Introduction

The NHS was created out of the ideal that good healthcare should be available to all, regardless of wealth. When the service was launched in 1948 by Aneurin Bevan it was based on three core principles:

  • that it meet the needs of everyone
  • that it be free at the point of delivery
  • that it be based on clinical need, not ability to pay

These principles have guided the development of the NHS for the past 70 years and remain at its core.

NHS website – Principles and values that guide the NHS

What is the NHS Constitution?

The Constitution sets out the principles and values of the NHS in England, bringing together in one place information on what staff, patients and the public can expect.

Originating in 2009, the Constitution covers:

  • Principles that guide the NHS in all that it does.
  • Values that should underpin everything NHS service providers do.
  • Rights to which patients, public and staff are entitled, and pledges made by the NHS.
  • Responsibilities which the public, patients and staff owe to one another.

The central message of the Constitution is that “the NHS belongs to us all”.

The Health Secretary and all NHS bodies – including private, voluntary and third sector providers supplying NHS services – are required by law to take account of the Constitution in their decisions and actions.

Gov.uk website – The NHS Constitution for England

Principles

Principles that guide the NHS

Seven key principles guide the NHS in all that it does. They are underpinned by core NHS values which were derived from consultations with staff, patients and the public. They are:

1. The NHS provides a comprehensive service, available to all

2. Access to NHS services is based on clinical need, not an individual’s ability to pay

3. The NHS aspires to the highest standards of excellence and professionalism

4. The patient will be at the heart of everything the NHS does

5. The NHS works across organisational boundaries

6. The NHS is committed to providing best value for taxpayers’ money

7. The NHS is accountable to the public, communities and patients that it serves

Principles

Here we explore the principles in more detail…

1. The NHS provides a comprehensive service, available to all

“It is available to all irrespective of gender, race, disability, age, 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.

 

Principles

2. Access to NHS services is based on clinical need, not an individual’s ability to pay

“NHS services are free of charge, except in limited circumstances sanctioned by Parliament.”

Principles

3. The NHS aspires to the highest standards of excellence and professionalism

“It provides high quality care that is safe, effective and focused on patient experience; in the people it employs, and in the support, education, training and development they receive; in the leadership and management of its organisations; 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.”

Principles

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.”

Principles

5. The NHS works across organisational boundaries

“It works 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 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.”

Principles

6. The NHS is committed to providing best value for taxpayers’ money

“It is committed to providing the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves.”

Principles

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 organisation 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.”

Values

NHS values

Patients, public and staff helped develop six values that inspire passion in the NHS and that should underpin everything that it does. Individual organisations have developed and built upon these values, tailoring them to their local needs. NHS values provide common ground for co-operation to achieve shared aspirations, at all levels of the NHS. The core values are:

1. Working together for patients
2. Respect and dignity
3. Commitment to quality of care
4. Compassion
5. Improving lives
6. Everyone counts

Values

Here we explore the values in more detail…

1. Working together for patients

“Patients come first in everything we do. We fully involve patients, staff, families, carers, communities, and professionals inside and outside the NHS. We put the needs of patients and communities before organisational boundaries. We speak up when things go wrong.”

2. Respect and dignity

“We value every person – whether patient, their families or carers, or staff – as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits. We take what others have to say seriously. We are honest and open about our point of view and what we can and cannot do.”

3. Commitment to quality of care

“We earn the trust placed in us by insisting on quality and striving to get the basics of quality of care – safety, effectiveness and patient experience – right every time. We encourage and welcome feedback from patients, families, carers, staff and the public. We use this to improve the care we provide and build on our successes.”

Values

4. Compassion

“We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person’s pain, distress, anxiety or need. We search for the things we can do, however small, to give comfort and relieve suffering. We find time for patients, their families and carers, as well as those we work alongside. We do not wait to be asked, because we care.”

5. Improving lives

“We strive to improve health and wellbeing and people’s experiences of the NHS. We cherish excellence and professionalism wherever we find it – in the everyday things that make people’s lives better as much as in clinical practice, service improvements and innovation. We recognise that all have a part to play in making ourselves, patients and our communities healthier.”

