NHS Constitution

BG: Average 6.1; 7 Day Average 6.6; 14 Day Average 6.6; 28 Day Average; 6.7; Cigarettes 1; Wine 0 Glasses;

Yesterday I travelled up to London for a session organised by Diabetes UK to discuss the draft NHS constitution. I don’t think I’ve met a nicer bunch of people. This is a copy of a post I made on the www.diabetes.co.uk forum.

Apologies for the length of the posting, but this is something I feel very passionate about. Draft constitution information can be found here and the reason for publishing one is so that the patients and staff have all their rights and responsibilities in one place. The constitution is one of the reforms suggested by Lord Darzi.

Taken at face value it is a very laudable document and covers the rights and responsibilities of both patients and staff – though there are some concerns over the language used. The constitution differentiates between what is a right and what the document calls a pledge, that which the NHS aspires to provide. I was concerned to see that the NHS can only pledge the following:

The NHS will strive to ensure that services are provided in a clean and safe environment that is fit for purpose, based on national best practice.

The document does not differentiate between national strategies and local problems. In instances, like diabetes, which both the NHS and press call a national problem, but which is treated as a local issue hence the postcode lottery regarding some of the treatment we all receive. The constitution stresses the local nature of treatment, which is right for local issues but isn’t for a problem like diabetes where treatment must be, IMO, of a consistent quality throughout England with the following weasel phrases:

You have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you.

You have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you.

Another point that was raised yesterday was that the document does not cover the individuality of all of us, for instance, the NHS play book for type 2s is that we should be prescribed a statin, whether or not we need one. I’ve been on 20mg Simvador since diagnosis, my GP has instructed me to double that, because regardless of the fact that my lipid profile has been perfectly satisfactory since a month after diagnosis,

that’s what the guidelines say.

During yesterdays discussions it was recognised that, with reference to the first patient responsibility

You should recognise that you can make a significant contribution to your own, and your family’s, good health, and take some personal responsibility for it.

there are at least three types of diabetics:

• Those in denial;
• Those who will just follow guidance;
• Those of us who take an interest in our condition.

very often our HCPs lump everyone together – expecting more from some of us, and disregarding the input of those who actually want to participate in a treatment plan. This is a particular bugbear of mine:

You should treat NHS staff and other patients with respect and recognise that causing a nuisance or disturbance on NHS premises could result in prosecution.

but this isn’t reciprocated it is not a patient right to be treated with respect nor is it a staff responsibility – so they can be as rude to us as they like, and we just have to accept it with a stiff upper lip – errrr, no.

There are concerns over how much it will cost to produce and distribute both the constitution and the patients handbook.

Still, yesterday was a consultation, and the DUK team left with a lot of words, some of which were in some semblance of an order, to send back to the DH (hopefully in the same order). I really did feel as if we were being listened to (there was a DH representative there for the first part of the day). I would like to congratulate DUK on what was a well organised, if quickly convened, day.

First Great Western proved really surprising – the 6:25 from Worcester was cancelled

Today I have an appointment with a dietitian, it’s taken since the end of June to eventually get to see one, rarer than rocking horse doo-doo apparently.