The UK’s National Health Service (NHS) Constitution, the first document of its kind in the world, was launched yesterday at Downing Street. It was signed by Prime Minister Gordon Brown, Secretary of State for Health Alan Johnson and the chief executive of the NHS, David Nicholson.

Mr Johnson said this “momentous point in the history of the NHS” would ensure the Service is protected for generations to come. “The content of the Constitution is based on discussions with thousands of NHS staff and patients across the country and will form the basis of a new relationship between staff and patients - a relationship based on partnership, respect and shared commitment where everyone knows what they can expect from the NHS and what is expected from them,” he said.

The Constitution makes explicit the rights of people to: - make choices about their care and to information to help exercise that choice; - receive the vaccinations recommended for them by the Joint Committee on Vaccination and Immunisation under an immunisation programme; - entitlement to drugs and treatments recommended by the National Institute for health and Clinical Excellence (NICE) for use in the NHS, if their doctor says they are clinically appropriate; - expect local decisions on funding of other drugs and treatments to be made rationally, following a proper consideration of the evidence; and -make complaints and have redress.

Mr Nicholson said the work programme exploring the merits of an NHS Constitution had been “a fantastic opportunity to listen to what matters most to our patients, public and staff and to use this to set out clearly the values and purpose of the NHS system.”

Added Professor Steve Field, chairman of the Royal College of General Practitioners (RCGP), the statement in the Constitution that patients have a responsibility to register with a GP practice “reinforces the central role of the GP and the importance of continuity of care in the NHS today and in the future.”

However, other voices urged caution. The Patients Association described the Constitution as consisting “largely of optimistic pledges without any incentive for NHS managers to deliver - whether that be through rewards or adverse consequences for failure,” and said it did not expect it to make any difference to the care patients receive.

Also, “patients need to know what the duty in the new Health Bill, requiring NHS organisations to ‘have regard to the NHS Constitution’, will really mean in practice,” added the Association’s director, Katherine Murphy. “For the NHS Constitution to be effective, Trusts need to do more than ‘have regard’ to it. The time for NHS management to manage as if their jobs depended on it is long overdue. The time for words like safety, quality, choice and, in this case, Constitution to have the meaning they have elsewhere in life is also long overdue,” she said.

The British Medical Association (BMA) also feels that, 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,” said Dr Hamish Meldrum, chairman of council at the BMA.

“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,” he added.

Moreover, the country’s largest union, Unite, warned that the “fine words and elegant phrases” embedded in the Constitution must not be used as a smokescreen for private companies to take a larger slice of NHS services.”

David Fleming, Unite’s national officer for health, added that it was “a shame” that the role of the trade unions and professional associations are not mentioned in the main body of the Constitution. 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,” he said.