The National Health Service Constitution. Part 1

Nye would be very proud wouldn't he?

So the NHS is to gets its own constitution. What a wonderfully empowering thought that is, and Dr Rant welcomes this document with alacrity and considers it to be almost as good as the old 1991 Patient’s Charter. It’s still up for consultation, so we though we’d be helpful and offer some feedback (that the DoH mandarins will surely devour with glee) for as everyone knows, “Feedback is the breakfast of champions,” and Gordon Brown is such a prize champion isn’t he?

In this piece, the original DoH text is in bold type and our comments on it in italics. In recognition of the fact that most of our readers have shorter attention spans than a guest on the Jeremy Kyle show, we've broken it down into bite-size, easily digestible chunks of goodness............

"The NHS belongs to the people. (Apart from those bits we have sold off under PFI, or to property developers. The fact your grand mother gave money to buy the land originally is really not very relevant and modern now is it?)
It is there to improve our health, (but sadly we don’t have a good definition of health to use) supporting us to keep mentally (ah yes another successful escapee from care in the community has probably written this) and physically well, (unless you are staff in which case we won’t even send flowers to your funeral) to get better when we are ill (unless you want an expensive drug for cancer, or ARMD) and, when we cannot fully recover, to stay as well as we can. It works at the limits of (economic) science-bringing the highest levels of human knowledge and skill to save lives and improve health. (Well it should do this….but it doesn’t) It touches our lives at times of basic human need, when care and compassion are what matter most. (True, but they are a bit expensive to provide aren’t they?)

The NHS is founded on a common set of principles, values and commitments that bind together the people who it serves – patients and public – and the staff who work for it. (Yes we’re all one big happy family of shiny happy people aren’t we? And I do so much hope the managers are still enjoying the away day to Mars. Now there’s a work at the limits of science. How many tons of bureaucratium can a rocket lift?))

This Constitution establishes the principles and values of the NHS in England. It sets out commitments to patients, public and staff in the form of rights to which they are entitled and pledges which the NHS will strive (but fail) to deliver, together with responsibilities which the public, patients and staff owe to each other to ensure that the NHS operates fairly and effectively. All NHS bodies and private and third sector providers supplying NHS services will be required by law to take account of this Constitution in their decisions and actions. (but it’s not legally enforceable, and actually there are enough fudge factors that we haven’t left any hostages to the legal eagles)
The Constitution will be renewed every ten years, with the involvement of (carefully hand picked) patients, public and staff. It will be accompanied by the Handbook to the NHS Constitution, to be renewed every three years, setting out current guidance on the rights, pledges, duties and responsibilities established by the Constitution. These requirements for renewal will be legally binding. They will guarantee that the principles and values which underpin the NHS are subject to regular review and recommitment; and that any government which seeks to alter the principles or values of the NHS, or the rights, pledges, duties and responsibilities set out in this Constitution, will have to engage in a full and transparent debate (just like Labour have done the last 11 years) with the public, patients and staff. (Oh yes it’s a difficult issue so better call for a “ National Debate” But make sure you know the answer first)

Principles that guide the NHS:

Seven key principles guide the NHS in all it does. They are underpinned by core NHS values which have been derived from extensive discussions with staff, patients and the public. These values are set out at the back of this document.

1. The NHS provides a comprehensive service, available to all irrespective of gender, race, disability, (unless you need long term rehab in which you’re a social services case mate, not NHS) age, (unless you need long term nursing care) religion or sexual orientation. (It pays to prevent and kill babies, but not to make them!) It has a duty to each and every individual that it serves. (Unless it’s dental work, long term geriatric care, infertility treatment or NICE says we can’t afford it) At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population. (Ah yes, Glasgow East- Labour’s little secret- Government spending doesn’t work)

2. Access to NHS services is based on clinical need, not an individual’s ability to pay. (Unless it’s the local IVF service) NHS services are free of charge, except in limited circumstances sanctioned by Parliament.

3. The NHS aspires to high standards of excellence and professionalism – in the planning and delivery of the clinical and other services it provides; in the people it employs and the education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population. (Sadly aspirations are no guarantee of performance)

4. NHS services must reflect the needs and preferences of patients, their families and their carers. (Of course, which is why we close services and make people travel miles to the alternative. But that’s so much more patient centred isn’t it?) Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. (However we circumscribe what choices they can make, and if they vote Tory they deserve their local hospital closing down and a forty mile round trip to their nearest other one.)

5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. (We squabble endlessly about the difference between social and health care, whilst the bed blocker rots in bed 5) The NHS is an integrated system of organisations (which just don’t talk to each other) and services bound together by the principles, values and commitments now reflected in the Constitution. The NHS is committed to working jointly with local authorities and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and wellbeing. (Of management consultants)

6. The NHS is committed to providing best value for taxpayers’ money (of course, as exemplified by PFI and NPunFIT for anything) and the most effective and fair use of finite resources. (Like keeping hospitals open in Labour constituencies) Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves. (That'll be big business, consultancy firms, PFI companies, and ex-Ministers like Warner and Hewitt then?)

7. The NHS is accountable to the public, (How? Through a lap dog backbench MP?) communities (How? By closing down community health councils? By local democracy? Or not at all?) and patients (well if they moan enough, or sue for negligence) that it serves. The NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. (Central credit and local blame works so well) The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to public, patients and staff. (It is. The minister is always right, and the doctors and nurses are just whinging malcontents) The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose. (It will be self revalidating and force doctors into ever more agonies of expiation) In addition, all NHS organisations will give patients and the public the opportunity to influence and scrutinise their performance and priorities; and patients, public and staff will be involved in relevant decisions about the NHS which affect them, either directly or through their representatives. (Provided we have vetted them properly first. We don’t want the hoi polloi entering now do we? Or even some of those oiks who can’t distinguish their mushy peas from the guacamole can we?)"

[Join Britain's most popular borderline personality disordered medical blogger for part 2 of the NHS constitution deconstruction soon - Ed]