TWO major health unions have reacted cooly to the Labour government’s new NHS Constitution, launched last Wednesday, which contains ‘rights’ and ‘responsibilities’ for both patients and health professionals.
Dr Hamish Meldrum, Chairman of Council at the British Medical Association (BMA), said: ‘The patients who depend on the NHS and the staff who work in it have both long deserved a clearer idea of their rights and responsibilities.
‘This is a welcome restatement of the principles of equality and compassion on which the health service is based.
‘Yet we need more than a “feelgood” document. In its current form, it is unclear how the Constitution will change the everyday experiences of patients and staff.
‘Concrete measures such as the creation of a national independent board to oversee the day-to-day operation of the NHS would help depoliticise it.
‘There also needs to be much more engagement with the public and staff about the way services are delivered at a local level. The BMA will continue to push for progress on these issues.
‘Moreover, recent events, and recent government policies, mean that the founding principles of the NHS are increasingly vulnerable.
‘The controversy over top-up payments is evidence that the NHS is not fully comprehensive, and a wider, public debate on the range of services that it can and cannot provide, is long overdue.
‘The government also says the NHS is committed to providing best value for taxpayers’ money.
‘Yet many of its health policies have wasted public money, particularly those which have locked the NHS into long-term contracts with commercial providers but failed to deliver on expected activity.’
However, the Unite trade union is concerned that the NHS Constitution might be a ‘smokescreen’ for more privatisation.
It said: ‘the NHS workforce must be fully involved in how the new NHS Constitution evolves’.
Unite National Officer for Health, David Fleming, said: ‘We welcome any step that makes the NHS more accountable to patients and clients, makes clearer what they are entitled to, and that staff and patients are treated with respect and dignity.
‘However, another important part of the equation in making this Constitution work on a practical level on a daily basis is involving the workforce and their trade unions in its development.
‘It is shame that the role of the trade unions and professional associations are not mentioned in the main body of the Constitution.
‘The NHS Constitution is “a top down” document, but it needs the speech and language therapist, the lab technician, the health visitor, the ambulance personnel and the maintenance staff to be consulted fully on how it can be best implemented.
‘Unite remains wary about the government’s continued obsession with privatisation of the NHS and we would not like the fine words and elegant phrases embedded in the Constitution to be used as a smokescreen for private companies to take a larger slice of NHS services.
‘The Constitution enshrines further involvement of private and third sector organisations in the delivery of NHS services i.e. privatisation.
‘But at the same time, the constitution seeks to enshrine the efficient and best use of resources – however it is now evident that marketisation and privatisation are not the best use of such resources. Private Finance Initiatives (PFIs), for example, are wasteful.
‘There is, therefore, a glaring contradiction in the constitution as to what it hopes to achieve.
‘We will be raising these apparent contradictions with ministers.’
However, Unison, the UK’s largest health union has welcomed the NHS Constitution calling it ‘A vision of which Nye Bevan could be proud’.
The government’s document on the NHS Constitution states that ‘Access to NHS services is based on clinical need, not an individual’s ability to pay. NHS services are free of charge, except in limited circumstances sanctioned by Parliament.’
And it continues: ‘NHS services must reflect the needs and preferences of patients, their families and their carers.
‘ . . . The NHS is committed to working jointly with local authorities and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and well-being.’
It outlines ‘rights’ and ‘responsibilities’ for the ‘public, patients and staff’.
Patients’ ‘rights’ include: ‘You have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament. You have the right to access NHS services. You will not be refused access on unreasonable grounds.
‘You have the right to expect your local NHS to assess the health requirements of the local community and to commission and put in place the services to meet those needs as considered necessary.
‘You have the right, in certain circumstances, to go to other European Economic Area countries or Switzerland for treatment which would be available to you through your NHS commissioner.’
News Line asked the Department of Health what are ‘reasonable’ grounds to refuse treatment.
Their reply was: ‘The Handbook to the NHS Constitution sets out what each right and pledge means.
‘In the case of this right, you can access the NHS services in your area that are provided by your local Primary Care Trust.
‘This includes access to a GP, dentist or hospital.
‘NHS services will always be available for the people who need them.
‘No-one can deny access to these services because of a patient’s race, religion, disability or sexual orientation – these are all “unreasonable grounds” on which to refuse patients access.
‘Reasonable grounds to refuse a patient access to the NHS would be if they were abusive or violent, for example.
‘Access to NHS services is not removed in situations where patients pay for additional private care (clarified in the government’s response to Professor Richards’ report, Improving access to medicines for NHS patients).’
The Constitution also states that patients’ ‘responsibilities’ include: ‘You should recognise that you can make a significant contribution to your own, and your family’s, good health and well-being, and take some personal responsibility for it.
‘ . . . You should keep appointments or cancel within reasonable time. Receiving treatment within the maximum waiting times may be compromised unless you do.
‘ . . . You should participate in important public health programmes such as vaccination.’
The Constitution ‘applies to all staff, doing clinical or non-clinical NHS work, and their employers. It covers staff wherever they are working, whether in public, private or third sector organisations.
‘Staff have extensive legal rights, embodied in general employment and discrimination law. These are summarised in the Handbook to the NHS Constitution.
‘In addition, individual contracts of employment contain terms and conditions giving staff further rights.’
Staff are told: ‘You have a duty to accept professional accountability and maintain the standards of professional practice as set by the appropriate regulatory body applicable to your profession or role.
‘. . . You have a duty to act in accordance with the express and implied terms of your contract of employment.’
Giving the NHS Constitution a gushing welcome, Karen Jennings, Unison Head of Health, said: ‘The Constitution enshrines the guiding principles of the NHS providing a guiding beacon for healthcare for generations to come. It is a vision of which Nye Bevan could be proud.
‘The hard work and wide consultation has paid dividends. For the first time we have a document that lays down clearly the rights and responsibilities of both patients and staff.
‘Crucially, the Constitution applies to any private health provider working in the NHS, bringing public sector values and the public sector ethos into the private sector.
‘Those who do not support the Constitution need not apply.’