NHS constitution- another bad labour idea- FT Editorial

The key test of any health reform should be whether it will actually improve the quality of care that patients receive.

By any measure, the latest big new idea from Gordon Brown, the British prime minister, fails the test: that, after muddling along without one for 60 years, the National Health Service in England (healthcare is now devolved in Scotland and Wales) should have a constitution.

The very origins of the idea betray its weakness. It was initially dreamt up by Andy Burnham, then a junior health minister, as a means of celebrating the NHS’s 60th anniversary this July.

Why not, he mused, lay out the service’s values and ethos, setting out what patients can expect in terms of rights and responsibilities?

The real motivation, however, was far tawdrier.

Labour hoped that something could be written about the service being tax-funded and largely free at the point of use in language that the Conservative opposition would balk at. Labour would then go into the next election arguing that the NHS was not safe in Tory hands.

There was never a chance of that. David Cameron, the Conservative leader, has been at great pains to commit his party to the current model of the NHS, sealing off the subject as an election vulnerability.

But the idea, once born, has refused to die. Even now, weeks before its intended publication, no one in Whitehall seems to have much idea of what might be in it.

The plan may set out some responsibilities (not to abuse the service), some rights to minimum standards of care and possibly some definition of who should do what in the NHS from ministers downwards.

But the odds are it will either be so vacuous as to be meaningless, or that it will open up cans of worms that ministers will wish they had never touched.

If the constitution tries to define entitlements, ministers risk having to decide what should be in (and not in) a “core” NHS. States round the world have tried the idea and found it lacking.

If the new model deals with accountability, it risks freezing what should be flexible: healthcare systems need to be malleable to respond to changing technology, disease and patterns of care. That risk will rise if it is a legal document.

And if it is not put into law it will count for nothing more than the stated principles of the NHS – all of which are contained in countless Department of Health documents, and some of which are already enshrined in law.

This futile exercise will create the illusion of activity while doing nothing to improve patient care. It should be dropped.

Ministers instead should concentrate on their other (and wholly welcome) proposals this week: ensuring that patients have choice and that hospitals have real financial incentives to improve the quality of care.


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