Andrew Lansley asked the Future Forum to advise him how to strengthen the NHS Constitution – advice that will now go to Jeremy Hunt. But what does it actually mean, to ‘strengthen’ the NHS Constitution? The challenge is an interesting one and there is no single answer.
It is natural to start with the content of the Constitution and ask if it is fit for purpose three years – and a world away – from its launch. Is it understandable? Does it need updating? Are the rights strong enough? Should pledges be turned into rights? There is no end to the possibilities for revising the text (some of which would require primary legislation).
But let’s not get carried away with drafting. Perhaps the most salient feature of the Constitution is how little known it is. I chaired a fascinating session with voluntary organisations a few weeks ago. They know the Constitution very well and are great champions of the values and principles that lie at its heart.
People have sometimes said that the Constitution amounts to ‘fine words but no teeth’. What would a world look like in which the Constitution had teeth?
Did we talk about the content? Hardly. The meat of the discussion was how to raise the profile of the Constitution and find ways for it to be used with impact by staff, patients, service users and families. We heard the story of one charity that in the early days of the Constitution disseminated copies enthusiastically to local activists and service users. That was until people came back saying, “Er, how do we actually use it to change anything?” Enthusiasm waned.
It seems to me that, apart from questions of content, there are three vital ingredients for strengthening the Constitution:
- visibility: making it better known
- traction: making it a force for driving improvements and sustaining high standards
- challenge: making it a tool that people can use to challenge health and social care to do better and, where necessary, to seek redress when things go wrong.
In this context, the new statutory duty to ‘promote’ the NHS Constitution may turn out to be very important. This duty will lie with the NHS Commissioning Board and with the new clinical commissioning groups. How should it be carried out? It would be possible for the Commissioning Board to put copies of the Constitution in every surgery and clinic in the land and to devise some kind of performance management framework for assessing compliance with it. How effective would that be? I wonder.
Another approach would be to focus on the values and principles of the Constitution and ensure that these are embedded in the way that health and care professionals are recruited, trained, developed and held to account.
People have sometimes said that the Constitution amounts to ‘fine words but no teeth’. What would a world look like in which the Constitution had teeth? It might have a radically redesigned system for inviting feedback, addressing concerns and handling complaints: one which was easy to access, easy to use, responsive, humane, cathartic and dedicated to learning from people’s experiences to improve care.
If that is one thing that comes out of the review of the NHS Constitution, I will be happy.
What do you think?