6. Everyone counts

“We maximise our resources for the benefit of the whole community, and make sure nobody is excluded, discriminated against or left behind. We accept that some people need more help, that difficult decisions have to be taken – and that when we waste resources we waste opportunities for others.”

Rights and NHS pledges

Patients and the public: rights and NHS pledges

Everyone who uses the NHS should understand what legal rights they have. For this reason, important legal rights are covered in the Constitution, which also explains what people can do if they believe they have not received what is rightfully theirs.

The Constitution also makes pledges that the NHS is committed to achieve. Pledges go above and beyond legal rights. In reality, this means that pledges are not legally binding but represent a commitment by the NHS to provide comprehensive high-quality services.

Several rights and pledges are outlined, for example, under “access to health services” the Constitution sets out that patients and the public have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament.

In return the NHS commits (or pledges) to provide convenient, easy access to services within agreed waiting times.

Rights and NHS pledges

The full list of rights and pledges covers:

  • 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 the NHS
  • Complaint and redress

Rights and NHS pledges

Staff: rights and NHS pledges

The Constitution recognises that it is the commitment, professionalism and dedication of NHS staff that makes the difference. High-quality care requires high-quality workplaces, with commissioners and providers aiming to be employers of choice.

It lists several rights, such as the right have a good working environment with flexible working opportunities, consistent with the needs of patients and with the way that people live their lives.

In return, the NHS commits (or pledges) to provide positive working environments for staff and to promote supportive, open cultures that help staff do their jobs to the best of their abilities.

The Constitution applies to all staff, doing clinical or non-clinical NHS work – including public health – and their employers. It covers staff wherever they are working, whether in public, private or voluntary sector organisations.

Responsibilities

Patient and public responsibilities

The core message of the Constitution is that “the NHS belongs to all of us”. It promotes actions to help it work effectively and to ensure resources are used responsibly. Patients and the public are asked to:

  • Recognise 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 – the main point of access to NHS care as commissioned by NHS bodies.
  • Treat NHS staff and other patients with respect and recognise that violence, or the causing of nuisance or disturbance on NHS premises, could result in prosecution. You should recognise that abusive and violent behaviour could result in you being refused access to NHS services.
  • 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.

Responsibilities

  • 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 – about your experiences and the treatment and care you have received, including any adverse reactions you may have had. You can often provide feedback anonymously and giving feedback will not affect adversely your care or how you are treated. If a family member or someone you are a carer for is a patient and unable to provide feedback, you are encouraged to give feedback about their experiences on their behalf. Feedback will help to improve NHS services for all.

Responsibilities

Staff responsibilities

All staff have responsibilities to the public, patients and colleagues. Staff are asked to pay special attention to the following legal duties:

  • Accept professional accountability and maintain the standards of professional practice as set by the appropriate regulatory body applicable to your profession or role.
  • 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.
  • Act in accordance with the express and implied terms of your contract of employment.
  • Not to discriminate against patients or staff and to adhere to equal opportunities and equality and human rights legislation.
  • Protect the confidentiality of personal information that you hold.
  • Be honest and truthful in applying for a job and in carrying out that job.

Responsibilities

The Constitution also lists expectations that reflect how staff should play their part in ensuring the success of the NHS and delivering high-quality care, two examples of which are below:

  • Provide all patients with safe care, and to do all you can to protect patients from avoidable harm.
  • Follow all guidance, standards and codes relevant to your role, subject to any more specific requirements of your employers.

Where does the Constitution apply?

NHS staff conduct and standards

Those who work in the NHS must abide by their own codes of conduct and standards.

These include the Standards of Business Conduct Policy for NHS England staff and Managing Conflicts of Interest in the NHS guidance for staff and organisations.

These two documents provide definitions and guidance on areas such as conflicts of interest, declarations of interest, gifts and hospitality, sponsorship and sponsored events.

NHS England website – Standards of Business Conduct Policy

NHS England website – Managing Conflicts of Interest in the NHS

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