Saturday, January 24, 2009

Constitution for the NHS

The publication of a new Constitution for the National Health Service (NHS) has been described as heralding a "new era of patient rights." Prime Minister, Gordon Brown, stated "This is a great day for the NHS, it is a great day for Britain. I am very pleased to be here on this historic occasion." The Constitution affirms the emphasis on patient choice and patient rights advocated in the NHS and is the result of an investment of £1M and consultation with NHS staff and patients.

The result clarifies the "patient choice" policies of the NHS in the rights and responsibilities of patients as well as health care workers and institutions. The Constitution establishes that patients may choose a GP practice and cannot be refused by that practice without reasonable grounds.
Health Secretary, Alan Johnson (pictured at right), explained that this emphasis on patient choice is the basis for a greater cooperation between patients and health care professionals: "This is a momentous point in the history of the NHS. Following on from Lord Darzi's Next Stage Review [High Quality Health Care For All], the launch of the NHS Constitution shows how its founding principles still endure today and have resonance for staff, patients and public alike." Lord Darzi's Review was published last June and maintained the need for a constitution to declare and protect the principles and values of the NHS in England.

The Health Secretary stated further that the new Constitution "will ensure that we protect the NHS for generations to come ... and will form the basis of a new relationship between staff and patients - a relationship based on partnership, respect and shared commitment where everyone knows what they can expect from the NHS and what is expected from them." Part of that relationship and cooperation means greater emphasis on patient information as to alternative treatments so that they are able to choose between options, rather than relying upon "doctor knows best."

Of the 25 rights, rights to access approved drugs, information and treatment are also set out in the constitution. Following controversies last year associated with drug pricing and the capacity to provide access to NHS patients, it is of interest that under the Health Bill 2009, introduced into Parliament 15 January 2009 (if enacted), it would become a statutory duty to account for these rights when making a decision (Clause 2).

However, in addition to the staffing and funding implications, many are unconvinced that having regard to these rights will make a lot of difference in practice. Dr Hamish Meldrum (Chair of the British Medical Association (BMA)) suggest it is simply "a feel-good document." The Patients Association, issued a statement in which it described the document as full of simply "optimistic pledges" without any incentive to deliver. Director of the Patients Association, Katherine Murphy (pictured at right), stated "We do not expect this document to make any difference to the care patients are receiving ... Patients need to know what the duty in the new Health Bill, requiring NHS organisations to ‘have regard to the NHS Constitution’, will really mean in practice. For the NHS Constitution to be effective, Trusts need to do more than ‘have regard’ to it. The time for NHS management to manage as if their jobs depended on it is long overdue. The time for words like safety, quality, choice and, in this case, Constitution to have the meaning they have elsewhere in life is also long overdue."

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