The NHS Constitution for England is a document that sets out the objectives of the National Health Service, the rights and responsibilities of the various parties involved in health care, (patients, staff, trust boards) and the guiding principles which govern the service. First published on 21 January 2009 it was one of a number of recommendations in Lord Darzi's report 'High Quality Care for All' as part of a ten-year plan to provide the highest quality of care and service for patients in England. Previously these rights and responsibilities had evolved in common law or through English or EU law, or were policy pledges by the NHS and UK government have been written into the document. It can be seen as a development of the ideas that began with the introduction of the Patient's Charter in 1991.
Unlike a real constitution, the document is not itself legally enforceable, though it purports to set out the rights that patients and staff. It is fairly brief, written in plain terms and is simple to understand. Accompanying is a handbook which gives more information to patients and staff about the document, and also provides detail on the legislation that underpins the rights. A statement of NHS accountability also gives a clear account of the NHS system of accountability, transparency and responsibility.
In summary, seven key principles guide the NHS in all that it does:
1.The NHS provides a comprehensive service, available to all irrespective of age, gender, disability, race, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. . It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides, and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.
2.Access to NHS services is based on clinical need, not an individual's ability to pay (except in exceptional circumstances sanctioned by Parliament).
3.The NHS aspires to the highest standards of excellence and professionalism to provide high quality care that is safe, effective and focused on the patient experience; in the people it employs, and in the support, education, training and development that they receive; in the leadership and management of its organizations; and through its commitment to innovation and to the promotion, conduct and use of research to improve the current and future health and care of the population. Respect, dignity, compassion and care should be at the core of how patients and staff are treated, not only because that is the right thing to do, but because patient safety, experience and outcomes are all improved when staff are valued, empowered and supported.
4.The patient will be at the heart of everything the NHS does. It should support individuals to promote and manage their own health. NHS services must reflect, and should be coordinated around and tailored to, the needs and preferences of patients, their families and their carers. As part of this, the NHS will ensure that in line with the Armed Forces Covenant, those in the armed forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area they reside. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. The NHS will actively encourage feedback from the public, patients and staff, welcome it and use it to improve its services.
5.The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is an integrated system of organisations and services bound together by the principles and values reflected in the document. The NHS is committed to working jointly with other local authority services, other public sector organisations, and a wide range of private and voluntary sector organisations to provide and deliver improvements in health and wellbeing.
6.The NHS is committed to providing best value for taxpayers' money and the most effective, fair sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves.
7.The NHS is accountable to the public, communities and patients that it serves. The NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organization of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose.
The NHS Constitution outlines a series of patient rights, along with commitments from the NHS, to the patient. These are in the areas of;
- Access to health services - Quality of care and environment - Nationally approved treatments, drugs and programmes - Respect, consent and confidentiality - Informed choice - Involvement in your healthcare and in the NHS - Complaint and redress.
Access to health services
The document defines rights regarding access to health services, including rights to:
- access NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament
- never be refused access on unreasonable grounds
- expect the NHS to assess the requirements of your community and put in place the services to meet those needs
- not to be unlawfully discriminated against in the provision of NHS services
- access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer a range of suitable alternative providers if this is not possible (waiting times are described in the Handbook)
The NHS also commits:
- to provide convenient, easy access to services within the waiting times set out in the Handbook to the NHS Constitution
- to make decisions in a clear and transparent way
- to make the transition as smooth as possible when referred between services, and to put 'you, your family and carers at the centre of decisions that affect you of them (pledge).'
Quality of care and environment
The document defines rights regarding quality of care and environment, including:
- The right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality.
- The right to be cared for in a clean, safe, secure and suitable environment
- The right to receive suitable and nutritious food and hydration to sustain good health and wellbeing
- The right to expect NHS organisations to monitor, and make efforts to improve, the quality of healthcare they commission or provide
The NHS also commits:
- to identify and share best practice in quality of care and treatments.
Nationally approved treatments, drugs and programmes
The document defines rights regarding approved treatments, drugs and programmes. Patients have the right to:
- drugs and treatments that have been recommended by NICE for use in the NHS, if their doctor says they are clinically appropriate for them.
- 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 that you and your doctor feel would be right for you, the local NHS must explain that decision.
- receive the approved vaccinations that the Joint Committee on Vaccination and Immunisation recommends that you should receive under an NHS-provided national immunization programme.
