Observations Public Policy

Does the NHS really need a constitution?

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39545.432407.59 (Published 10 April 2008) Cite this as: BMJ 2008;336:804
  1. Rudolf Klein, visiting professor, London School of Economics and London School of Hygiene and Tropical Medicine
  1. Rudolfklein30{at}aol.com

    The best hope is that ministers will resist the temptation to introduce instant solutions to problems that are rooted in the nature of the NHS as a tax funded service that rations scarce resources

    The junior health minister Ara Darzi proposed it. The prime minister endorsed it. The BMA supported it. The secretary of state for health is busy working on it. The notion that the NHS should celebrate its approaching 60th anniversary by unveiling a constitution now has a seemingly irresistible momentum. Who can argue against an NHS constitution that would, in Lord Darzi’s words, “enshrine the values of the NHS,” “increase local accountability to patients and public,” and “define the rights and responsibilities of patients?”

    The rhetoric is seductive. But once we start thinking about how we might translate it into practice, the arguments begin. Let’s start with the rights and responsibilities of patients. How are these to be defined? Will the rights be restatements of existing policies about waiting times between referral and treatment or in accident and emergency departments? Or will they define entitlements to a specific package …

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