The NHS “constitution” – a charter for spin doctors, lawyers and management consultants.

The NHS Constitution has arrived. I hope you feel better for it.

I opened my copy with eager anticipation, having heard so much about it from Ministers and spinners at the public expense. I am afraid it turned out to be a bit of a let down.

The first surprise is it does not seem to be a Constitution in the normal sense. It does not set out the structure and rules governing the complex web of Trusts, Boards, Complaints procedures, surgeries and hospitals that comprise the modern NHS. It’s not as close to a Constitution as the “non constitutional” Lisbon Treaty turned out to be!

It came as no surprise to discover it is written in that same deadening mixture of bureaucratic mumbo jumbo, legalese and the blindingly obvious that characterise much of this government’s propaganda, Green and White papers and so-called consultation documents. Let me give you a flavour:

1. Bureaucrat English addressed to staff “to play your part in sustainably improving services by working in partnership with patients, the public and communities”.
2. Legalese addressed to all of us: “Pledges go above and beyond legal rights. This means that pledges are not legally binding but represent a commitment by the NHS to provide high quality services”.
3. The blindingly obvious: “You have the right to access NHS services. You will not be refused access on unreasonable grounds”

One of the main things my constituents want is the reassurance that if they have to go into an NHS hospital for an operation they will not pick up a deadly hospital acquired infection. So what does the Constitution tell them – and me as their representative – on this crucial issue?

At first my hopes rose. It says “ You have the right (presumably legally enforceable) to be treated…in a properly approved or registered organisation that meets required levels of safety and quality”. Presumably contracting MRSA or c dif would mean the organisation had fallen short of that standard?

When I read on my hopes sank. The lawyers had spotted that snag. We learn that “The NHS also commits (I fear not legally enforceable) to ensure that services are provided in a clean and safe environment …(pledge)”

Ministers and their legal advisers have decided they cannot solve the hospital infection issue anytime soon, so we have no rights on that score.

There is also a studied ambiguity, or a contradiction, in the overarching principles and aims. Item One in the document tells us “it has a wider social duty to promote equality through the services it provides, and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population” – a fine aim. Yet Item Two tells us “Access to NHS services is based on clinical need” which would be blind as between people from different social backgrounds with differing life expectancies.

If you haven’t read your own copy yet, it’s not compulsive bedtime reading. It filled in a short tube journey for me yesterday, but left me in despair at how much money might have been spent on what turned out to be another spin game. This “Constitution” will not cure a single patient.

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29 Comments

  1. Ian Jones
    Posted January 22, 2009 at 8:17 am | Permalink

    Surely it should come under Health and Safety legislation and the managers are prosecuted. Or do Labour only want to crack down on the private sector and leave their union friends free?

  2. Blank Xavier
    Posted January 22, 2009 at 8:21 am | Permalink

    > “Pledges go above and beyond legal rights. This means that
    > pledges are not legally binding but represent a commitment by
    > the NHS to provide high quality services.”

    I’m gobsmacked.

    Pledges go “above and beyond”…

    …by being legally unenforceable.

    This isn’t a serious document.

    • Posted January 22, 2009 at 9:20 am | Permalink

      That one made me chuckle. It’s treating us like children who don’t understand the difference and is therefore really patronising. May I suggest the document author as public sector redundancy number one.

      That said, I may try this with the police “Yes, officer, I have not paid my road tax which you have a legal right to expect, but I pledge to pay it and that goes above and beyond my legal duty and it represents a committment on my part to do so”

      • Posted January 22, 2009 at 4:20 pm | Permalink

        That in turn made me chuckle. I’d love to find a real-life situation in which to try that one out. Perhaps I can send it in reply to the BBC licensing people in response to those evil letters they keep sending me.

  3. rob atkins
    Posted January 22, 2009 at 8:44 am | Permalink

    An NHS Constitution. At last ! How did we ever manage without it for the last 60 years ?

