Open consultation

NHS Constitution: 10 year review

Published 30 April 2024

Applies to England

Summary

The NHS Constitution sets out the principles, values, rights and pledges underpinning the NHS as a comprehensive health service, free at the point of use for all who need it.

The NHS Constitution empowers patients, staff and the public to know and exercise their rights in order to help drive improvements in quality, efficiency and responsiveness throughout the NHS. It brings together, in one place, existing rights as set out in various legislation. It does not, in itself, create new rights or replace existing ones.

The NHS belongs to all of us. 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. We are now seeking views on how best to change the NHS Constitution. This consultation is part of the process to complete the 10 year review, as legislated for in the Health Act 2009.

The NHS Constitution applies to all those who use its many services, its staff and providers. During this consultation exercise, we want to hear from people across this broad spectrum, to help us define and enshrine the values of the NHS for years to come.

Over the next 8 weeks we look forward to hearing from patients, carers, NHS staff and the public on the proposals set out in this document. We will use the feedback from the consultation to work out how best to reflect these changes in the NHS Constitution.

Introduction

The Health Act 2009 requires that every 10 years the Secretary of State must carry out a review of the NHS Constitution. On a 10 year review, we are required to consult:

• patients and organisations representing patients
• staff and organisations representing staff
• carers
• members of the public
• each of the bodies required to have regard to the NHS Constitution in performing its health service functions:
  • NHS England
  • integrated care boards (ICBs)
  • local authorities
  • NHS trusts and foundation trusts
  • special health authorities
  • the National Institute for Health and Care Excellence (NICE)
  • the Care Quality Commission (CQC)
  • the Health Services Safety Investigations Body (HSSIB)
  • other providers of NHS and public health services (including independent providers and GPs)
• anyone else the Secretary of State considers appropriate

The NHS Constitution is designed to be an enduring document. The threshold for making changes to the NHS Constitution should be high. Any changes should be clear and compelling. That is why the Health Act 2009 requires there to be a consultation on all changes to the content of the NHS Constitution, and for any changes to the 7 guiding principles of the NHS to be set out in regulations.

Subject to the outcome of this consultation, the government plans to publish an updated NHS Constitution during 2024. The department will also publish a revised NHS Constitution handbook. We do not intend to consult on changes to the handbook in and of themselves.

Role of the NHS Constitution

The NHS Constitution brings together the principles, values, rights and responsibilities that underpin the NHS. It sets out the enduring character of the NHS as a comprehensive and equitable health service. It is intended to empower patients, staff and the public to know and exercise their rights to help drive improvements throughout the NHS.

The NHS Constitution is a ‘declaratory document’, codifying rights contained in existing legislation and drawing them together in one place. It does not, in itself, create new rights or replace existing ones. The handbook to the NHS Constitution describes the legal basis of each right, helping patients, staff and the public to understand how to enforce their rights. Pledges in the NHS Constitution are aims which the NHS is committed to achieve. Unlike rights, pledges do not have a legal underpinning, but there is a clear expectation that they can, and should, be delivered.

The proposals set out in this consultation document build on earlier amendments to the NHS Constitution. In 2013, following consultation, the NHS Constitution was strengthened in the following areas:

• patient involvement
• feedback
• candour
• end of life care
• integrated care
• complaints
• patient information
• staff rights, responsibilities and commitments
• dignity, respect and compassion

And, following a 2015 consultation on updating the NHS Constitution, further changes were made building on the recommendations of the Francis Report:

• creating a more patient-centred NHS
• clarifying that patients have a right to safe and high-quality care
• clarifying that staff have a duty to help
• inserting the expectation that staff will follow guidance and comply with standards relevant to their work
• reflecting the establishment of fundamental standard patient rights
• reflecting the introduction of a more compelling statutory duty of candour

In addition to the Francis Report changes, further changes were made which:

• highlighted the importance of the transparency and accountability within the NHS
• gave greater prominence to mental health
• made reference to the Armed Forces Covenant

Statutory duties

The Health Act 2009 includes provisions related to the NHS Constitution and places a statutory duty on the Secretary of State to:

