Patients' bills of rights regarded with scepticism in UK

In 1991, John Major's new Conservative government created a Patients' Charter in the UK. It was supposed to be part of the “breath of fresh air” that marked the end of Margaret Thatcher's 11 years in office, and listed the standards of service that people could expect to receive within the National Health Service (NHS). This included their right to have treatment options explained, to see their medical notes, to have a general practitioner and to be referred to a specialist as required.

Doctors hated it, though few said so publicly. Already hard pressed, they felt that the charter ignored their rights and simply offered a sledgehammer to their more difficult patients. “The problem was, it gave patients a lot to demand but it was very one-sided — and it couldn't be fulfilled,” explains Kristin McCarthy, director of Doctor Patient Partnership, an offshoot of the British Medical Association.

A north London GP told CMAJ that the charter “promised people loads of things, but it wasn't the job of the people who wrote the charter to do the delivering — it's like the postman telling the baker to stay open all day. Initially it raised people's expectations and they demanded more, but now that everyone knows the health service is at the breaking point, they've stopped asking.”

By 1998 the government decided the charter needed revision and created a team led by Greg Dyke, then chair of an independent television company and now chair of the BBC. He scrapped unrealistic parts, such as the promise to admit patients within 2 hours of their assessment in the emergency room. He also recognized that staff didn't like the charter; they felt it may have contributed to the rise in violence against NHS staff because it increased patients' expectations without spelling out their responsibilities.

The result of Dyke's deliberations were refined, censored, improved and sanitized through various committees and eventually published in July 2000 as Your Guide to the NHS (www.nhs.uk/nhsguide). A year later, the government decided that the guide should replace the 10-year-old charter in England, but not in Wales, Scotland, or Northern Ireland — a typical British muddle.

The guide lists core principles, which include meaningless things — “the NHS will provide a comprehensive range of services” — which belie the fact that many people cannot get treatment for common problems such as varicose veins and hernias. It also says that “the NHS will support and value its staff,” which makes the staff smile. The guide included a pledge to reduce waiting lists, but on June 14, less than 3 months after it was incorporated, this was changed to a pledge to limit waiting times (still up to 1 year for a hip replacement).

The new guide has had a mixed reception. The NHS Confederation, representing NHS trusts and health authorities, welcomed it. McCarthy says it balances the rights of staff and patients and asks patients to use the most appropriate resource, which might be a pharmacist or telephone helpline.

But Patient Concern, a pressure group, is unhappy: “We were hoping for a better charter with more rights and more teeth,” it responded, “but instead the first 12 pages are a patronizing lecture on drinking wisely and giving blood.”