    As if the Government hadn’t anything more important to be focussing on. Once again, this Labour Government fiddles while the country burns …

  4. Sarah H
    Posted January 22, 2009 at 8:53 am | Permalink

    I totally agree with your sentiments. Until 10 years ago I worked in a Trust HQ Human Resources so I saw first hand the wastage, non-jobs and rubbish called manpower statistics and planning. I, too, wonder what this latest nonsense has cost to produce. You only have to visit your local GP surgery to see leaflet after leaflet in display racks all aimed at improving the nation’s health.They are lovely glossly leaflets, but at what cost? The sad reality seems to be a lottery draw as to whether you will have a good or bad hospital for treatment, and in a real emergency there is no choice – labour spin tells us there is now a choice of where you are treated, but in an emergency it is surely pot luck. There are many good stories about treatment but these seem to be outweighed by the horror ones. As for patient rights, we all know how long it takes and the toll on someone’s health t get re-dress. As an aside, the general public has had to sit and watch helplessly whilst their valued community hospitals have been closed. We got the impression that Opposition parties did little to stop this. No, I fear that our Health, along with the Economy is in a sad state and what is frightening is that there will be less money available and the patient will surely suffer again. So Labour should forget re-hashing the Constitution because they have meddled and messed around with our Health Service and particularly Doctors and Consultants contracts, as they have with every other Whitehall Department. That is the nature of Labour and particularly our P.M.

    • THE ESSEX BOYS
      Posted January 22, 2009 at 11:40 am | Permalink

      Well said Sarah – it’s the opinions and experience of those who have worked on the inside that are invaluable.

      In the pub on Sunday we were running through the lack of Cabinet talent versus the newly boosted shadow team (with heavyweights like Redwood, Davis and even Rifkind participating from the wings.)
      We wondered what had happened to the once garrulous Alan Johnson…now we know!
      This document from the extracts published so far is totally trite and as one of our group will no doubt add – totally sh*te!

      You echo JR’s comment on the sheer cost of all this nonsense (and I agree about those lealets overflowing in every surgery and library).
      Do the costs just get absorbed or buried? Can Freedom Of Info isolate and inform us of the direct and indirect expense of producing this quasi constitutional tome?
      Once more this government of none of the talents (GOTTs) – and no business or frontline experience by any of its key people – assumes that by publishing a document (or leaflet) it makes it true and will make it happen!

      • Posted January 22, 2009 at 12:30 pm | Permalink

        I thought it was GOATs (Government of all talents) not GOTTs but perhaps ‘Government of no apparent discernable skill’ would be more appropriate?

        • THE ESSEX BOYS
          Posted January 22, 2009 at 9:50 pm | Permalink

          Oops – sorry Stuart. GOVERNMENT OF NONE OF THE TALENTS should have been refered to as GONOTTS which, come to think of isn’t such an inappropriate acronym!

          We also rather like your GONADS, something this government clearly lacks!

      • Sarah H
        Posted January 22, 2009 at 12:42 pm | Permalink

        Hi there
        I suppose the only thing I want to make clear is that the majority of health professionals are hardworking and do a great job, under very difficult circumstances. It is some of the management ideas that are questionable and some of the white collar workers who are there for life! Again, I must not generalise.
        I like your comment about Alan Johnson but I am also not too convinced about Andrew Lansley either, though, he can surely only be better, can’t he?!! Somehow I don’t think an ex-Postman knows too much about running a huge health organisation!

        • THE ESSEX BOYS
          Posted January 22, 2009 at 10:01 pm | Permalink

          Sarah – I think most folk accept that it’s the interfering bureaucrats and meddlers and not the professionals who are to blame. Did you see Gerry Robinson’s review?

          And as for Postman Pat we also regularly ask why a bunch of former trade union officials, polytechnic lecturers and back office political workers should suddenly be endowed with the skill to understand and manage the complexities of a government department employing thousands of staff and spending billions of (our)pounds!

          Yes, we do think AL can only be better and so can the shadow cabinet so, irrespective of the odd niggling doubt, let’s both keep up the pressure shall we? Best wishes

  5. Posted January 22, 2009 at 9:57 am | Permalink

    Agreed.

  6. AndyC
    Posted January 22, 2009 at 11:24 am | Permalink

    Typical Department of Health. In my job I deal with health statistics a lot. They are always ready with this sort of guff, but if you try to find out how many hospitals the UK operates, or what the country spends on health, they either don’t know or won’t tell you. I suspect the former, in fact!

    In slight mitigation, it’s not just a UK thing, many countries are going the way of rights, charters, constitutions etc etc. A lot of it is UN/WHO-inspired. There are some benefits in developing countries perhaps, but here it’s just a waste of time and money.

