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Monday 28th May 2018

The NHS constitution

2nd July 2008

Daniel Finkelstein argues that an NHS constitution should clarify what we do not have a right to.

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The constitution for the National Health Service is a document that reads as if Comrade Judith from Monty Python’s Life of Brian drew it up after a meeting of the People’s Front of Judea.

The rights established by the new draft constitution fall into two parts - those that you already have and which are not changed by its publication, and those it suggests it is providing, but in reality you do not have and will never have.

With a technological revolution under way in medical services, we are reaching a point when the services we could obtain are so great that it is testing our willingness to pay for it all for everyone.

A decision is needed on where the “limits of social provision lie” and that decision is with us now.

But the NHS constitution has passed over this.

While stating the NHS “has a wider social duty to promote equality through its services” it cannot acknowledge a reality that makes complete equality impossible.

The notion of replacing the NHS with “social insurance” will not make the problem of funding new drugs go away and we cannot continue rationing by stealth either.

The Department of Health needs to start work on a new declaration, a “quite different document.”

It cannot be one that announces your rights and the things the NHS promises to provide you, but one that does quite the opposite.

It must be a document that tells you what you don’t have a right to and the NHS refuses to promise you.


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