• ensure that the NHS Constitution and the handbook continue to be available to patients, staff and members of the public
• review the NHS Constitution at least once every 10 years, in consultation with patients, staff, carers, members of the public and the bodies who are required to have regard to the NHS Constitution and such other persons as the Secretary of State considers appropriate
• republish the NHS Constitution if any revisions are made
• only make changes to the guiding principles in accordance with regulations
• review the handbook to the NHS Constitution at least once every 3 years and to republish after any revision
• report every 3 years on how the NHS Constitution has affected patients, staff, carers and members of the public since the last report was produced

The Health Act 2009 also places a statutory duty on NHS England, ICBs, local authorities, NHS trusts and foundation trusts, special health authorities, NICE, CQC, HSSIB and other providers of NHS and public health services (including independent providers and GPs) in England to have regard to the NHS Constitution in performing health service functions.

The National Health Service Act 2006 (NHS Act 2006) also includes provisions related to the NHS Constitution. These place a statutory duty on the Secretary of State to have regard to the NHS Constitution when exercising functions in relation to the health service. It also places a statutory duty on NHS England and ICBs to promote the NHS Constitution. This means that in exercising their functions, they must act with a view to securing that health services are provided in a way that promotes the NHS Constitution, and to promote awareness of it, among patients, staff and members of the public.

Proposed changes to the NHS Constitution

Introduction

This section outlines our proposals for amending the NHS Constitution. We do not propose any changes to the guiding principles of the NHS, with the exception of bringing the text under Principle 1 in line with the Equality Act 2010 (see the section ‘Technical changes to reflect the Equality Act 2010’). In summary, the principles will continue to be:

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.

As in 2015, our approach to updating the document has been to ensure that proposed changes are consistent with the NHS Constitution’s intended purpose and that they are:

• empowering to patients and staff
• legally accurate
• concise and accessible
• of general concern to all patients
• meaningful to individuals

We propose a limited set of specific changes to improve the current content, reflect important changes to government policy and to keep both the NHS Constitution and the handbook legally up to date.

The specific changes we propose are set out in the questions below. This incorporates a detailed commentary explaining each individual change and should be considered alongside the information in this consultation document. There is no word limit for responses, but to help with our analysis, please try to keep your answers to 250 words per question.

We are also seeking your views on the NHS Constitution as a whole. We will take your comments into account when considering the review.

Responding to deterioration

Patients and their families, carers and advocates have a critical part to play in their care and can be uniquely placed to identify deterioration in their or their loved ones’ condition, including where that indicates a need for an escalation in their treatment or care. We need to facilitate this input more effectively to ensure concerns are listened to and appropriately acted upon, including when there are concerns the local team are not responding to deterioration appropriately. We also need to take a structured approach to obtain information relating to a patient’s condition directly from patients and their loved ones at least daily.

We propose adding the following new pledge for patients and the public under ‘Involvement in your healthcare and the NHS’:

The NHS pledges to provide patients (and their families, carers and advocates) who are in acute or specialist provider sites a structured approach to providing information about their or their loved one’s condition at least daily and if they have concerns about physiological deterioration that are not being responded to, access to a rapid review by appropriate clinicians from outside their immediate care team.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Health disparities

There are stark disparities in how long people live and how long people live in good health across England. Poor health outcomes arise from particular combinations of factors and their impact varies geographically: inner city areas have younger populations but higher levels of homelessness and air pollution, and rural and coastal areas typically have an older age demographic, with some coastal areas and rural areas having high levels of deprivation (as addressed in the Chief Medical Officer’s annual report for 2021).

Under the NHS Act 2006, NHS England and ICBs are required, in the exercise of their functions, to have regard to the need to reduce inequalities between persons with respect to their ability to access health services, and outcomes (including outcomes that show the quality of the patient experience). These and other duties on health bodies were strengthened in the Health and Care Act 2022. The Levelling Up White Paper and subsequent Levelling-up and Regeneration Act 2023 established the Levelling Up health mission to narrow the gap in healthy life expectancy by 2030 and increase healthy life expectancy by 5 years by 2035.

The NHS Constitution currently sets out, under the value ‘Everyone counts’, that:

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.

