My Lords, I did not agree with everything that the noble Lord said, but I congratulate him on how he set out the pressures that the health service faces and will face in future. As he forecast, it is for reasons like that that I advocate a royal commission to examine the future financial—and I emphasise financial—requirements of the health service and propose ways in which that demand can be met. My proposal has absolutely nothing to do with the current industrial dispute. Indeed, I suspect that the BMA would not be a natural supporter of such an independent investigation.
Basically, I want a commission to investigate how we can continue to afford a National Health Service providing care irrespective of income, which is what everyone in all parties wants, while recognising the financial challenges of an ageing population and the extra cost involved in medical advance. At the same time, we must recognise that public spending on health should not crowd out all other areas. I also want to see good education, a strong police service and—if noble Lords are interested, we are debating this subject next Thursday at about the same time—better prisons. If this is not an intrusion into private grief, I want a strong defence policy as well.
It is against that background that I would set out four requirements for a royal commission. First, it should be absolutely independent; it should be neither a political body nor an insider body. Secondly, it should look at how we finance the health service, otherwise there is absolutely no point. What we want are the best ideas on financing a service that we all value, irrespective of party, and we should re-examine old policies—for example, policies such as prescription charges, which mean at the moment that 90% of prescriptions are prescribed free. Thirdly, a royal commission should look at all the options; it should certainly examine experience, particularly in other countries of Europe, but it should investigate the potential of a health tax—a ring-fenced contribution to the costs of healthcare, which would have the advantage of connecting the taxpayer much more closely to the cost of the health service that they finance.
Fourthly, and lastly—and personally I regard this as crucial—a royal commission should investigate the long-term savings and benefit of better public health. Both Governments have failed here. The national health basically remains a sickness service, not because that is what Health Ministers want but because that is what the Treasury allows. The Treasury will try to provide resources for treating the casualties, but it is very reluctant to invest in preventing those casualties. It says that you cannot show that it will work, when the evidence is clear that prevention policies can and do work, not least in the 1986 AIDS campaign, which reduced not only HIV but all other sexual diseases at the same time. Even worse than this general failure is the fact that the Treasury has now chosen public health as the one area in the whole of the health field where spending is to be reduced, which is an entirely retrograde step.
There is a vast amount to do, and what we do now has implications for years to come. I believe that a royal commission has the potential to provide a proper base on which to face the financial challenges and to win public support.