NHS Constitution – response to consultation October 2008

Submission on behalf of the Socialist Health Association.

The Socialist Health Association was founded in 1930 to campaign for a National Health Service and is affiliated to the Labour Party. We are a membership organisation with members throughout the United Kingdom who work in and use the NHS. We include doctors and other clinicians, managers, board members and patients.

1.We are uneasy at the notion that the fundamental principles of a constitution, if that is what they are, should only apply in England. We are entirely in favour of the devolution of power to Wales, Scotland and Northern Ireland and watch with interest the different approaches taken. Indeed we would like to see more devolution of decision making to English regions. But we think that the idea of the nation embedded in the National Health Service should refer to the United Kingdom, and that the principles invoked should be sufficiently fundamental to command agreement across the devolved administrations.

2.The absence of any commitments in public health is very noticeable. If it is intended that the NHS should continue to be responsible for improving the health of the population (the wisdom of which we doubt) then this important role should be reflected in the constitution. We suggest that a good start would be a commitment that the government will not by action or inaction damage the health of the population.

3.Ministers place much reliance on the power of competition to improve services. In reality, as Gordon Brown pointed out in 2003 “50 per cent of admissions, 75 per cent of hospital beds taken up by emergency urgent or maternity cases – non-elective cases where patients are generally unable to shop around”. If we add to this the people who have little choice because of local geography or because they need specialist services then we see how weak the power of competition in health really is. So we need to develop both individual and collective mechanisms to drive improvement and responsiveness.

4.Rights only have meaning if there are adequate mechanisms to enforce them. At an individual level we have to rely on the NHS complaints system, currently in the middle of yet another reorganisation. The experience of complaining patients is very unsatisfactory. We can hope that the new procedure will prove to be an improvement, but we would like to see more robust action taken against organisations which fail to deliver an adequate complaints system. The constitution could provide a framework which could help patients in their efforts to make the NHS more individually responsive.

5.At a community level there is little opportunity for delivering local accountability and in many places little genuine local involvement. We are calling for a national debate on an accountable NHS and we attach a copy of the document we have prepared with the NHS Alliance. PCT non-executives are accountable to the Secretary of State, not to their local community. We think they should be accountable to, and elected by, their local community, either directly or via the local authority. We entirely agree that “The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to public, patients and staff.“ But the system is not clear, and we have not seen any effective proposals to make it so. Local Primary Care Trusts are, for the most part, invisible and have not begun to effectively engage with their local communities because they are too busy dealing with instructions from the centre.

6.The constitution says this: “You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services. The NHS will strive to provide you with the information you need to participate effectively to influence the planning and delivery of NHS services. (pledge)”. There should be a matching pledge that NHS organisations will be responsive to the needs and wants of their local populations. Although it will not be possible to do everything that the local population wants, NHS organisations need to demonstrate that there is a continuous proactive dialogue with the local population to decide on the quality and shape of current and future service provision.

7.It is unfortunate that this consultation should take place before most of the local LINK organisations are sufficiently well established to respond. We hope that this latest mechanism for local engagement will in time be more effective than its predecessors and we suggest that once established the national organisation of LINKs should be invited to comment on the working of the constitution.