Two weeks ago now the UK government launched the concept of an NHS constitution as one of its new ‘big ideas’. We asked Karl Milner, Director of Communications for NHS Yorkshire and the Humber (strategic health authority)... “So, does the NHS really need a constitution?”
Jon Chandler 
15 Jul, 2008
A ‘More Perfect’ NHS
The NHS has survived 60 years without a constitution. Its mission to “heal the sick” and its modus operandi to provide healthcare “free at the point of use, regardless of circumstance” has been broadly accepted in to the reasons one could quote for being proud to be British. So why mess with that un-written covenant now?
I think there are three principle reasons why the Government and NHS Management board are being brave in opening the debate over a constitution.
Firstly,
the very mission that the NHS embarked on in 1948 – to heal the sick, has become
an unworkable singular pursuit. The NHS can and does “heal the sick” at a remarkable
lick. In my own region of Yorkshire and the Humber we deal with 116,000 patients
a day, 90% of who are satisfied with our care. By 2010 we will need 10% more
GPs than we have now and the healing they guide their patients to will be more
intensive and expensive than ever imagined in 1948. With an aging population,
increasing patient demand and vastly more powerful medicine we are not going
to be able to “heal the sick” unless we “keep people well”. That is a fundamental
change, which will require a positive commitment to health from the British
people. That can only happen if we strike a new covenant on what the NHS is
for.
The
second reason would be to finally settle the persistent debates that surround
the NHS, its purpose, its structure, its responsibilities and so on. Ever since
the NHS was set up in 1948 politicians have been rehearsing the same arguments
and all of them revolve around unfinished business. 
Should the NHS provide
a universal or a uniform service? Are Doctors state employees or independent
businessmen? Are hospital managers on the side of the patient or the staff?
Whatever side of the table you sit on, the consultation on the constitution
will frame all these debates whether we get to “perfect” or not.
The third reason is that the NHS has transformed and lifted post-war British
society. It is an institution responsible for bringing about change and as
a side effect it has thinned the gap between rich and poor. It is an institution
that the British people broadly is a good thing. We currently have a society
that supports the NHS, we have a set of politicians who agree the NHS’s basic
modus operandi “Free at the point of need, regardless of circumstance”. The
NHS has set out seven basic principles that have implicitly surrounded that
sound-bite:
- Comprehensive service available to all
- Access to NHS Services on clinical need not ability to pay
- NHS aspires to high standards of excellence and professionalism
- NHS services must reflect the needs and preferences of patients, their families and their carers
- NHS works in partnership with others organisations in the interest of patients, local communities and the wider population
- NHS is committed to providing best value for taxpayers’ money
- NHS accountable to the public, communities and patients that it serves
If we enter this debate now, at a time of great support for the NHS, we might avoid confusion over decisions made in the future. The debate starts here, let’s define our common ground and by doing so prepare the NHS to be “more perfect” – another 60 years should just be a start.
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