Constitutional rights in danger of smothering local NHS values

The draft, published as part of Lord Darzi's review over the summer, was well received by the NHS. It was seen as a surprisingly successful attempt to articulate the values of the service.

But it has failed to catch the public's imagination. As we report this week, the response to the consultation process has, in many areas, been derisory.

People certainly care about their NHS - according to pollsters Ipsos Mori it is up there with the monarchy when it comes to adored British institutions. Neither is there any lack of willingness to engage in debate about local health services, as anyone who has tried to reconfigure so much as an accident and emergency department coffee machine will testify.

Public indifference

But local efforts to engage the public in debate have generally been poor, verging on the invisible. However, the big NHS players have certainly made their views known. Both the NHS Confederation and NHS Employers appear to believe the constitution is over-prescriptive. They fear values, identity and staffing risk being corralled by the centre.

The best trusts have a clear sense of their own values and mission, derived from the leadership of their management team - as the finalists in the HSJ Awards demonstrate. Every hospital I have visited has a distinct identity, triangulated with its local community, the services it provides and the vision of its senior staff. The values of the NHS are the foundations, but the local identity and values drive improvement and excellence. Smothering this in an overly prescriptive corporate identity would be anathema to a service which claims to be promoting local autonomy.

On staffing, there are nagging fears the Department of Health's workforce directorate is increasingly trying to line-manage the service. The director general of workforce, Clare Chapman, built her career at Pepsi Cola and Tesco, not companies noted for celebrating organisational diversity.

The constitution has its part to play in the NHS. But it must be a driver of local power, not central diktat.