The role of the National Health Service (NHS) Constitution in balancing patient rights

The Department of Health and Social Care in England has just published two important publications on the NHS Constitution. The Handbook to the NHS Constitution for England, updated and the Third Report on the Effect of the NHS Constitution.

The NHS Constitution

The NHS Constitution articulates the principles of operation and purpose of the NHS along with its underpinning values. It is an important publication setting the tone and flavor of how the NHS and its staff function and relate to those whom it serves. It can be viewed as the bedrock of NHS service delivery.

The updated NHS Constitution Handbook includes a strengthening of the patient and public responsibilities section. Making clearer the vital role that patients and the public play regarding NHS sustainability and to ensuring that resources are focused on those who need them most.

Both publications address the inherently unequal power relationship between nurses, doctors, the wider NHS and patients. The NHS Constitution can be seen as an attempt to redress this balance by laying down fundamental rights, NHS pledges and responsibilities.

The NHS Constitution Handbook

The NHS Constitution handbook is a large and complex document, running to 160 pages. It is well written and contains essential information. In part 1, NHS values are discussed, part 2, principles that guide the NHS, part 3, patients and the public, part 4, staff.

Part 3 covers patients and the public and includes discussion of  the following:

  • Access to health services
  • Quality of care and environment
  • Respect, consent and confidentiality
  • Informed choice
  • Involvement in your healthcare and the NHS
  • Complaint and redress
  • Patient and public responsibilities
  • Patient Safety Context

NHS Constitution review report

The Secretary of State for Health and Social Care is required to report to Parliament on the effect of the NHS Constitution every three years. A big positive in the report is the number of staff who are proud to work for the NHS.The survey in 2015 and 2018 asked staff whether they are proud to work for the NHS and over 90 percent of staff agreed that they were.

Awareness of the NHS Constitution

The report paints a mixed picture of awareness of the NHS Constitution. NHS staff are much more aware of it than the public. In 2018, 19 percent of members of the public surveyed said that they had heard of the NHS Constitution when prompted by a written description but not its name. This is a fall of 5 percent from the 2015 figure of 24 percent and an overall fall of 3 percent since 2009.The percentage of staff who believe it is important that the NHS has a Constitution in 2018 remains high at (73 percent).

The new publications on the NHS Constitution are to be welcomed.

The NHS Constitution Handbook and the Third  report on the effect of the NHS Constitution contains very useful findings, information, ideas, concepts and values which underpin the operation of our NHS. These can be seen to help balance the health care equation. In the NHS Constitution there are very well-crafted ideals, and these richly underpin our health care system.

The problem

The problem lies with the NHS Constitution’s poor impact on the public, and this needs to improve, otherwise it will be a document that is likened to a one-way street. Traffic is seen to be moving in only one direction, down the NHS’s side of the road. A name change could perhaps work wonders. The term, ‘Constitution’ is a legalistic term and may be misunderstood by the public. It could have an elitist flavor which might mean the public don’t see it as a relevant document to them. The publications clearly show that there are many positives resulting from the NHS Constitution concept.

John Tingle

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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