The British Medical Association has recommended a written constitution for the National Health Service, which would be overseen by independent governors, not politicians.
The proposals form part of a 24-recommendation discussion paper A rational way forward for the NHS in England, which claims to outline an alternative approach to reform, which would separate national politics from the day-to-day running of the health service.
The proposed constitution “would contain the core values of the NHS incorporating new ones such as supporting education and research alongside the founding values,” said the BMA, noting that it would include a charter explaining “what the public can expect as patients and carers and what the NHS expects from them.” The paper adds that “crucially it would also contain arrangements to determine the range of services that are nationally available on the NHS, together with nationally-agreed standards for the quality of those services.”
BMA chairman James Johnson said that “if we are going to retain an equitable, universal approach within limited resources then priority setting is inevitable. Politicians need to acknowledge this, and that it happens already but in a non-transparent and piecemeal fashion. A clear and transparent approach is needed.”
Under the proposals, the UK parliament would establish and appoint the NHS Board of Governors which would be responsible for ensuring compliance with the NHS Constitution and be accountable to parliament. An executive management board, appointed by the governors, “would guide the performance and national operation of the NHS,” the paper recommends.
Mr Johnson said that “as the ultimate guardians of the public purse, politicians and parliament should decide the high-order questions around setting priorities and funding,” but when it comes to the day-to-day running of the NHS, “the role of national politics should be significantly reduced. The time has come to look at a much more independent framework for the NHS to allow greater flexibilities for health economies to develop care systems and to find ways of increasing local accountability.”
The BMA report includes a wide range of recommendations which include an independent review of the structure for the provision of public health, “clinical engagement with health professionals early on in the process of shaping health policies” and the creation of elected ‘local health councils’.
Mr Johnson concluded by saying that “the government’s injection of funds has led to considerable improvements but there has been a failure to engage either the public or clinicians in the government’s reform agenda. That reform is destabilising the NHS and the system of care is becoming fragmented.”
However, some critics feel that the BMA’s proposals could also prove to be divisive. A debate over core services the NHS could afford over coming decades would lead to the reduction in patients' entitlement to treatment and other observers have suggested that the reforms would merely lead to more bureaucracy.
