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An NHS constitution for England

February 2008






Introduction
Through the BMA’s Caring for the NHS campaign the medical profession has demonstrated its desire to play a leading part in recasting health service reform and to express an enduring commitment to the NHS. Although critical of a large number of specific reforms introduced since the year 2000, the medical profession, in chorus with other groups allied to the NHS, has repeatedly voiced the more general concern that the volume of reform to which the NHS in England has been subject, and the pace of its introduction in recent years, has both destabilised the health service and alienated large sections of its dedicated staff.

The BMA, however, has not simply criticised reform from a distance but has chosen to accept the responsibility of advancing alternative perspectives that might better achieve the objective of an NHS fit for the 21st century. To this end, the BMA has urged the Government to enter into a constructive and meaningful dialogue with the medical profession, other NHS professionals, the public and patients in order to realise a new approach to reform that will safeguard the future of the NHS.

We have consulted widely – not only amongst the medical profession but engaging all parties whom share a relationship with the NHS – and developed proposals for a way forward that will ensure the NHS can deliver improving health to the population in an efficient and equitable manner, honouring a set of shared values and principles to which all those that are invested in the NHS can subscribe.

In its discussion paper, ‘A rational way forward for the NHS in England’ the BMA recommended that a constitution for the NHS be established. The constitution would offer an opportunity to enshrine the core values of the NHS in a formalised document and provide a constitutionally-entrenched framework concerning the rights and expectations of the public and patients. Furthermore, a constitution would be expected to define NHS governance arrangements and, reflecting the BMA’s preferred position in this respect, ensure the NHS is granted a significantly greater level of freedom from party politics and with it a new found autonomy. Within that autonomy we called for greater operational power for health professionals matched by a new and real accountability to the people and by a greater strategic policy role for Parliament. It has disappointed us that some commentators have characterised this as a bid for professional power, thus ignoring the role we would assign to Parliament and the people. We think it is sensible for those who understand and are committed to the NHS to take on the responsibility of making it work, but equally we would not advocate a particular interest group being granted power to run it without genuine accountability to the people. We offer to make the NHS work and to account to the people for doing so.

Since the publication of the BMA’s paper in spring 2007, the issue of an NHS constitution has been a continued focus for debate and discussion. The concept has found expression both in the Government’s ongoing NHS Next Stage Review and in the Conservative Party’s recent draft NHS Bill. This paper sets out in more detail the benefits that might be conferred by a constitution for the NHS in England and just what such a constitution might comprise.