Give the Westminster Watchdog teeth: the need for a new Commission

Opinion logoHealth and related social care in the UK are in a critical state. The improvements that recent Labour governments had made to the NHS, such as much lower waiting lists, have been and are still being damaged by, first, the coalition government and then by the Tory government. Social care has been savagely clobbered by the public expenditure reductions affecting local government.  We need the urgent development of much better health and social policies by government of the kind carried out by good all-party parliamentary  select committees.

John Lister’s article (26 May [1]) on the plight of the NHS and related social services was typically informative and disturbing. His conclusion was succinct – that a “universal health service like the NHS cannot be delivered on Osborne’s funding of 7 per cent of GDP or less”.  The respected NHS Support Federation calculates that the UK spends less of its GDP on health than 12 of the 15 original EU countries.

The rise in the costs of healthcare in the UK and internationally are partly due to demographic reasons – populations are ageing and subject to more chronic diseases such as diabetes – and partly due to advances in care such as new drugs and new diagnostic and other technology, for instance, for clinical monitoring.

Does the government’s drive to privatise, that is, to significantly increase the commercial rather than public provision of healthcare, lead to efficiency and lower costs? It does not. Healthcare in the US can be regarded as a vast test-bed for extensive and competitive commercial healthcare – and the overall costs are no less than double those of the UK in terms of percentage of GDP spent on health.  Furthermore, the biggest cause of personal bankruptcies in the US is still healthcare bills despite Medicare and Medicaid. And fraud in US healthcare is notorious – the FBI has a special section for tackling healthcare fraud!

A comparison of healthcare in the US with Canada is instructive.  A recent study commented: “much of the appeal of the Canadian system is that it seems to do more for less. Canada provides universal access to health care for its citizens, while nearly one in five non-elderly Americans is uninsured. Canada spends far less of its GDP on health care (10.4 per cent, versus 16 per cent in the US) yet performs better than the US on two commonly cited health outcome measures, the infant mortality rate and life expectancy.”

Despite the international evidence, the right in the UK tends to react to increasing healthcare costs by advocating and implementing privatisation –  and by cutting services such as preventive  (public health) services (e.g. sexual services), and by closing hospitals  even though we are seriously ‘under bedded’ in comparison with many countries.

There is a need for a tough analysis of health problems and the urgent but not hasty development of much better polices for health and social care. Although it is out of fashion, consideration is now being given to the careful setting up of a well-staffed royal commission that would be required to report in say 6 months.  This is not an unrealistic deadline.

The Commons health select committee could provide the all-party basis for proposals for setting up the commission that are called for to reach as broad a consensus as possible. The select committee could be asked to draw up the proposed aims and terms of reference of the royal commission and make public recommendations for its membership and support services. Such initiatives would give NHS and social care staff – and the citizenry –  the benefit of new politics.


Dr Peter Draper

Former director the Unit for the Study of Health Policy

[The views expressed in this post do not necessarily reflect those of Doctors for the NHS.]

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[1] Lister, J. (2016) Privatisation is the Tory bottom line. Morning Star, 26 May [online] Available at:


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