  7. number 6
    Posted January 22, 2009 at 11:51 am | Permalink

    Yet more government bull. Nu Labour think that issuing aspirations via soundbites or hugely expensive glossy publications is the be all and end all of solving a problem.

    The consitution is a waste of space from a waste of space government.

  8. Julian
    Posted January 22, 2009 at 12:00 pm | Permalink

    This is an early manifestation of Gordon Brown’s redefining the term “constitution”. He spoke a while ago about a national “constitution of rights and responsibilities”. This is not what a constitution is for. Laws of the land define our responsibilities. A constitution ensures that the state doesn’t infringe our rights with laws or by any other means.

    This is an Orwellian watering down of the langauge, softening us up for the removal of yet more of our rights in favour of the state.

    • adam
      Posted January 22, 2009 at 5:11 pm | Permalink

      Rights with responsibilities is a new federal citizenship idea, it comes from the European Union, Jack Straw among others has been promoting it.
      It is very post industrial, post modern. Very Starship Troopers.
      I think the idea is you need to earn your rights.

      The New World Order is replacing the old 20th century idea of the public sector, the private and voluntary sectors are being used to fill the old role. Privatisation and PPP are coupled with an increase in corporate CSR, which leads to programmes like Orange Rock Corps, Npower climate cops, styled on global citizen corps, alongside an encouraged increase in charity and voluntary work. Many students in school are expected to chose either Combined Cadet Force, DofE or community service to complete, one can imagine how that will be linked with the new citizenship qualifications and pledge.
      Obama is talking about similar ideas, increased sacrifice for the country, compulsory civilian security force for 18 to 25s.

  9. Posted January 22, 2009 at 12:36 pm | Permalink

    I see a number of you picked out the same phrase I did as being enough to make the document fit only for a shredder.

    i.e. 2. Legalese addressed to all of us: “Pledges go above and beyond legal rights. This means that pledges are not legally binding but represent a commitment by the NHS to provide high quality services”.

    Thank you Mr Redwood for yet another scintillating expose of yet another complete waste of time and money policy from Labour.

    My own understanding of a “constitution” is that it is precisely designed to give legal support to the subject matter. This does not and thus it is as worthless as Labour are.

    Might I also mention since you mentioned the Lisbon Treaty, that those who are interested in researching why Britain was taken into the European Union and how we were hoodwinked into what we thought was a common market, take a little time to read Margaret Thatcher’s archives on the matter which you can find here. if you’re not already aware of the evidence.

    http://rugfish.blogspot.com/2009/01/how-british-were-conned-into-europe.html#links

    I wrote to my MP about this several months ago and he in turn asked questions of Jim Murphy the then Minister for Europe. His reply ? “Interesting”.

    A cover-up has been made of the subject of the archives since 1970 but now they are public knowledge.

    The NHS Constitution is the first step toward the European Health Directive which will itself become Law once The Lisbon Treaty give the EU the sanction to start meddling with it.

    I believe there is no graver issue facing our nation than the Lisbon Treaty and the fact the NHS Constitution has no legal legitimacy confirms my belief that British Law is subject to a higher authority and that our parliament has completely lost power over the tru future direction of the NHS once the Lisbon Treaty has been fully ratified.

  10. Monoi
    Posted January 22, 2009 at 1:12 pm | Permalink

    Mr Redwood, is despair the only thing that piece of gargabe inspires in you?

    How about rage for once?

  11. Mark Shillaker
    Posted January 22, 2009 at 1:18 pm | Permalink

    I love the creation of the vague new category ‘Pledges’ – presumably, placing them ‘above and beyond legal rights’ places them equally above and beyond any kind of meaning definition or discussion at all then – handy, when the inevitable excuses and obfuscations start to flow as patients experience of the NHS fails to improve . More vapid dross from this knackered administration.