We propose adding the following sentence to the value ‘Everyone counts’ to provide further detail on how the NHS works to understand the needs of different people and reduce disparities: 

NHS organisations work with statutory and non-statutory partners, using the best data available, to understand the range of healthcare needs within and between local communities and how to tailor services accordingly and fairly, reducing disparities in access, experience and outcomes for all.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Environmental responsibilities

The NHS is a major contributor to the UK’s carbon footprint, being responsible for over 30% of public sector emissions. The government has already placed legal duties on NHS bodies through the Health and Care Act 2022 that compel action on environmental issues.

As the hosts of the United Nations Climate Change Conference of the Parties (COP26) in 2021, the government further committed to updating the NHS Constitution to reflect its environmental responsibilities, while guaranteeing transparency for patients and the public on how this work aligns with the NHS’s core principles and the government’s overall environmental strategy.

We are therefore proposing to add a new NHS value of ‘Environmental responsibilities’:

We play our part in achieving legislative commitments on the environment. We do this by improving our resilience and efficiency, while always prioritising value for money. We will never compromise standards of care or the needs of patients in pursuit of these targets.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Patient responsibilities

The NHS belongs to all of us. 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.

Currently, the NHS Constitution asks patients in ‘Patients and the public: your responsibilities’:

Please keep appointments or cancel within reasonable time. Receiving treatment within the maximum waiting times may be compromised unless you do.

We propose strengthening this responsibility, to make it clearer that patients should cancel or rearrange appointments when they are unable to attend. We also propose strengthening the responsibility on the NHS to communicate appointment information clearly with patients and consider accessibility needs.

Therefore, we propose changing this sentence to:

Please keep appointments or reschedule or cancel as soon as you know you will not be able to attend the appointment. Receiving treatment within the maximum waiting times, as well as care to other patients, may be compromised unless you do. The NHS will communicate information about your appointment in a clear and timely way, including in alternative formats when this is appropriate and reasonable.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know  

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Research

Under the NHS Act 2006, the Secretary of State, NHS England and ICBs have duties to facilitate or otherwise promote research on matters relevant to the health service, and to facilitate the use of evidence obtained from research.

In partnership with the NHS, the National Institute for Health and Care Research (NIHR) has recently launched the Be Part of Research service to help support the discharge of these duties. Members of the public can sign up to the service and get in touch with researchers to discuss eligibility for participation in particular research studies. NHS England has also integrated the Be Part of Research service into the NHS App.

To better support our aim to embed research in the NHS, we propose strengthening the existing pledge (“to inform you of research studies in which you may be eligible to participate”).  

We propose adding an additional sentence to the pledge:

Health research and the offer to be part of research should be integrated into health and care across the NHS.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Leadership

The NHS Constitution and the Staff handbook already include an extensive set of rights and pledges that are focused on ensuring staff have rewarding roles and feel supported in the workplace. These could be reinforced by reflecting the important role that leaders and senior managers can play in creating good workplace culture.

To achieve this, it is proposed that we add the following wording near the beginning of ‘Staff: your rights and NHS pledges to you’:

Both the handbook to the NHS Constitution and the Staff handbook outline the rights and pledges that are central to creating a positive and supportive culture in the NHS workplace. Strong and effective leadership, management and governance of NHS organisations is central to the delivery of high-quality care, will support learning and innovation and promote an open and fair culture.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Sex and gender reassignment

In the NHS Constitution, ‘Access to health services’ includes a right for patients to “receive care and treatment that is appropriate to you, meets your needs and reflects your preferences”.

We want patients to feel confident asking for care that meets their needs and preferences, including requests for intimate care to be carried out by someone of the same sex. We also want patients to have confidence that any such request will be accommodated, where reasonably possible.

Same-sex care is recognised through accompanying CQC statutory guidance to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The guidance sets out how providers should act when providing intimate or personal care, and make every reasonable effort to make sure that they respect people’s preferences about who delivers their care and treatment, such as requesting staff of a specific sex. We are defining sex as biological sex.

We are defining intimate care as an examination of breasts, genitalia or rectum, and care tasks of an intimate nature such as helping someone use the toilet or changing continence pads. This definition aligns with that used by the General Medical Council.

The NHS Constitution does not currently reference same-sex intimate care. We want to introduce a new pledge to reinforce NHS healthcare providers’ responsibilities to accommodate requests of this nature where reasonably possible.

