The NHS Consititution

Stuart Weir
1 July 2008

Stuart Weir (Cambridge, Democratic Audit): Seven years ago I sat on a radical commission into the future of the NHS with Will Hutton in the chair and alongside Allyson Pollock, Conor Gearty and others. We were very fearful for the prospects for what we saw as Britain’s “greatest and most prized institution”.

We believed that the market-driven mechanisms that the government was introducing, and the restless demand for change after change, was destroying both the universalist ethic of the service and the morale of the people who worked in it. We found that the service was virtually unaccountable at all levels, from its national direction down to complaints and redress at patient level. Our main recommendation was that the government should consult widely over writing an NHS constitution that protected its founding principle – that people should have “access to free medical treatment at the time of need".

Well, it seems that Lord Darzi, the health minister, proposes to give the NHS a constitution of sorts that will afford some protection both of a patient-centred and, crucially, funding for the next ten years. Given that the Conservatives are very likely to win the next election and plan more marketisation, this is to some degree reassuring. It is however a matter for regret that this latest and sensible scheme of reforms has come from on high rather than from a meaningful consultation process. It is said that a future government would have to resort to legislation to unravel the quasi constitution, giving space for public resistance and debate. Well maybe. But we have seen all too often how a government can proclaim a policy of unimpeachable virtue while its actions contradict its rhetoric. The NHS will still be vulnerable in my view to death by a thousand reforms and cuts.

It would be good if OurKingdom could initiate a debate in some depth about the nitty-gritty of the Darzi prescription. For example, can’t power be devolved from the ten regional health authorities, remote bodies that are essentially quangos in all but name and form, and be made more accountable downwards? Does localism have to mean a post-code lottery? Can’t primary care trusts be made more democratic so that people can contribute collectively as well as individually as consumer-patients to raising the service’s standards? The work of Marian Barnes and her colleagues on local participation has shown how much value people who rely on services can bring to their reform. Most of important of all, how can we best prime ourselves and the public to defend as well as improve the most valuable public institution to we collectively have?

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