The NHS also commits:
- to provide screening programmes as recommended by the UK National Screening Committee
Respect, consent and confidentiality
With regard to rights regarding respect, consent and confidentiality, the NHS Constitution gives patients the right to:
- be treated with dignity and respect in accordance with your human rights.
- be protected from abuse and neglect, and care and treatment that is degrading.
- accept or refuse treatment that is offered to you, and not to be given any examination or treatment without valid consent.
- be given information about the test and treatment options available to you, what they involve, and their risks and benefits.
- access your own health records, and to have any factual inaccuracies corrected.
- privacy and confidentiality and to expect the NHS to keep their confidential information safe and secure.
- be informed how your information is used
- request that your confidential information is not used beyond your own care and treatment, and to have your objections considered, and where your wishes cannot be followed, to be told the reasons including the legal basis.
The NHS also commits:
- to ensure those involved in your care and treatment have access to your health information
- that if you are admitted to hospital, you will not have to share sleeping accommodation with patients of the opposite sex
- to anonymise information collected during the course of your treatment
- where identifiable information has to be used, to give you the chance to object wherever possible
- to inform you of research studies in which you may be eligible to participate
- to share with you any correspondence sent between clinicians about your care.
Patients are given rights under the document in relation to informed choice including the right to:
- choose their own GP practice, and to be accepted by that practice unless there are reasonable grounds to refuse
- express a preference for using a particular doctor within your GP practice, and for the practice to try to comply.
- transparent, accessible and comparable data on the quality of local healthcare providers, and on outcomes, as compared to others nationally.
- make choices about the services commissioned by NHS bodies, and to information to support these choices.
The NHS also commits to:
- inform you about the healthcare services available to you, locally and nationally.
- to offer you easily accessible information in a form you can understand.
Involvement in your health care and in the NHS
The NHS recognized fully that the population has rights regarding involvement in their own health care and in the NHS. There are rights to:
- be involved in planning and making decisions about your health and care with your care provider or providers, including your end of life care, and to be given information and support to enable you to do this. Where appropriate this right includes your family and carers. This includes being given the chance to manage your own care and treatment if appropriate.
8to an open and transparent relationship with the organization providing your care. You must be told about any safety incident relating to your care, which, in the opinion of a healthcare professional, has caused, or could still cause, significant harm or death. You must be given the facts, an apology, and any reasonable support you need.
- be involved, directly or through representatives, in the planning of health care services commissioned by NHS bodies, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.
The NHS also commits:
- to provide you with the information and support you need to influence and scrutinize the planning and delivery of NHS services.
- to work in partnership with you, your family, carers and representatives.
- to involve you in discussions about planning your care and to offer you a written record of what is agreed if you want one.
- to encourage and welcome feedback on your health and care experiences and use this to improve services.
Complaint and redress
When complaining or seeking redress, patients are given rights to:
- have any complaint you make about NHS services, acknowledged within three working days, and to have it properly investigated.
- discuss the manner in which the complaint is to be handled, and to know the period within which the investigation is likely to be completed and the response sent.
- be kept informed of progress and to know the outcome of any investigation into your complaint, including an explanation of the conclusions and confirmation that any action needed in consequence of the complaint has been taken or is proposed to be taken.
- take your complaint to the independent Parliamentary and Health Service Ombudsman, if you are not satisfied with the way your complaint was dealt with by the NHS.
- make a claim for judicial review if you think you have been directly affected by an unlawful act or decision of an NHS body or local authority.
- compensation where they have been harmed by negligent treatment.
The NHS also commits to:
- ensure that you are treated with courtesy and you receive appropriate support throughout the handling of a complaint; and that the fact that you have complained, will not adversely affect any future treatment.
- ensure that when mistakes happen, or if you are harmed whilst receiving health care, you receive an appropriate explanation and apology
- ensure that the organization learns lessons from complaints and claims, and uses these to improve NHS services.
3b. Patients and the public responsibilities
The NHS belongs to us all. There are things that we can all do for ourselves and for one another, to help it work effectively, and to ensure resources are used responsibly
- recognize that you can make a significant contribution to your own, and your family's, good health and wellbeing, and take personal responsibility for it.
- register with a GP practice
- treat NHS staff and other patients with respect and recognize that violence, or the causing of nuisance or disturbance on NHS premises, could result in prosecution.