We propose adding a pledge to ‘Access to health services’ to state that:

Patients can request intimate care be provided, where reasonably possible, by someone of the same biological sex.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

The NHS Constitution contains a pledge that states:

if you are admitted to hospital, you will not have to share sleeping accommodation with patients of the opposite sex, except where appropriate, in line with details set out in the handbook to the NHS Constitution.

This means that patients should not have to share sleeping accommodation with patients of the opposite sex and should also have access to segregated bathroom and toilet facilities. Patients should not have to pass through opposite-sex areas to reach their own facilities. Women in mental health units should have access to women-only day spaces.

Sleeping accommodation includes areas where patients are admitted and cared for on beds or trolleys, even when they do not stay in hospital overnight. It therefore includes all admissions and assessment units (including all clinical decision units), plus day surgery and endoscopy. It does not include areas where patients have not been admitted, such as accident and emergency cubicles.

Single-sex accommodation can be provided in:

• single-sex wards (this means the whole ward is occupied by men or women but not both)
• single rooms with adjacent single-sex toilet and washing facilities (preferably en-suite)
• single-sex accommodation within mixed wards (for instance, bays or rooms that accommodate either men or women (not both), with designated single-sex toilet and washing facilities preferably within or adjacent to the bay or room)

In considering how the provision of single-sex accommodation for men and women should apply to transgender people - a term used to refer to people whose gender identity is different from their biological sex - the needs of each patient in a ward or clinical area should be considered on an individual basis to understand how best to protect the privacy, dignity and safety of all patients. When making these decisions it is important to balance the impact on all service users and show that there is a sufficiently good reason for limiting or modifying a transgender person’s access.

Recognising the concerns that patients may have about sharing hospital accommodation with patients of the opposite sex, we propose to amend the pledge to reflect the legal position on the provision of same-sex services and on which transgender patients can be offered separate accommodation as a proportionate means to a legitimate aim.

Specifically, the Equality Act 2010 expressly allows for the provision of single-sex or separate-sex services if certain conditions are met. Such provision must be a proportionate means of achieving a legitimate aim. The act also allows for persons with the protected characteristic of gender reassignment to be provided a different service in this scenario, provided such an approach is a proportionate means of achieving a legitimate aim. This could, for example, mean a transgender patient is provided with a single room in a hospital setting (provided other clinical priorities are considered). Any decision relating to accommodation of transgender patients should always consider the privacy, dignity and safety of all patients in a ward or bay.

We propose adding additional wording to the pledge on sleeping accommodation to state:

if you are admitted to hospital, you will not have to share sleeping accommodation with patients of the opposite biological sex, except where appropriate. The Equality Act 2010 allows for the provision of single-sex or separate-sex services. It also allows for transgender persons with the protected characteristic of gender reassignment to be provided a different service - for example, a single room in a hospital - if it is a proportionate means of achieving a legitimate aim.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

In the NHS Constitution, ‘Access to health services’ includes a right for patients to “receive care and treatment that is appropriate to you, meets your needs and reflects your preferences”. Meeting the needs of patients includes respecting the biological differences between men and women, such as sex-specific illnesses and conditions.

If these biological differences are not considered or respected, there is the potential for unintended adverse health consequences. Language, therefore, is very important when communicating with patients. Patients may be unclear about whether a specific condition applies to them and may not come forward for treatment if language is ambiguous. Clear terms that everyone can understand should always be used.

To this end, we propose adding a new right to ‘Access to health services’ to make clear patients have a right to expect that NHS services will reflect their preferences and meet their needs, including the differing biological needs of the sexes.

The wording we are proposing for the new right is related to the legal obligations on the NHS through the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014/2936 about providing person-centred care. It also aligns with the Equality Act 2010, specifically paragraphs 26, 27 and 28 of schedule 3 relating to separate services and single-sex services respectively.

We propose adding a right to ‘Access to health services’ to state that:

You have the right to expect that NHS services will reflect your preferences and meet your needs, including the differing biological needs of the sexes, providing single and separate-sex services where it is a proportionate means of achieving a legitimate aim.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Technical changes to reflect the Equality Act 2010

The Equality Act 2010 establishes protection by references to the characteristic of sex as defined in the act. We therefore propose to change the language in the NHS Constitution from ‘gender’ to ‘sex’ to align with legislation where appropriate.     

