The NHS Constitution
The NHS Belongs
to the People.
It is there to improve our health and
well-being, supporting us to keep mentally and physically well,
to get better when we are ill and, when we cannot fully recover,
to stay as well as we can to the end
of our lives. It works at the limits of
science – bringing the highest levels of human knowledge and
skill to save lives and improve health. It touches our lives at
times of basic human need, when care and compassion are what
matter most.
The NHS is founded on a common set of
principles and values that bind together the communities and
people it serves – patients and public – and the staff who work
for it.
This Constitution establishes the
principles and values of the NHS in England. It sets out rights
to which patients, public and staff are entitled, and pledges
which the NHS is committed to achieve,
together with responsibilities which the
public, patients and staff owe to one another to ensure that the
NHS operates fairly and effectively. All NHS bodies and private
and third sector providers
supplying NHS services are required by
law to take account of this Constitution in their decisions and
actions.
The Constitution will be renewed every
10 years, with the involvement of the public, patients and
staff. It is accompanied by the Handbook to the NHS
Constitution, to be renewed at least every three years, setting
out current guidance on the rights, pledges, duties and
responsibilities established by the Constitution. These
requirements for renewal are legally binding. They guarantee
that the
principles and values which underpin the
NHS are subject to regular review and recommitment; and that any
government which seeks to alter the principles or values of the
NHS, or the rights, pledges, duties and responsibilities set out
in this Constitution, will have to engage in.
Principles that
Guide the NHS
Seven key principles guide the NHS in
all it does. They are underpinned by core NHS values which have
been derived from extensive discussions with staff, patients and
the public. These values are set out at the back of this
document.
1. The NHS provides a comprehensive
service, available to all irrespective of gender, race,
disability, age, sexual orientation, religion or belief. 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. NHS services
are free of charge, except in limited circumstances sanctioned
by Parliament.
3. The NHS aspires to the highest
standards of excellence and professionalism – in the provision
of high-quality care that is safe, effective and focused on
patient experience; in the planning and delivery of the clinical
and other services it provides; in the people it employs and the
education, training and development they receive; in the
leadership and management of its organisations; and through its
commitment to innovation and to the promotion and conduct of
research to improve the
current and future health and care of
the population.
4. NHS services must reflect the needs
and preferences of patients, their families and their carers.
Patients, with their families and carers, where appropriate,
will be involved in and consulted on all decisions about their
care and treatment.
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 now
reflected in the Constitution. The NHS is committed to working
jointly with local authorities and a wide range of
other private, public and third sector
organisations at national and local level to provide and deliver
improvements in health and well-being.
6. The NHS is committed to providing
best value for taxpayers’ money and 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.
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.
2a. Patients
and the Public – Your Rights and NHS Pledges to You
Everyone who uses the NHS should
understand what legal rights they have. For this reason,
important legal rights are summarised in this Constitution and
explained in more detail in the Handbook to the NHS
Constitution, which also explains what you can do if you think
you have
not received what is rightfully yours.
This summary does not alter the content of your legal rights.
The Constitution also contains pledges
that the NHS is committed to achieve. Pledges go above and
beyond legal rights. This means that pledges are not legally
binding but represent a commitment by the NHS to provide
high-quality services.
Access to
Health Services:
-
You have the right to receive NHS
services free of charge, apart from certain limited
exceptions sanctioned by Parliament.
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You have the right to access NHS
services. You will not be refused access on unreasonable
grounds.
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You have the right to expect your
local NHS to assess the health requirements of the local
community and to commission and put in place the services to
meet those needs as considered necessary. You have the
right, in certain circumstances, to go to other European
Economic Area countries or Switzerland for treatment which
would be available to you through your NHS commissioner.
You have the right not to be unlawfully
discriminated against in the provision of NHS services including
on grounds of gender, race, religion or belief, sexual
orientation, disability (including learning disability or mental
illness) or age.
You have the right to access services
within maximum waiting times, or for the NHS to take all
reasonable steps to offer you a range of alternative providers
if this is not possible. The waiting times are described in the
Handbook to the NHS Constitution.
