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The Brits and their health constitution

Posted by John McDonough  March 17, 2014 07:23 AM

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I spent some time this past week in England on a training program and had the opportunity to observe an orientation for new training faculty in the UK's National Health Service (NHS). One item they focused on was the NHS Constitution, a document I had never seen before. Funny, the Brits don't have a written constitution for their nation, though they do have one for their health care system. Here is the opening:

The NHS belongs to the people.
It is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as weNHS.jpg can to the end of our lives. It works at the limits of science -- bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.

The full constitution is an impressive document, addressing principles, values, rights, and responsibilities for patients, providers, and the public. Here's the handbook. It's not old. Though the NHS has been around since 1948, the constitution was first published in 2009 after an inclusive process to produce it.

These days, the NHS is experiencing a boatload of difficulties and challenges, as is nearly every health system on the planet. One thing that everyone I spoke with found hilarious is the notion that Brits, given the chance, would want to replace their health care system with ours. Brits want improvement and change, though nothing like our system, which is why all three major political parties always emphasize their support for the NHS.

One tangible sign of change is a two-year old grassroots movement called NHS Change Day. Last March, 189,000 participants -- mostly NHS physicians, nurses, and other personnel -- made personal pledges to work to improve the system, and this year they are have already surpassed 480,00 pledges, aiming for 500K by March 31st.

Both of these, the NHS Constitution and the Change Day, made me wonder if we would ever see such activity here in the U.S. The notion of a single health system "constitution," or more accurately, a core values statement, could be as controversial to achieve as the Affordable Care Act. Are Americans that divided? Look at the NHS "key principles" in their health constitution:

1. The NHS provides a comprehensive service available to all...
2. Access to NHS services is based on clinical need, not an individual's ability to pay.
3. The NHS aspires to the highest standards of excellence and professionalism.
4. The NHS aspires to put patients at the heart of everything it does.
5. The NHS works across organizational boundaries and in partnership with other organizations in the interest of patients, local communities and the wider population.
6. The NHS is committed to providing best value for taxpayers' money and the most effective, fair, and sustainable use of finite resources.
7. The NHS is accountable to the public, communities, and patients that it serves.

Right off the bat, Americans clearly do not agree on numbers 1 and 2. Rhetorical consensus, perhaps. Even the ACA only moves us in the direction of these goals, far short of achievement. As a society, for better or worse, we're not even close.

On the other hand, a national pledge day to dedicate everyone to the three core aspects of the "Triple Aim," why not?

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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