Additionally, we propose changing the language ‘marital or civil partnership’ to ‘marriage and civil partnership’ and ‘religion, belief’ to ‘religion or belief’ to align with the wording in the Equality Act 2010.

Under principle 1, the NHS Constitution currently sets out that:

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.

Changing this or any other principle in the NHS Constitution would require the government to introduce secondary legislation.

Under ‘Access to health services’, the NHS Constitution currently sets out that:

You have the right not to be unlawfully discriminated against in the provision of NHS services including on grounds of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status.

We propose changing the language from ‘gender’ to ‘sex’, ‘religion, belief’ to ‘religion or belief’, and ‘marital or civil partnership status’ to ‘marriage and civil partnership status’ so that the amended text reads as follows.

Under principle 1:

It is available to all irrespective of sex, race, disability, age, sexual orientation, religion or belief, gender reassignment, pregnancy and maternity or marriage and civil partnership status.

Under access to health services:

You have the right not to be unlawfully discriminated against in the provision of NHS services including on grounds of sex, race, disability, age, sexual orientation, religion or belief, gender reassignment, pregnancy and maternity or marriage and civil partnership status.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Unpaid carers

The government is committed to supporting the health and wellbeing of unpaid carers and supporting people who are carers to balance employment with their caring responsibilities, where they wish to do so. The proposed amendments update the NHS Constitution to reflect changes introduced in the Health and Care Act 2022.  

Section 10 of the Health and Care Act 2022 imposed a duty for NHS England to involve unpaid carers in the planning of commissioning arrangements and, in certain circumstances, the development and consideration of proposals by NHS England to change commissioning arrangements and decisions of NHS England relating to the operation of commissioning arrangements.

The Health and Care Act 2022 also includes provisions in respect of:

• the promotion of the involvement of unpaid carers in decisions by ICBs relating to the prevention or diagnosis or care and treatment of patients
• the involvement of unpaid carers in commissioning arrangements by ICBs
• where a patient is likely to have needs for care and support following discharge from hospital, the involvement of unpaid carers in discharge plans

Within ‘Patients and the public: your rights and the NHS pledges to you’, we propose referencing unpaid carers explicitly. The aim is also to reinforce the principle that the NHS has specific responsibilities towards unpaid carers as part of recent legislation and to capture duties and entitlements that have been introduced in the last 10 years relevant to unpaid carers and young carers.

We propose to add an additional pledge to ‘Involvement in your healthcare and the NHS’:

We pledge to recognise and value your caring responsibilities.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree      
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

In line with the measures introduced for unpaid carers and the people they are caring for within the Health and Care Act 2022, we propose to add an additional right and pledge to ‘Involvement in your healthcare and the NHS’:

The NHS pledges to provide you the opportunity to give feedback, make suggestions and raise concerns about the care we provide for the person you care for. We pledge to respect your expertise, listen and to involve you in decisions (with the consent of the patient).

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree      
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

We propose to add an additional right to ‘Involvement in your healthcare and the NHS’:

You have the right to be involved (with patient consent) at the earliest available opportunity when plans are being made to discharge the person you care for from hospital.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree      
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Volunteers

Within ‘Staff: your rights and NHS pledges to you’, we propose inserting an additional sentence at the end of the pledges section recognising the importance of the role NHS volunteers play in contributing to the success of the health service. This will signal the support the NHS will continue to offer to volunteers who play a vital role in making a difference to patients and services.

While volunteering sits inside a different legal framework to employment, volunteers still have important legal duties and responsibilities. Therefore, we also propose inserting a sentence at the end of the responsibilities for staff section to reflect the responsibilities all volunteers have to the public, patients, fellow volunteers and staff.

We propose adding a new pledge to the staff section:

The NHS recognises the incredibly important work volunteers undertake in making a difference to staff, patients and their families. Volunteers complement the NHS workforce; they do not replace it. The NHS will support and encourage volunteers in all aspects of their roles.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree      
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Health and work

Work is an important determinant of health, both directly and indirectly on the individual, their families and communities. Fifteen million of the working age population have a long-term health condition and although 10 million of those are in employment, many with long-term conditions are economically inactive.

The government has an ambitious package of support to help people with health conditions and disabled people to start, stay and succeed in work. In the Spring Budget 2023 and the Autumn Statement 2023, we announced new investment to improve access to joined-up work and health support.

