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BMA publishes NHS constitution

A written constitution for the NHS overseen by an independent board of governors were two of the major recommendations published by the British Medical Association (BMA) in its proposals for the future of the NHS

A written constitution for the NHS overseen by an independent board of governors were two of the major recommendations published by the British Medical Association (BMA) in its proposals for the future of the NHS in England.

The 8 May discussion paper entitled A Rational Way Forward for the NHS in England outlines an alternative approach to health reform, with the BMA suggesting a system to separate national politics from the day-to-day running of the health service.

The BMS says the NHS constitution would contain the core values of the NHS, while incorporating new ones, such as supporting education and research alongside the founding values. It would also include a charter detailing what the public can expect as patients and carers and what the NHS expects from them. The paper would also contain arrangements to determine the range of services that are nationally available on the NHS, together with nationally-agreed standards for the quality of those services.

The BMA has suggested an enhancement of local groupings, which would include patients and clinicians, to agree and define a process for delivering the national core services and to decide on any additional health services (to be funded from central resources) which would be available in that area.

The BMAís proposal describes a Parliament which would establish and appoint the NHS board of governors. The board would then be responsible for ensuring compliance with the NHS Constitution and be accountable to Parliament. An executive management board, appointed by the governors, would guide the performance and national operation of the NHS.

Mr James Johnson, chairman of the BMA, said: "The BMA believes that the NHS should provide a comprehensive range of services, available to all on an equal footing. If we are going to retain an equitable, universal approach within limited resources then priority setting is inevitable. Politicians need to acknowledge this, and that it happens already but in a non-transparent and piecemeal fashion. A clear and transparent approach is needed."

Johnson added: "As the ultimate guardians of the public purse, politicians and parliament should decide the high-order questions around setting priorities and funding. When it comes to the day-to-day running of the NHS, the role of national politics should be significantly reduced. The time has come to look at a much more independent framework for the NHS to allow greater flexibilities for health economies to develop care systems and to find ways of increasing local accountability."

Other recommendations in the BMA report included:

  • A shift in focus by the Department of Health toward public health to reduce health inequalities

  • An independent review of the structure for the provision of public health

  • Clinical engagement with health professionals early on in the process of shaping health policies

  • Improved commissioning of services, led by the public sector

  • Private sector provision should only be commissioned where there is no NHS capacity, supporting rather than supplanting it ñ no further central procurement of private sector provision

  • Making the provision of high quality medical education a central part of improved commissioning

Johnson stated: "We advocate an alternative, rational approach to health reform. The governmentís injection of funds has led to considerable improvements but there has been a failure to engage either the public or clinicians in the governmentís reform agenda. That reform is destabilising the NHS and the system of care is becoming fragmented."

"Our proposals reflect a long-term commitment to the NHS. Doctors want to play a leading role in recasting reform for the benefits of patients. We wish to work with other health professionals, patients and managers to agree a shared vision for the future that engages the public and professions alike. Together we can make the NHS work for the 21st century and beyond," concluded Johnson.

To access the report click on the following link:

http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/PDFrationalwayforward/$FILE/rationalwayforward.pdf

2nd September 2008

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