt
was ready to trigger a landmark cross-party RC into the future of the NHS.
On the other hand, other commentators agree with the need for cross-party support but
argue that other forms of inquiry are preferable to RCs. For example, according to Davies
et al. (2018), of the three possible types of inquiry – RC, independent inquiry, parlia-
mentary inquiry – the last would be the most likely to be effective. They argue that the
recent record of RCs, such as those on the Reform of the House of Lords and on Long-
term Care, is poor. On the other hand, they claim that recent independent inquiries such
as Wanless (on NHS funding), Turner (on pensions), Dearing and Browne (on university
tuition fees) and Dilnot (on social care) have been influential (but see below). Moreover,
RCs are unwieldy and take too long (but see Saatchi and Nutt, 2018). They point out that
more than 100 MPs, including 21 select committee chairs, have supported a campaign
led by Sarah Wollaston, the Chair of the Health and Social Care, and Liaison Com-
mittees, to establish a parliamentary ‘commission’ into health and social care. Similarly,
former CEO of the NHS, Nigel Crisp (Saatchi et al., 2017) states that while a RC has
some merits in being above politics, authoritative, and open in its deliberations, and
would potentially command wide support, it has formal and restrictive processes for
taking evidence and consultation, can be very expensive and can be lengthy. However,
the biggest argument against a RC is that a more flexible, quicker process that directly
involves people from all parts of the health and care system, including patients, families
and carers, is a better option.
This article focuses on the impact of RCs and similar advisory bodies, particularly on
finance recommendations, of three inquiries with broad remits across the whole of the
NHS from very different periods: Guillebaud (1956); Royal Commission on the National
Health Service (1979); and House of Lords Select Committee on the Long-term Sus-
tainability of the NHS (2017). There is fairly limited coverage of these in the standard
academic texts. While the texts predate the last select committee, Ham (2009) and Klein
(2013) cover both Guillebaud and the royal commission in about half a page and a page
each respectively. The most coverage is in the magisterial text by the official historian of
the NHS. In some 1200 pages and two volumes of text covering the NHS up to 1979,
Webster (1988) covers Guillebaud in about eight pages, while Webster (1996) explores
the royal commission in about 10 pages.
This article first explores RCs (and similar inquiries) in the NHS, before focusing on
the three inquiries listed above in more detail, and then proceeding to a wider discussion
and conclusion.
200 Teaching Public Administration 37(2)
To continue reading
Request your trial