Intended for healthcare professionals

Head To Head Head to Head

Should we have a royal commission on the NHS?

BMJ 2017; 357 doi: (Published 06 April 2017) Cite this as: BMJ 2017;357:j1621
  1. Maurice Saatchi, Conservative member of the House of Lords1,
  2. Paul Buchanan, patient editor2,
  3. Nigel Crisp, independent member of the House of Lords3
  1. 1London SW1P 3QL
  2. 2The BMJ
  3. 3London
  1. Correspondence to: Paul Buchanan pbuchanan{at}, Nigel Crisp crisp{at}

A high level inquiry could detoxify the radical changes needed and command wide support, say Maurice Saatchi and Paul Buchanan; but Nigel Crisp thinks that a less formal, more flexible and collaborative approach could be quicker

Yes—Maurice Saatchi and Paul Buchanan

Never has there been a better time or a more compelling reason, as Brexit is negotiated, for a considered and politically neutral review of our health services. The fiscal implications of dealing with the projected numbers of people with diabetes alone, for example, are enough to prompt a rethink of the whole system and of how society needs to change.

Political football

But the NHS has become a political football. People disagree even on whether it has a problem, let alone the possible solutions. We need an honest broker, a peacemaker: we need a royal commission on the NHS.1

Royal commissions are public inquiries at the highest level, called to look into matters of utmost importance, and few issues are more important to the future of our country than the health and wellbeing of our citizens. Their many advantages include the ability to secure the vital cross party support needed to embed lasting changes and to detoxify reforms that otherwise may be too politically dangerous to pursue.

Royal commissions are independent—governments cannot interfere once they have started—and therefore sit outside politics. They are also powerful and can compel people to produce documents and other evidence in their inquiries.

And we will need the power to ask difficult questions of experts from all sections of society. We must challenge what we think we know about the problems the NHS faces today. We must think beyond the structures and institutions of the previous century.

Is the NHS no longer …

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