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, so that patients and the public can understand
how services are planned and delivered (pledge); and to make
the transition as smooth as possible when you are referred
between services, and to include you in relevant discussions
(pledge).
Quality of care and environment: You
have 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.
You have 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 ensure that
services are provided in a clean and safe environment that is
fit for purpose, based on national best practice (pledge); and
to continuous improvement in the quality of services you
receive, identifying and sharing best practice in quality of
care and treatments (pledge).
Nationally approved treatments, drugs
and programmes: You have the right to drugs and treatments hat
have been recommended by NICE3 for use in the NHS, if your
doctor says they are clinically appropriate for you. You have
the right to 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 you and your doctor feel would be right
for you, they will explain that decision to you. You have the
right to receive the vaccinations that the Joint Committee on
Vaccination and Immunisation recommends that you should
receiveunder an NHS-provided national immunisation programme.
The NHS also commits: to provide
screening programmes as recommended by the UK National Screening
Committee (pledge). Respect, consent and confidentiality: You
have the right to be treated with dignity and respect, in
accordance with your human rights.
You have the right to accept or refuse
treatment that is offered to you, and not to be given any
physical examination or treatment unless you have given valid
consent. If you do not have the capacity to do so, consent must
be obtained from a person legally able to act on your behalf, or
the treatment must be in your best interests.
You have the right to 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. You have
the right to privacy and confidentiality and to expect the NHS
to keep your confidential information safe and secure. You have
the right of access to your own health records. These will
always be used to manage your treatment in your best interests.
The NHS also commits: to share with you
any letters sent between clinicians about your care.
Informed choice: You have the right to
choose your GP practice, and to be accepted by that practice
unless there are reasonable grounds to refuse, in which case you
will be informed of those reasons.
You have the right to express a
preference for using a particular doctor within your GP
practice, and for the practice to try to comply.
You have the right to make choices about
your NHS care and to information to support these choices. The
options available to you will develop over time and depend on
your individual needs. Details are set out in the Handbook to
the NHS Constitution.
The NHS also commits to inform you about
the healthcare services available to you, locally and nationally
and to offer you easily accessible, reliable and relevant
information to enable you to participate fully in your own
healthcare decisions and to support you in making choices. This
will include information on the quality of clinical services
where there is robust and accurate information available.
Involvement in
Your Healthcare and in the NHS.
You have the right to be involved in
discussions and decisions about your healthcare, and to be given
information to enable you to do this.
You have the right to be involved,
directly or through representatives, in the planning of
healthcare 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 commits to provide you with
the information you need to influence and scrutinise
the planning and delivery of NHS
services and to work in partnership with you, your family,
carers and representatives.
Complaint and redress:
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You have the right to have any
complaint you make about NHS services dealt with efficiently
and to have it properly investigated.
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You have the right to know the
outcome of any investigation into your complaint.
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You have the right to take your
complaint to the independent Health Service Ombudsman, if
you are not satisfied with the way your complaint has been
dealt with by the NHS.
You have the right to make a claim for
judicial review if you think you have been directly affected by
an unlawful act or decision of an NHS body. You have the right
to compensation where you have been harmed by negligent
treatment.
The NHS also commits to ensure you are
treated with courtesy and you receive appropriate support
throughout the handling of a complaint; and the fact that you
have complained will not adversely affect your future treatment
when mistakes happen, to acknowledge them, apologise, explain
what went wrong and put things right quickly and effectively and
to ensure that the organisation learns lessons from complaints
and claims and uses these to improve NHS services.
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You should recognise that you can
make a significant contribution to your own, and your
family’s, good health and well-being, and take some personal
responsibility for it.
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You should register with a GP
practice – the main point of access to NHS care.
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You should treat NHS staff and other
patients with respect and recognise that causing a nuisance
or
-
disturbance on NHS premises could
result in prosecution.
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You should provide accurate
information about your health, condition and status.
