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Editor's blog 27 June 2008: An NHS constitution in 60 words

Featuring contributions from John Appleby, Nick Bosanquet, Andy Cowper, Alan Maynard, Martin Rathfelder, Bob Sang, Michael Sobanja and Ruth Thorlby

Prior to the publication of the new constitution as part of the 60th anniversary celebrations for the NHS next week, we publish a range of people’s suggestions for how one might address the subject in 60 words. The original intention was to do something lighthearted – a point missed by one or two people we asked. Plenty of serious points nevertheless arose …

John Appleby (chief economist) and Ruth Thorlby (fellow in health policy), Kings Fund
Three different suggestions from the Kings Fund

[after the English Bill of Rights, 1689]
We the people of England declare in our NHS constitution:
Freedom from:
• excessive ministerial interference
• inequitable social insurance
• cruel and unusual hospital toilet facilities
• drugs without randomised control trial
Freedom to:
• petition the Monitor
• care regardless of class status and income
• bare arms against MRSA
• elect PCTs without interference from the SHAs

[after the Preamble to the American constitution]
We the People of the England, in Order to form a more perfect NHS free at the Point of Care, establish better Outcomes, reduce health inequalities, ensure cost effective care, provide for old age, promote general Wellbeing, and secure the Blessings of NICE to ourselves and our Posterity, do ordain a Constitution for the NHS regardless of our Lifestyle Behaviour.

[after John Lilburne, c1615-1657, ‘Agitator’]
We the free People of England, to whom Bevan hath given the NHS, do with submission to its wisdome, and desiring equity thereof; Agree to abolish prescription charges, set bounds and limits to our taxes and remove all known Healthcare Acquired Infecktions and that there shall be no further raining of publick moneyes on physicians or forraigne health care providers.

Nick Bosanquet, professor of health policy, Imperial College London
Comparable accounting for quality and value

We the people require a sound economic framework to speed progress towards improved outcomes and better services. Commissioning should be separated from provision. All NHS services, including those delivered by private and voluntary enterprise, should have trading accounts on a comparable basis, giving information on costs and income. NHS managers should have a duty to ensure quality and best value.

Andy Cowper, editor, Health Policy Insight
Slightly predictable, but here it is anyway

We the people believe an NHS constitution is quite unnecessary. Defining minimum entitlements may help a few, but risks limiting ambition. 1948’s ‘New NHS’ pamphlet stated, “everyone … can use it or any part of it … there are no charges, save for a few special items.” At best, it’ll be vague, vacuous rhetoric; at worst, potentially a lawyer’s charter.

Alan Maynard, professor of health economics, University of York
Impossible to edit this down to 60 words. So good, it doesn’t matter.

Comrades! Our leaders require us to recognise the ubiquitous nature of scarcity and the inevitability of death. In exchange, these rulers will use competition to create uncertainty for all providers, in an effort to reduce their practice and outcome variations and meet patient needs efficiently. Rationing will be on the basis of need (defined as the patient’s ability to benefit from care per £1,000 spent). Social security for lawyers will be provided - not only from litigation about consumers’ rights, but also by contention over the public-private mix of provision. Support the revolution! Long life and good care for the proletariat!

Martin Rathfelder, director, Socialist Health Association
Simplicity can be very effective

We the people of the United Kingdom expect that our government will:
• help us protect our own health
• do nothing to make us unhealthy
• protect us from exploitation or abuse when we are sick or vulnerable
• give us power to decide how our taxes are spent
• treat us all fairly
• ensure that the rich and the poor are treated alike

Bob Sang, professor of patient and public involvement, London South Bank University
Remembering that it is our NHS

We the people call for the return to social ownership of the NHS, fulfilling the promises made for an NHS that is locally owned, socially productive, safe, and sustainable. We call for ever-greater community engagement in planning and commissioning services and the rapid assimilation of learning from patients’ experiences, to assure a proper financial return for the planned future investments.

Michael Sobanja, chief executive, NHS Alliance
Refocussing the system where it matters

We the people want a National Health System that focuses on health, not just sickness; addresses inequalities; and places trust in professionals to work with local citizens and patients to determine priorities and services appropriate to local needs. We want an end to unwarranted political tinkering in a health system that now needs to mature from the grass roots up.