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The ten principles of the NHS - as authored by Andrew Lansley

If I were to sit down and write the NHS Constitution, I think I could do no better than these ten core principles of the NHS:

1. The NHS will provide a universal service for all based on clinical need, not ability to pay.

2. The NHS will provide a comprehensive range of services.

3. The NHS will shape its services around the needs and preferences of individual patients, their families and their carers.

4. The NHS will respond to different needs of different populations.

5. The NHS will work continuously to improve quality services and to minimise errors.

6. The NHS will support and value its staff.

7. Public funds for healthcare will be devoted solely to NHS patients.

8. The NHS will work together with others to ensure a seamless service for patients.

9. The NHS will help keep people healthy and work to reduce health inequalities.

10. The NHS will respect the confidentiality of individual patients and provide open access to information about services, treatment and performance.

We know that the Future Forum is now reviewing the NHS Constitution. I wonder if it can do any better than these ten? We do not know because the NHS Constitution working group has not published its minutes nor its agenda, so we will just have to wait and see.

So who is the author of these ten principles of the NHS?

It is Andrew Lansley. They are in the Conservative party policy document NHS Improvement Plan published in September 2008 when the Tories were in opposition and desperate to detoxify the party’s reputation on the NHS.

Lansley says:

We believe there is a crucial need for proper legislation to ensure that all bodies and organisations providing NHS care would have to have regard to core principles of the NHS in caring for patients, and for the duties and responsibilities of NHS bodies, and rights for patients, to be clearly set out in statute. We will enshrine ten core NHS principles in legislation, for the first time establishing a guaranteed, statutory basis for the principles applied by NHS bodies.

Stirring stuff.

But has Lansley done this? Well, until the Future Forum working group reports we will not know.

It is interesting, however, to note that Lansley’s core principles are patient rights and NHS responsibilities. I suspect that the Future Forum will introduce some rights patients do not want, like the “right” to have to use a private provider which will be wrapped up in some fancy phrase including the word “choice”.

But mainly I think it will impose some new patient responsibilities.

The NHS Information Strategy was published recently. The NHS Constitution is mentioned several times. For example, in Section 4.70 and 6.6 the strategy says that the constitution will be “strengthened” to allow patients to “leave feedback or make complaints” about care; to give access to services and our own records online; and the provision of information support services.

These are all rights.

However, 5.41 talks about responsibilities:

5.41 The Government has also committed to consulting on an amendment to the NHS Constitution. Following on from the independent review of information governance, this will make more explicit proposals for the ‘consent deal’ – and will ensure that all interested parties have a chance to express their views on how they would like consent for the sharing of personal information to be sought and recorded.

The ‘consent deal’ is described in section 5.39, which tells us how valuable our medical records are and lists the two principles of the ‘consent deal’ concocted by the Future Forum:

• You have a right to access your data and a right to withhold consent to its being shared. You have a corresponding responsibility to let us use your data in the interests of your own care and of improving the service for others.

• We have a right to use your data, and a corresponding responsibility to tell you exactly what we plan to do with it and, when sharing it, to take all reasonable steps to protect your confidentiality.

Note how much of this is a patient responsibility. The ‘deal’ is that you get NHS care free-at-the- point-of-delivery and the NHS can use that data for whatever uses it wishes (as long as they tell you, of course).

The ten clear, concise principles that Lansley formulated in opposition to set out the rights of NHS patients are unlikely ever to become part of the NHS Constitution. Instead, we are more likely to have heaped upon us more responsibilities.

Richard Blogger writes about the NHS and social policy at NHS Vault.

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