NHS Constitution for England

The NHS constitution for England is a formal constitution which, in one document, intends to lay down 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.^[1] 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.^[2] 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 now been written into the constitution. It can be seen as a development of the ideas in John Majors Patient's Charter.

The NHS grants patients rights but it provides no remedy for breaches.

The Constitution is a fairly brief document that is written in plain terms and is simple to understand. Accompanying the constitution is a handbook which gives more information to patients and staff about the constitution, a statement of NHS accountability gives a clear account of the NHS system of accountability and responsibility.

Guiding principles

In summary, seven key principles guide the NHS in all that it does:

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 diagnose, treat and improve physical and mental health. 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.
Access to NHS services is based on clinical need, not an individual’s ability to pay (except in exceptional circumstances sanctioned by Parliament).
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.
The NHS aspires to put patients at the heart of everything it does. NHS services must reflect the needs and preferences of patients, their families and their carers.
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 Constitution.
The NHS is committed to providing best value for taxpayers' money and the most effective, fair sustainable use of finite resources.
The NHS is accountable to the public, communities and patients that it serves. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff.

The NHS grants patients rights that are intended to be legally enforceable, and it also makes other non-binding pledges. These are in the areas of access; quality of care and environment; access to treatments, medicines and screening programmes; Respect, consent and confidentiality; informed choice; patient involvement in healthcare and public involvement in the NHS; and complaints and redress. It does not provide any new means of redress for breaches of the constitution.

Access to health care

The constitution defines rights regarding access to health care which will be:

access to health services free of charge, apart from certain limited exceptions sanctioned by Parliament
never refused on unreasonable grounds
to 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
to 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

The NHS also commits:

to provide convenient, easy access to services within the waiting times set out in the Handbook to the NHS Constitution (pledge)
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 constitution defines rights regarding quality of care and environment as follows:

Treatment with a professional standard of care, by appropriately qualified and experienced staff, an organisation that meets required levels of safety and quality.
Patients can expect NHS organisations to monitor, and make efforts to improve, the quality of healthcare they commission or provide

add pledges that services will be provided in a clean and safe environment that is fit for purpose, based on national best practice and that there will be a continuous improvement in the quality of services, identifying and sharing best practice.

Approved treatments, drugs and programmes

The constitution 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 ^[3] 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 under an NHS-provided national immunisation programme.

and pledges 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.
accept or refuse treatment that is offered, and not to be given any examination or treatment without valid consent.
be given information about your proposed treatment in advance, including any significant risks and any alternative treatments which may be available, and the risks involved in doing nothing.
privacy and confidentiality and to expect the NHS to keep their confidential information safe and secure.
access to their own health records. which will always be used to manage treatment in the patient's best interests.

and pledges that it will share with patients any letters sent between clinicians about their care.

Informed choice

Patients are given rights under the constitution 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.
make choices about their NHS care and to information to support these choices.

The NHS also pledges to inform patients about the healthcare services available locally and nationally and will offer easily accessible, reliable and relevant information to enable patients to participate fully in their own healthcare decisions and to support them in making choices. This includes information on the quality of clinical services where there is robust and accurate information available.

Involvement in one's own 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 discussions and decisions about one's own health care, and to be given information to enable one to do this
be involved, directly or through representatives, in the planning of health care services, 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 pledges to provide the information needed for the people to influence and scrutinise the planning and delivery of NHS services and to work in partnership with patients, their family, carers and their representatives. It also pledges continuous improvement in the quality of services provided, identifying and sharing best practice in quality of care and treatments.

Rights of redress

When complaining or seeking redress, patients are given rights to:

have any complaint made about NHS services dealt with efficiently and to have it properly investigated.
know the outcome of any investigation into a complaint.
take a complaint to the independent Health Service Ombudsman, if they are not satisfied with the way your complaint was dealt with by the NHS.
make a claim for judicial review if they think they have been directly affected by an unlawful act or decision of an NHS body.
compensation where they have been harmed by negligent treatment.

The NHS also pledges to ensure patients are treated with courtesy and receive appropriate support throughout the handling of a complaint, and the fact that they have made a complaint will not adversely affect their future treatment. When mistakes happen, the NHS promises to acknowledge them, apologise, explain what went wrong and put things right quickly and effectively. It promises that the organisation will learn lessons from complaints and will use them to improve NHS services.

References

↑ NHS "The NHS Constitution for England". NHS choices. 26 March 2013. Retrieved 27 July 2014.
↑ Sourced from the National Archives
↑ In practice, the vast majority of drugs and treatments are available through the NHS but have NOT been explicitly approved by NICE or local NHS management but usage is simply accepted medical practice. This statement makes it clear that NICE decisions rule nationally and overrides local NHS management and in the absence of other guidance from local NHS management then responsibility lies with the doctor and patient together. NICE was originally established to guide national policy where there were significant differences of opinion between the different local NHS organizations over certain drugs and treatments – the so called postcode lottery, but local managements have generally had powers over budgets and coverage in their local area.