  12. no one
    Posted January 22, 2009 at 1:47 pm | Permalink

    the NHS is one area where the conservatives could win big time at the next election if they approached and phased things correctly

    its wide open to being blown open by good radical ideas that really do put the buying power in the patients hands, this could be as dramatic as council house purchasing was for winning over voters, if done and sold in the right way

    if the public school boys running the conservative party want some quick pointers do get in touch…

    start with easy stuff

    anyone waiting (between 1st GP referral and treatment) longer than X weeks is given a cheque to go private/abroad, no veto on this from nhs, and reduce X by a few days a month over time!

    patients can go to any dam GP they like, and incentivise the GPs to need to see patients, ie paid per visit not per person on their lists

    any hospital which fails basic food or clean site inspection gets closed immediately and all patients moved to a private hopsital (needs buffer capacity to do this)

    incentivise consultants to put people on their treatment lists, current crap where cancer patients who should be getting an op only get “hormone therapy” ie a pill cos its easier for the nhs has got to stop!

    this is so EASY to solve, needs real empowered customers where patients can walk out of the hospital if the staff are rude and go somewhere else AND THE HOSPITAL LOOSES REVENUE IF THEY DO

    etc etc

    good luck!

  13. Johnny Norfolk
    Posted January 22, 2009 at 3:50 pm | Permalink

    Par for the course from labour,.

    All talk and no action, but this time the talk does not even make sense.

    Is it any wonder we are in the mess we are in.

  14. mikestallard
    Posted January 22, 2009 at 4:32 pm | Permalink

    On Today yesterday morning, Alan Johnson was interviewed.
    He admitted that the document had cost £1,000,000 to produce.
    When the interviewer – I forget her name – asked if this money could not have been better spent elsewhere, he replied that a million pounds was a drop in a bucket compared to the total NHS expenditure.
    He then laughed at her naivety.
    When my wife goes shopping, she always looks for a couple of pence off here and there. I know that Mrs Thatcher did the same with the economy.
    The result – in both cases – must be balanced books.
    This has everything to do with the current economic crisis. Throw money at it and don’t check the details! (purchase of RBS? Bail out of the banks? SATs fiasco? the Dome?)

  15. A Griffin
    Posted January 22, 2009 at 4:46 pm | Permalink

    The modern N.H.S. is run on business models with patient care episodes treated (ie. dealt with) and recorded. Hospital medical management has been fragmented by non-medical manager directed clinical systems that do not allow for continuity of care (speciallty wards removed, consultant team working replaced with medical shifts), added to by a dumbing down of medical training ( feminized and no longer based on science, which together with run-through training, now produces plenty of cheap but inferior”consultants.”) No one is in charge ( except the politicians), certainly not medical staff or managers,( who are just following orders.) When the present generation of senior docters retire in around 10 years time the system will explode due to it’s own lack of professionalism and some clever politician will probably blame it on the staff. Improvements in the N.H.S. have been largely due to advances in medical science, which has disguised the extent of loss of the plot at the frontline. Is the N.H.S. there to help people who are ill and what are their needs?, or is it some giant machine that everyone tinkers with, without knowing how it works? This new publication is just more glossy advertising by the government.

    Reply: there are some very good female doctors – I don’t think the problem is “feminisation”

  16. steve harris
    Posted January 22, 2009 at 8:54 pm | Permalink

    This latest-of-many NHS constitutions differs not at all from vast numbers of similar documents written in that nauseatingly sub-standard form of English known as Managementspeak. Private companies, political parties, branches of all levels of the public services, the Boy Scouts, the Girl Guides and churches have been using it for many years. Such ‘constitutions’ are nothing but a thousand anile Mission Statements strung end to end. As Mission Statements always sound anodyne and fluffy, it’s extremely difficult to ridicule them without sounding like a reactionary curmudgeon. Calling it ‘vapid dross’ in fact flatters the drudges who employ it.

    There must be a small army of scribes employed by the NHS and by the government in every other part of the public sector to compose this tripe. The amount of increasingly borrowed money consumed by their salaries must run to hundreds of millions or even billions of pounds.

  17. A Griffin
    Posted January 23, 2009 at 11:00 am | Permalink

    I accept that there are many brilliant female doctors (I was one!),however what I was trying to allude to by stating that the medical undergraduate couse has been ‘feminized’ was the simple fact that it no longer appeals to the best male A level students. I believe that this is because much of the core science has been removed and replaced by light weight politically inspired content. This lowering of standards for both sexes will eventually lead to more compliant, less questioning and lower value medical staff. They will just be workers in a medical treatment factory.

