The consensus view seems to be that a constitution for the NHS is a good idea. Gordon Brown wants one; Ara Darzi thinks it’s the best thing since sliced bread; the Tories want one; the BMA wants one; an awful lot of health campaigners agree that an NHS constitution is by definition a good thing.
The New Labour intention is that the constitution goes through a bit of fake consultation now, it gets reviewed in ten years time, and in the meantime – so we are told – the future of the NHS is assured.
Does a constitution protect the NHS? It’s worth some careful thought.
The constitution now out for consultation sets in stone the current drive towards the fragmentation and privatisation of the NHS. So we are told ‘all NHS bodies and private and third sector providers supplying NHS services will be required by law to take account of this constitution in their decisions and actions’. We are told ‘the NHS is an integrated system of organisations and services…’ – rather than the single public organisation that many campaigners believe it should be. We are told ‘The NHS is committed to working jointly with… a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and wellbeing’.
Darzi agrees. His Final Report concludes that one of the reasons for the constitution is because ‘as the NHS evolves, a wider range of providers, including those from the third and independent sectors are offering NHS-commissioned services’.
If this constitution is nodded through, privatisation is part and parcel of the NHS for the next ten years. How much of the NHS will be left in ten years time if the current gallop towards privatisation continues? By the time the constitution is reviewed, the NHS could well be reduced to a logo at the top of the appointment letters (and even the logo now seems to be subject to a ‘rebranding’ exercise).
This is perhaps the most important element of this constitution. An unwanted and damaging process will become irreversible. The NHS gets taken apart – and the Government (Labour or Tory) says, ‘Well, it’s nothing to do with us. It’s in the constitution’.
And that’s the second reason why a constitution is such a bad idea. Accountability disappears.
Conventional wisdom is that a constitution is a good idea because it stops politicians interfering with the NHS and using the NHS as a ‘political football’. The challenge is that the football is already sailing through the air, and a constitution simply allows the Government to duck responsibility for where it lands.
The reality is that an NHS constitution will result in less accountability. The Government continues to determine the overall direction of travel of the NHS – in this case, a sharp drive towards privatisation. The Government determines the funding available for the NHS. The Government in practice sets the political context in which ‘local decision makers’ make their decisions. (Any NHS Chief Executive with half a brain knows that you opt for privatisation of local services if you want to keep your job).
There is a strong risk of the Government effectively hiding behind a constitution that is updated once every ten years and denying responsibility for the management of the NHS. Where’s the accountability in that?
Local campaigners will already be familiar with the grotesque lack of accountability of many PCTs, and the privatisation of commissioning and service provision will reduce accountability further. A constitution that lets politicians off the hook makes things even worse.
There are fundamentally different political philosophies when it comes to healthcare. Socialists believe that looking after sick and vulnerable people is just part of what we do in a decent and caring society. Parties of big business – Labour or Tory – believe that healthcare is a great opportunity for their mates to return a hefty profit. Nothing could be more political than this. I want the opportunity to challenge the privatising politicians who are destroying the NHS. A constitution is a nice idea – but it makes it that much harder to point the finger of blame.