The only reference to employment in the current NHS Constitution is with regard to NHS employees’ rights and this does not reflect the NHS’s key role in supporting people to work.

We propose adding the following wording to the NHS value ‘Improving lives’:

We support people to remain in, and return to, work, reflecting the good impact that work can have on a person’s health and wellbeing.

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree      
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Person-centred care

With 1 in 4 adults living with at least 2 health conditions, for many people care is rarely about a single visit to a single service. To effectively support people to manage the complexity of multiple health conditions, there is an increased need for co-ordinated clinical support across primary, community and secondary care. A critical aspect of this is greater join-up between mental and physical health services. Experiences of healthcare and support should feel person-centred, co-ordinated and tailored to the needs and preferences of the individual, their carers and family. This expectation is also set out in CQC’s fundamental standards, which includes a standard on person-centred care.

We propose amending the existing pledge in ‘Access to health services’ from: 

make the transition as smooth as possible when you are referred between services, and to put you, your family and carers at the centre of decisions that affect you or them

to:

support a co-ordinated approach to your care and make the transition as smooth as possible between services, including physical and mental health services, particularly if you have a number of health conditions, and to put you, your family and carers at the centre of decisions that affect you or them

Question

To what extent do you agree or disagree with this proposal?

• Agree
• Neither agree nor disagree
• Disagree      
• Don’t know

If you have any further views on the proposal, please provide these in up to 250 words, if possible.

Other areas

We know you come into contact with the NHS throughout your lives, and the rights and pledges within the NHS Constitution cover the breadth of experiences you have when you use NHS services. We’re keen to hear whether you feel the NHS Constitution reflects the experiences you have and gives you the support you need in your care and your working lives.

We welcome comments on any further areas you believe we should consider, which can be best delivered through the NHS Constitution, and anything you feel should change in the current document.

Question

If you have any other comments about the NHS Constitution, please provide these.

Technical amendments

Further, we propose additional technical changes to the NHS Constitution. As these are only technical changes, we are not seeking your views on them. These include:

• replacing “Secretary of State for Health” with “Secretary of State for Health and Social Care”
• replacing “You have the right to authorisation for planned treatment in the EU under the UK EU Trade and Cooperation Agreement where you meet the relevant requirements. You also have the right to authorisation for planned treatment in the EU, Norway, Iceland, Lichtenstein or Switzerland if you are covered by the Withdrawal Agreement and you meet the relevant requirements” with “You have the right to authorisation for planned treatment in the EU and EFTA states under the UK’s reciprocal healthcare agreements where you meet the relevant requirements”

How to respond

This consultation closes at 11.59pm on 25 June 2024, and you can respond via our online survey.

Annex: glossary

NHS Constitution’s 5 main elements

The NHS Constitution for England is a ‘declaratory document’, articulating existing rights and responsibilities in one place. The NHS Constitution is made up of 5 main elements:

Principles

Enduring, high-level ‘rules’ that govern the way that the NHS operates, and define how it seeks to achieve its purpose.

Values

Values underpin the principles and are intended to provide the common ground for co-operation to achieve shared aspirations.

Rights

Entitlements protected by law. These include rights conferred explicitly by law and rights derived from legal obligations imposed on NHS bodies and healthcare providers. The NHS Constitution brings together all these rights in one place but does not create, replace or change them.

Pledges

Aims that the NHS is committed to achieve. Pledges are not legally binding and express an ambition to improve going beyond legal rights. Pledges, though, are more than aspirations: there is an expectation that pledges will be delivered, whether through performance management, regulation, choice or accountability frameworks.

Responsibilities

Expectations of how patients, the public and staff can help the NHS work effectively and ensure that finite resources are used fairly.

Additional documents

The NHS Constitution is also supported by 2 additional documents that provide further information, including information that would be subject to frequent changes, allowing the NHS Constitution itself to be a more high-level and enduring document:

Handbook to the NHS Constitution

Provides additional, detailed information on the principles, rights, pledges and responsibilities set out in the NHS Constitution, as well as explaining what underpins them.

Statement of NHS Accountability

A description of the system of responsibility and accountability for taking decisions in the NHS. The Statement of NHS Accountability was last published in 2009 and archived in 2013. Since then, the legislative framework of the NHS has changed. A new Statement of NHS Accountability will be published later this year.