    Reply: Thanks for the clarification. You make a very interesting point

  18. A Griffin
    Posted January 23, 2009 at 2:45 pm | Permalink

    The solution to the problems of health care. is not more competition between all hospitals, which would be very wasteful of resources, but better competance. Using competition as a reward system, would result in the better services being monopolised by the middle classes, who are very good at hunting out anything to their advantage, to the detriment of the weak (just look at the schools!) More competition would provide a business solution, but would require extra top-up funding by society (if choice is to be real and not just a lie), and therefore would result in the loss of ‘free’ care for all, which could no longer be afforded. It would just cost too much public money to make it work and would be unfair.That’s why the general public are so wary of it. Private companies can also hide all sorts of nasties, just look at some of our banks! I have personally seen filthy toilets in private hospitals as well as N.H.S. ones. Private medicine is not better than the N.H.S., they both have their faults as well as their advantages and there are good and bad providers in both. We all rely on the N.H.S. when we have a medical emergency however rich we are. We need it to be there, and we need it to be a quality service. Money used as a main motivator in health care delivery, contaminates the relationship between doctor and patient (just look at the States) and ultimately that with society as a whole. Equally medical care driven by patient wants rather than patient needs will guide the providers in the wrong direction. and be just as demoralizing. Competition will probably drive services into the private sector, which may be the cheapest, but not necessarily the best. The other side of the patient treatment experience is determined by the quality of the medical (in its broadest form) staff. Let these staff be responsible for determining the way treatment is delivered with rewards for successful innovation and let them be accountable to the patients for best outcome and to the government for best value. The downside to all this is that there will be a limit to public resources.The goverment needs to be open about rationing of health care and clearly state what can and what cannot be afforded and yes, if funds are inadequate, those that can pay towards their care should be asked to do so (many will be happy to do so for a good service that is fair if they have access to insurance for it). I believe that a system like this ,within the N.H.S.,will empower and reward (yes financially as well) the most competent staff, and ultimately give best value to taxpayers. Most health care professionals have a true vocation to do their best for their patients and it is this which needs to be allowed to blossom. If they are required to work in a deadening environment where they have no say and only the cost or targets matter, is it any wonder that their patients complain, or that they just decide to go through the motions for the pay cheque?

  19. bill
    Posted January 24, 2009 at 3:02 pm | Permalink

    The Conservatives are partly to blame. They have never dared to attack the NHS. They have never pointed out the obvious truth that it was a flawed attempt to manage the mass health service which had emerged from the ability to mass produce safe and effective drugs. Year after year labour has been able to make political capital out it . There has never been any valid reason for the conservatives to continue to acquiesce in this myth.

  20. GH
    Posted January 25, 2009 at 8:48 am | Permalink

    The DoH has also been caught out trying to weaken medical confdentiality, again. From the BMJ:

    Organisations that are charged with safeguarding patient confidentiality had objected strongly to a section in the draft handbook that said, “Patients can . . . expect that a health professional or a research professional who owes the same duty of confidentiality as a health professional may use care records, in confidence, to identify whether they are suitable to participate in approved clinical trials.

    “Appropriate patients will be notified of opportunities to join in, and will be free to choose whether they wish to do so, after a full explanation.”

    The organisations that expressed reservations included the UK Council for Caldicott Guardians (UKCCG), the Patient Information Advisory Group, and the new National Information Governance Board, which came into operation this month. The UKCCG, whose members are responsible for safeguarding patient confidentiality in the NHS, called for the statement to be removed from the constitution pending “much deeper discussion and legal consideration.”

  21. pp
    Posted February 16, 2009 at 11:16 am | Permalink

    As the benefit of whole constitution project is based on driving up NHS quality by making it easier for the public to complain, and the fact that the national audit office have previously reported that complaints do not improve NHS standards. The whole thing appears to have demonstably been a waste of money before it was even singed off.

    I have written asking the department for more info on this:-

    http://www.whatdotheyknow.com/request/nhs_constitution_projected_benef

    They are going to be out of office soon – I hope these stupid projects will be reviewed and dropped as soon as possbile after the new government taking over.

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, He graduated from Magdalen College Oxford, has a DPhil and is a fellow of All Souls College. A businessman by background, he has been a director of NM Rothschild merchant bank and chairman of a quoted industrial PLC.

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