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You should keep appointments, or
cancel within reasonable time. Receiving treatment within
the maximum waiting times may be compromised unless you do.
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You should follow the course of
treatment which you have agreed, and talk to your clinician
if you find this difficult.
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You should participate in important
public health programmes such as vaccination.
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You should ensure that those closest
to you are aware of your wishes about organ donation.
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You should give feedback – both
positive and negative – about the treatment and care you
have received, including any adverse reactions you may have
had.
Staff – Your
Rights and NHS Pledges to You
It is the commitment, professionalism
and dedication of staff working for the benefit of the people
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.
All staff should have rewarding and
worthwhile jobs, with the freedom and confidence to act in the
interest of patients. To do this, they need to be trusted and
actively listened to. They must be treated with respect at work,
have the tools, training and support to deliver care, and
opportunities to develop and progress.
The Constitution applies to all staff,
doing clinical or non-clinical NHS work, and their employers. It
covers staff wherever they are working, whether in public,
private or third sector organisations.
Staff have extensive legal rights,
embodied in general employment and discrimination law. These are
summarised in the Handbook to the NHS
Constitution.
In addition, individual contracts of
employment contain terms and conditions giving staff further
rights.
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 raise
an internal grievance and if necessary seek redress, where it is
felt that a right has not been upheld; and can raise any concern
with their employer, whether it is about safety, malpractice or
other risk, in the public interest.
In addition to these legal rights, there
are a number of pledges, which the NHS is committed to achieve.
Pledges go above and beyond your legal rights. This means that
they are not legally binding but represent a commitment by the
NHS to provide high-quality working environments for staff.
The NHS commits 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 training for their
jobs and line
management support to succeed. to
provide support and opportunities for staff to maintain their
health, well-being and safety.
To engage staff in decisions that affect
them and the services they provide, individually, through
representative organisations 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 and to
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 Public Interest
Disclosure Act 1998.
Staff – Your
Responsibilities
All staff have responsibilities to the
public, their patients and colleagues.
Important legal duties are summarised
below.
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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.
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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.
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You have a duty to act in accordance
with the express and implied terms of your contract of
employment.
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You have a duty not to discriminate
against patients or staff and to adhere to equal
opportunities and equality and human rights legislation.
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You have a duty to protect the
confidentiality of personal information that you hold unless
to do so would put anyone at risk of significant harm.
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You have a duty to be honest and
truthful in applying for a job and in carrying out that job.
The Constitution also includes
expectations that reflect how staff should play their part in
ensuring the success of the NHS and delivering high-quality
care.
You should aim to maintain the highest
standards of care and service, 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
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 staff5 or the organisation itself, at the earliest
reasonable opportunity; 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.
You should contribute to a climate where
the truth can be heard and the reporting of, and learning from,
errors is encouraged; and 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.
NHS Values
Patients, public and staff have helped
develop this expression of values that inspire passion in the
NHS and should guide it in the 21st century. Individual
organisations will develop and refresh their own values,
tailored to their local needs. The NHS values provide common
ground for co-operation to achieve shared aspirations.
Respect and dignity. We value each
person 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 about our point of view
and what we can and cannot do.
Commitment to quality of care. We earn
the trust placed in us by insisting on quality and striving to
get the basics right every time: safety, confidentiality,
professional and managerial integrity,
accountability, dependable service and
good communication.
We welcome feedback, learn from our
mistakes and build on our successes.
Compassion. We 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 those we serve and work alongside. We do not wait to be
asked, because we care.
Improving
Lives.
We strive to improve health and
well-being and people’s experiences of the NHS. We value
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.
Working together for patients.
We put patients first in everything we
do, by reaching out to staff, patients, carers, families,
communities, and professionals outside the NHS. We put the needs
of patients and communities
before organisational boundaries.
Everyone
Counts.
We use our resources for the benefit of
the whole community, and make sure nobody is excluded 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 others’ opportunities. We recognise that we
all have a part to play in making ourselves and our communities
healthier.
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