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NHS needs ‘a new constitution’

The NHS must continue to ‘adapt, develop and innovate’ if it is to survive into the next century, according to policy commentators at the King’s Fund, an independent London charity.

To do so, a new ‘NHS constitution’ will have to be negotiated between all stakeholders in the NHS, including taxpayers, service users and professionals, say writers at the fund’s policy institute.

Writing in the 1997 edition of Health Care UK, the annual review of health care policy published by the King’s Fund, staff argue that the world has changed so much since 1948, and that the pressures on the NHS have grown so great, that Bevan’s ‘historic compromise’ with the professions is no longer sustainable.

Instead, they suggest, an explicit new agreement must be reached on such issues as the core values of the NHS, the ‘bundle of services’ which will be included within it; methods to promote and monitor equity of access to services; the rights of users; the nature of professionalism; and the role of the private sector.

The authors argue that ‘the starting point must be a statement of the core values which the NHS should embody’, alongside a definition of ‘the bundle of services which the NHS comprises’. But the difficulty of the task is recognised, especially given the experience of other countries, such as New Zealand, which have tried to define ‘core services’, and the authors do not attempt to provide definitive answers.

Methods to ensure that the goal of equity of access to care is being met are also required, they argue. Such methods should include an equitable and explicit resource allocation formula for allocating budgets to different areas, an issue which is set to become contentious if the locality commissioning model proposed in the NHS white paper goes ahead.

The NHS should also be carrying out regular ‘equity audits’ of specific services to check that the policy goal is being achieved in practice, they suggest.

The Patient’s Charter lacks coherence and needs a radical overhaul, say the authors. One possibility would be to adapt recent proposals from the Association of Community Health Councils of England and Wales, to extend the existing charter to cover issues important to users.

Finally, the role of the private sector needs to be reviewed. ‘Fair competition’ is suggested as a way to curb the private sector’s tendency to select profitable areas of medicine and relatively fit patients, and its reliance on the NHS for training and backup when things go wrong.

Health Care UK 1996/97. King’s Fund: 0171 307 2400