- provide accurate information about your health, condition and status
- keep appointments, or cancel within reasonable time. Receiving treatment within the maximum waiting times may be compromised unless you do.
- follow the course of treatment which you have agreed, and talk to your clinician if you find this difficult.
- participate in important public health programmes such as vaccination
- ensure that those closest to you are aware of your wishes about organ donation
- give feedback, both positive and negative.
4a. Staff rights and NHS pledges to staff
It is the commitment, professionalism and dedication of staff working for the benefit of the people that the NHS serves, which really make the difference. High-quality care requires high-quality workplaces, with commissioners and providers aiming to be employers of choice.
The rights are there to help ensure that staff;
- have a good working environment with flexible working opportunities, consistent with the needs of patients and with the way that people live their lives
- have a fair pay and contract framework
- can be involved and represented in the workplace
- have healthy and safe working conditions and an environment free from harassment, bullying or violence
- are treated fairly, equally and free from discrimination
- can in certain circumstances take a complaint about their employer to an Employment Tribunal
- can raise any concern with their employer, whether it is about safety, malpractice or other risk, in the public interest.
The NHS commits:
- to provide a positive working environment for staff and to promote supportive, open cultures that help staff do their job to the best of their ability
- to provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference to patients,their families and carers and communities
- to provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfill their potential
- to provide support and opportunities for staff to maintain their health, wellbeing and safety
- to engage staff in decisions that affect them and the services they provide, individually, through representative organizations and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families
- to have a process for staff to raise an internal grievance
- to encourage and support all staff in raising concerns at the earliest reasonable opportunity about safety, malpractice or wrongdoing at work, responding to and, where necessary, investigating the concerns raised and acting consistently with the Employment Rights Act 1996
4b. Staff responsibilities
All staff have responsibilities to the public, their patients and colleagues.
- You have a duty to accept professional accountability and maintain the standards of professional practice as set by the appropriate regulatory body applicable to your profession or role.
- You have a duty to take reasonable care of health and safety at work for you, your team and others, and to co-operate with employers to ensure compliance with health and safety requirements.
- You have a duty to act in accordance with the express and implied terms of your contract of employment.
- You have a duty not to discriminate against patients or staff and to adhere to equal opportunities and equality and human rights legislation.
- You have a duty to protect the confidentiality of personal information that you hold.
- You have a duty to be honest and truthful in applying for a job and in carrying out that job.
Staff should aim to:
- to provide all patients with safe care, and to do all you can to protect patients from avoidable harm
- to follow all guidance, standards and codes relevant to your role, subject to any more specific requirements of your employers
- to maintain the highest standards of care and service, treating every individual with compassion, dignity and respect, taking responsibility not only for the care you personally provide, but also for
your wider contribution to the aims of your team and the NHS as a whole
- to find alternative sources of care or assistance for patients, when you are unable to provide this (including for those patients who are not receiving basic care to meet their needs)
- to take up training and development opportunities provided over and above those legally required of your post
- to play your part in sustainably improving services by working in partnership with patients, the public and communities
- to raise any genuine concern you may have about a risk, malpractice or wrongdoing at work (such as a risk to patient safety, fraud or breaches of patient confidentiality), which may affect
patients, the public, other staff or the organisation itself, at the earliest reasonable opportunity
- to involve patients, their families, carers or representatives fully in decisions about prevention, diagnosis, and their individual care and treatment
- to be open with patients, their families, carers or representatives, including if anything goes wrong, welcoming and listening to feedback and addressing concerns promptly and in a spirit of co-operation
- to contribute to a climate where the truth can be heard, the reporting of, and learning from, errors is encouraged and colleagues are supported where errors are made
- to view the services you provide from the standpoint of a patient, and involve patients, their families and carers in the services you provide, working with them, their communities and other organisations, and making it clear who is responsible for their care
- to take every appropriate opportunity to encourage and support patients and colleagues to improve their health and wellbeing
- to contribute towards providing fair and equitable services for all and play your part, wherever possible, in helping to reduce inequalities in experience, access or outcomes between differing groups or sections of society requiring health care
- to inform patients about the use of their confidential information and to record their objections, consent or dissent
- to provide access to a patient's information to other relevant professionals, always doing so securely, and only where there is a legal and appropriate basis to do so.