BMA calls for NHS constitution

The BMA is urging the government to adopt a formal NHS constitution that would set out the responsibilities of the service in England and a new governance structure for administering it.

Under the plan, an NHS board of governors and an NHS executive management board would take responsibility for managing the day to day running of the NHS and for overseeing performance.

The medical profession, says the BMA, has become concerned that the volume and pace of reform in recent years have “destabilised the health service and alienated large sections of its dedicated staff.”

Noting that “much of the intervention from the centre results from the politicians’ fear that their careers may suffer at the hands of a stuttering NHS,” the BMA also calls for a greater role for parliament in setting broad health policy. Although the secretary of state would continue to determine overall priorities, the document says that “the element of the department concerned with NHS matters should be significantly reduced.”

Hamish Meldrum, chairman of the BMA council, said, “Such an important institution as the NHS should not be used by competing politicians trying to outbid each other with extravagant and unrealistic claims. We need to transform the culture of the health service from one of politicisation to one of professionalism.”

The BMA is also calling for a new patients’ charter, but the proposed document would bear little resemblance to the Patient’s Charter established in 1992, which was formally abandoned in 2001. Although that charter set maximum waiting times and guaranteed patients rights in areas such as choice of hospital food, the BMA argues that such details are better left to “other governance structures.”

Instead, it proposes a charter that would set out the fundamental rights of patients, in the manner of the European Charter of Patients’ Rights. This would include the right to confidentiality, the right to a choice of treatment where feasible, and the right not to accept treatment. At the same time, the charter would emphasise the responsibilities of patients to the NHS, such as the responsibility to follow health advice and treatments, and to make proper use of NHS resources.

A health minister attacked the proposals as a solution that would leave the government carrying responsibility without power. The undersecretary of state Ivan Lewis told the BMJ, “Alan Johnson [the secretary of state for health] has made it clear that transferring decision making powers to an unaccountable national board while retaining responsibility for NHS policy and investment would be a nonsense.”

But the government, which has yet to study the BMA’s proposal in detail, is likely to produce its own version of a constitution in the summer, to coincide with the 60th anniversary of the NHS.