A Constitution for the NHS?

Perhaps the greatest lasting achievement of the Attlee Government, the NHS is a testament to Britain's post-war social democratic consensus. Today the NHS costs £100bn per year, and remains the world’s largest publicly funded health service. But does it need a constitution?

Sixty years after its foundation, a very different Labour government is now proposing that the NHS has a constitution, which, the Department of Health states, "renews our commitment to the enduring principles of the NHS . . . for everyone, paid for out of taxes, based on clinical need rather than an individual's ability to pay".

A cynic might suggest that drafting a NHS constitution sixty years after the organisation has been founded might be an attempt to bask in the reflected glory of the work of those sixty years ago. Such cynicism will be nurtured by the fact that the constitution that is out for consultation sets out only "existing legal rights" alongside "values" and "principles".

Reflecting New Labour's obsession, the right "to choice" may be established – although this will have to pass through Parliament first, where presumably it will acquire a legally cogent definition. In an era of outsourcing, competition, PFI and internal markets, aspirations to accountability and a sense of public ownership look increasingly vulnerable – even with this loosely phrased constitution.

Despite such cynicism the document could provide a clear and educational guide for patients, as well as engendering a public debate about the role of the NHS. As such, the proposal for a NHS constitution is backed by both New Labour and the Tories, the British Medical Association – and tentatively by the King's Fund health think tank.

However, the constitution is composed flexibly enough to accommodate the increasing role of the private sector – so those hoping for a turn away from, or a bulwark against, the further marketisation of the NHS will be disappointed.

Health campaigners working in the NHS will welcome the pledge that "the NHS will strive to engage staff in decisions that affect them and the services they provide . . . all staff will be empowered to put forward ways to deliver better and safer services for patients". This phrase should be quoted to the Health Secretary and Manchester Mental Health & Social Care Trust until Karen Reissmann is reinstated – following her dismissal in November 2007 for criticising the transfer of NHS work to the voluntary sector.

The consultation on 'the NHS Constitution' is open until 17th October 2008.