Have anyone read the NHS Constitution? The draft document was launched a year ago, when Gordon Brown, former health secretary Alan Johnson and NHS chief executive David Nicholson staged a glitzy Downing St signing of this ‘historic document’ that would repackage targets as ‘patients’ rights enshrined in law.’ All of us were encouraged to feedback by February 5, 2010. But a DoH survey a month ago found that only 47% of NHS staff were even aware of the constitution, and just 22% of patients. And virtually no-one had an in depth knowledge of what it contained, leading the researchers to conclude there was a ‘vision gap’ and that more work was needed to keep it ‘vital and fresh.’
As a result, health secretary Andy ‘Little Boy’ Burnham added seven ‘vital and fresh’ patient rights to the twenty five we still haven’t read. These are that patients should have the right to 1) choose to die at home 2) access NHS dentistry 3) have a personal health budget 4) choose a GP practice offering extended access to evening and weekend appointments 5) have key diagnostic tests for suspected cancer patients within one week of seeing a GP 6) Be treated in a private hospital if the NHS can’t do so within 18 weeks of referral (or 2 weeks in the case of cancer) 7) have a 5 yearly NHS check to assess the risk of heart disease, stroke, diabetes and kidney disease (aged 40-74 only, starting 2012).
The idea that patients should have a clear idea of what we can expect for our £105 billion a year is not a bad one, and there are also responsibilities for patients and rights for NHS staff. But the NHS has to make ‘efficiency savings’ of at least £20 billion over the next few years and, along with Brown’s populist promise of free social care for the elderly, none of the rights appear to have been costed. Take Burnham’s first proposal. Half a million people die in England every year, two-thirds of them are over 75 and the vast majority of deaths follow a period of chronic illness such as cancer or heart disease. About 60% of these deaths currently occur in acute hospitals, there is no clinical need for patients to be there and most would rather die at home. But palliative care is so poorly funded by the NHS that many people only manage a home-death thanks to the work of hospices and other charities. So making this a legally enforceable right for such a large number of people without providing the resources to do it smacks of desperate electioneering.
Of the 25 original proposed rights, many are reworking of the original values of the NHS with appropriate cop outs (e.g. “You have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament.” And “You will not be refused access to NHS treatment on unreasonable grounds.”) There’s a proposed a legal right to receive any appropriate treatment that has been approved by NICE and a right (under certain circumstances) to be treated in other European Economic Area countries or Switzerland. And above all, “you have the right to be treated with dignity and respect” and “a right to a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality.”
All those on the wrong end of NHS scandals last year will doubtless be interested in the last right, which also comes with a right to compensation in the case of proven negligence. The fact that you have to go through the tortuous process of proving negligence when you’ve been harmed by healthcare will hardly make the NHS more humane. Indeed, the only winners in this scattergun of un-costed legal rights are likely to be lawyers. But you still have a month to air your views. Happy New Year.