Privacy notice

Summary of initiative or policy

The NHS Constitution sets out the values and rights underpinning the NHS as a comprehensive health service, free at the point of use for all who need it. The NHS Constitution empowers patients, staff and the public to know and exercise their rights in order to help drive improvements in quality, efficiency and responsiveness throughout the NHS. Any changes made to the NHS Constitution should therefore be clear and compelling - and should have the support of the public. This is why we are seeking views on how best to reflect these changes in the NHS Constitution.

Over the next 8 weeks, the Department of Health and Social Care (DHSC) would like to hear from patients, NHS staff, the public and our partners on the proposals set out in this document - and will use the feedback from the consultation to work out how best to reflect these changes in the NHS Constitution. 

Data controller

DHSC is the data controller.

What personal data we collect

We will collect and process the following personal data (where given):

• age
• sex
• gender identity
• geographical region
• ethnicity
• information relating to physical and/or mental health conditions
• religion
• organisation (where responding on behalf of an organisation)

In addition to the above, our survey provider (SocialOptic) will also process your IP address.

How we use your data (purposes)

The purpose for which we are processing your personal data is to obtain the opinions of patients, NHS staff, the public and our partners, on the proposals set out in this document - and will use the feedback from the consultation to work out how best to reflect these changes in the NHS Constitution.

Legal basis for processing personal data

Article 6(1)(e) of the UK General Data Protection Regulations (UK GDPR): processing is necessary for the performance of a task carried out in the public interest, or in the exercise of official authority vested in the controller. The Health Act 2009 requires there to be a public consultation on all changes to the content of the NHS Constitution.

As some of the data we are asking individuals to provide (if they choose) is more sensitive and is classed as ‘special category data’, we are also required to identify a suitable processing condition under Article 9 of the UK GDPR:

Article 9(2)(g): processing is necessary for reasons of substantial public interest (statutory and government purposes).

Data processors and other recipients of personal data

The survey is being run by SocialOptic Ltd, with whom DHSC has a contract to process data provided in response to online surveys and consultations.

Where individuals submit responses, we may publish their responses, but we will not publicly identify them. We will not publish any information that may lead to individuals being identified.

Responses submitted by organisations or representatives of organisations may be published in full.

Where information about responses is not published, it may be shared with officials within other public bodies and ministerial departments as is required to develop policy. Any information shared will not be personally identifiable.

International data transfers and storage locations

Your information will be stored on secure DHSC servers.

Storage of data by SocialOptic is provided via secure servers located in the UK.

Retention and disposal policy

Your personal data will be retained for 2 years. DHSC will securely store anonymised data to inform policy development.

How we keep your data secure

Your personal data will be securely stored on DHSC servers and shared with those involved in running the consultation.

Your rights as a data subject

By law, data subjects have a number of rights and this processing does not take away or reduce these rights under the EU General Data Protection Regulation (2016/679) and the UK Data Protection Act 2018 applies.

These rights are:

• the right to get copies of information - individuals have the right to ask for a copy of any information about them that is used
• the right to get information corrected - individuals have the right to ask for any information held about them that they think is inaccurate, to be corrected
• the right to limit how the information is used - individuals have the right to ask for any of the information held about them to be restricted - for example, if they think inaccurate information is being used
• the right to object to the information being used - individuals can ask for any information held about them to not be used. However, this is not an absolute right, and continued use of the information may be necessary, with individuals being advised if this is the case
• the right to get information deleted - this is not an absolute right, and continued use of the information may be necessary, with individuals being advised if this is the case

Comments or complaints

Anyone unhappy or wishing to complain about how personal data is used as part of this programme should contact data_protection@dhsc.gov.uk in the first instance or write to:

Data Protection Officer
1st Floor North
39 Victoria Street
London
SW1H 0EU

Anyone who is still not satisfied can complain to the Information Commissioner’s Office. Their postal address is:

Information Commissioner's Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF

Automated decision making or profiling

No decision will be made about individuals solely based on automated decision making (where a decision is taken about them using an electronic system without human involvement) which has a significant impact on them.

Changes to this policy

We keep this privacy notice under regular review, and we will update it if necessary. All updated versions will be marked by a change note on the consultation page. This privacy notice was last updated on 30 April 2024.