The health minister Andy Burnham has proposed developing a constitution for the NHS, to be unveiled next year on the health service's 60th birthday (Outspoken off-roader", February 14). He says that, as a result of reforms, "some are concerned that the values of the NHS are in some way up for grabs". He believes that it's time for these values - that the NHS is a comprehensive service, free at the point of use, provided according to need and not on the ability to pay - to be enshrined in law, and says "there needs to be a new consensus around the NHS as the right model for Britain's healthcare needs for at least the medium term".
While an NHS constitution is not an idea without merit, it misses the point. It will do little to address the paradox of a health service that professes equity as a core value but implements policies that contribute to widening inequalities. Cynics will say it is only a ruse to give the impression that the NHS is safe, while in practice it is as tightly under government control as ever. So can a constitution help to develop a quality, equitable NHS that improves health for all? For this to happen the government needs to take a long, hard look at current reforms.
A quick analysis shows a variable performance. There have been significant improvements in the quality and safety of care; the NHS is treating more people more quickly. However, central priorities have overshadowed action to address local issues. Coupled with policies that purport to be in the interest of quality improvements - for example, acute-service reconfigurations into "super" hospitals - actually being driven by different agendas, is it any wonder we are suspicious? Performance on reducing health inequalities has been shameful, with the gap in life expectancy between the poorest groups and the national average widening.
Most concerning are reforms that threaten improved health for all: the propagation of a market-based health system and consumerist policies, including independent-sector treatment centres (ISTCs), foundation trusts and many others. There is growing evidence that these policies are at odds with NHS core values. Apart from health being seen as a commodity and not a right, I have seen the inequity in access of patients to ISTCs for people with more complex conditions. NHS finance is again in the news, but ministers must look at their poor value-for-money policies such as shifting funding from the NHS to the private sector when there isn't a need, for example the privately run Greater Manchester Surgical Centre, running at less than 60% capacity in its first six months, equivalent to a loss of £1.9m.
The government's confused vision runs contrary to NHS values, to those of the vast majority of its staff, and to what the public wants. It is also contributing to conflicting cultures: one with a value and belief system based on collectivism and the other on consumerism. So although an NHS constitution may have a place, it needs to be seen in conjunction with, not instead of, a policy rethink in the NHS.
· Debbie Abrahams is a director of the International Health Impact Assessment Consortium at the University of Liverpool. She was chair of Rochdale primary care trust from 2002-6.
