Nearly full marks for Alan Johnson for publishing The NHS Constitution . As this is hopefully the beginning of the debate rather than its end, here are three ideas. What should be the role of constitutions, or as I argue contracts in our lives. First, we need similar constitutions/ contracts across most of our public life now as a way of allowing decent citizens to know what is expected of all of us. I’ve tried to pilot this idea in schools where the pupils themselves where the pupils themselves have come up with some pretty remarkable findings (see Neighbours from Hell). Any new contracts and going to be fairly rough and ready at first and the aim ought to be to get them, after much public discussion, revised quickly. It is a bit disappointing therefore that the new document talks of a revision in ten years!
The document sadly does not face up to two crunch issues. A main reason why health and equalities remain so stubbornly the same is differences in lifestyles. Of course it is so much more difficult for the poor to have a good diet. But many poor families manage and in so doing put most of us to shame. So under the section – your responsibilities – shouldn’t the first one be offering help to move to better diet and more exercise? The document simply talks about our having some personal responsibility here. I always find that action is far more likely if concrete steps are suggested.
The big hole in the document however concerns the bad behaviour against which too many staff suffer. The constitution doesn’t bite the bullet. We need to begin a public debate on whether a quickly revised constitution should clearly state that the courts will have powers, say after the second serious offence against staff, to exclude an individual’s NHS provision. Full Stop. The constitution pussyfoots around the issue. What do the public think though? Particularly as last year alone over 11500 NHS staff were subject to verbal or physical attacks.
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