By John Tingle, Assistant Professor, Birmingham Law School, University of Birmingham
Many organisations have mission, vision, value statements showing the character, personality, aims, mission, values, and brand of the organisation.
Mission statements are drafted in an aspirational way and as such function as clever marketing tools. The organisation is not being pinned down to specifics. The language used is flexible and vague enough to allow for a wide latitude of interpretation, meaning and expectations are set.
The NHS Constitution for England
The NHS Constitution can be viewed as NHS England’s Mission statement. It is a comprehensive document containing the core principles that guide it, its values, patient, staff rights and so on. It is the NHS’s window on the world. There are seven key principles stated that guide the NHS in all it does. These are underpinned by core NHS values which are also set out in the more detailed accompanying Handbook to the NHS Constitution for England.
The principles that guide the NHS
- The NHS provides a comprehensive service, available to all.
- Access to NHS services is based on clinical need, not an individual’s ability to pay.
- The NHS aspires to the highest standards of excellence and professionalism.
- The patient will be at the heart of everything the NHS does.
- The NHS works across organisational boundaries.
- The NHS is committed to providing best value for taxpayers’ money.
- The NHS is accountable to the public, communities, and patients that it serves, (p.4-5).
NHS Values
The core NHS values are stated as working together for patients, respect and dignity, commitment to quality of care, compassion, improving lives and everyone counts.
Rights and pledges
The NHS Constitution takes a rights-based focus in describing what patients and the public can expect from the NHS:
“You have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament” (p8)
“You have the right to receive care and treatment that is appropriate to you, meets your needs and reflects your preferences.” (p.8)
These are just some of the rights stated in the NHS Constitution. The NHS Constitution does not afford any new rights, it collects in one place and states those that already exist.
How useful is a rights focus?
It is questionable how much a rights focus is useful and realistic given the NHS model of care of providing free care for all. Perhaps the focus should be more on recognising interests given the community, collective type nature of the NHS? Difficult NHS resource allocation decisions will inevitably have to made and this will adversely affect some patients. The NHS faces an infinite demand for finite health care resources. Herring states the difficulties of a rights focus:
“A rather different concern is that rights encourage an individualistic approach which is focuses on the interests of particular people, rather than the good of society or the relational values between them.” (p.44)
Rights and pledges
There are also aspirational pledges set out in the NHS Constitution. There is an important distinction to be made between rights and pledges which is further explained in the Handbook to the NHS Constitution for England. This states that a right is a legal entitlement protected by law and is already in place. This is distinct from the term,” pledge,” which is more of an ambition.
Pledges exist in several areas in the NHS Constitution including access to health services, offering easily accessible, reliable, and relevant information in an understandable form and so on.
In terms of access to health services there are several NHS pledges which include to:
“provide convenient, easy access to services within the waiting times set out in the Handbook to the NHS Constitution.” (p8).
As we have seen through media reports many struggle to obtain GP appointments and reading this pledge will be uncomfortable reading for some.
NHS Constitution :10-year review
Legislation requires that the NHS Constitution be reviewed every 10 years and now is the time. This will take place in the form of an open consultation which closes on18th July 2024. Proposed changes will be in areas such as responding to deterioration, health disparities, environmental responsibilities, patient responsibilities, research, and other areas.
Healthwatch in a blog proffers a strong critique of the NHS Constitution:
“But 15 years later, amid struggles to get timely care and public satisfaction with the NHS.
at its lowest ever level, the Constitution is far from the “enduring” public touchstone envisaged.” (p.3).
They commissioned a poll to find out the extent to which the public knew about the NHS Constitution and what rights they wanted to see in it.
Low public awareness
The blog states that 1812 adults in England were polled and less than one-quarter 24% had heard of the NHS Constitution. Awareness was even lower, the blog states, among people over 55, at just 12%. The blog discusses gaps in the NHS Constitution and proposals for reform.
What’s in a name?
A key criticism of the NHS Constitution made in the Healthwatch blog is its name. I have often thought myself that the name is wrong. It is too technical, obscure, and far removed from the experiences of most people. We need a better, more public friendly name for the NHS Constitution and. Healthwatch agrees, stating, ”… the document should become a genuine ‘NHS Patient Promise’…” (p.6).
Conclusion
As a mission statement, the NHS Constitution paints a rosy picture of the NHS. A picture far removed from the everyday practical reality of NHS care. More aspirational than grounded in fact. Unrealistic expectations, through a rights focus are raised which can cause public, patient, staff disappointment and disenchantment. The ten-year review presents an opportunity to put matters right and to re set the NHS Constitution.
(This blog is based on one of my fortnightly opinion columns for the British Journal of Nursing.)