The Department of Health set out these proposals to strengthen the NHS Constitution for public consultation, with the NHS, patients and public all asked to respond.
The main changes proposed cover:
- a new responsibility for staff to treat patients not only with the highest standards of care, but also with compassion, dignity and respect
- a new pledge making it explicit that patients can expect to sleep in single-sex wards
- a new pledge to patients that NHS staff must be open and honest with them if things go wrong or mistakes happen – this ‘duty of candour’ will become a condition in the NHS Standard Contract from April 2013.
The changes also make it clearer that:
- patients, their families and carers should be fully involved in all discussions and decisions about their care and treatment, including their end of life care
- patients who are abusive or violent to NHS staff could be refused treatment
- the NHS is equally concerned about physical and mental health.
Comments on
Department of Health
A consultation on strengthening the NHS Constitution
The Royal College of Physicians of Edinburgh (the College) is pleased to respond to the Department’s consultation on strengthening the NHS Constitution.
The College has the following comments on the specific questions in the consultation:
Patient involvement
Q1. What are your views on the proposed changes to strengthen patient involvement in the NHS Constitution?
The College welcomes these proposals. It is right that the NHS Constitution puts greater emphasis on encouraging patient involvement, as this should be at the heart of the constitution and its principles, and reflect the increased expectation of close engagement between staff and patients across NHS.
Feedback
Q2. What do you think about our proposal to set out in the NHS Constitution the importance of patient and staff feedback towards improving NHS services?
The College agrees that feedback can play a vital role in improving NHS services. The views of patients and staff can offer a useful insight into services and the College supports the comments of the NHS Future Forum that “asking for and acting on feedback from the public, patients and staff is essential”. This could encourage more openness and transparency and enable discussion at an early stage. The College believes that in instances where negative feedback is given and, if appropriate, swift action is taken to address the matter, then there may be fewer instances of incidents escalating into more serious complaints.
Actively encouraging feedback may also assist in addressing wider cultural barriers to listening and change in this area, but should be supported from the top of organisations and include training programmes for staff in order to have significant impact.
Duty of Candour
Q3. Do you agree with, or have any concerns about, amending this pledge to make it more specific as suggested?
The College recognises that there is currently considerable public interest in patient safety, and open reporting, particularly in the wake of the Mid-Staffordshire inquiry. There is a need for the NHS to be recognised by the public as open and transparent about adverse incidents and poor quality. In this regard, we support the introduction of a contractual duty of candour in the NHS, and believe the proposed wording in the constitution provides the public and staff with the expectation that mistakes should be acknowledged, dealt with quickly and effectively and that where appropriate lessons will be learned.
The College recognises that this proposal may require further amendment following the second Francis Report and looks forward to seeing further detail in due course on the potential impact of the Inquiry report on proposals for a contractual duty of candour.
Making every contact count
Q4. What are your views on including in the NHS Constitution a new responsibility for staff to make ‘every contact count’ with the aim of improving health and wellbeing of patients?
The College agrees that making “every contact count” is a vital part of the role of NHS staff and supports its inclusion in the NHS Constitution. The College, however, cautions that staff must have adequate time and appropriate support to achieve this aspiration in each patient contact.
Integrated care
Q5. Do the proposed changes to the NHS Constitution make it sufficiently clear to patients, their families and carers how the NHS supports them through care that is coordinated and tailored around their needs and preferences?
The proposed changes are a step in the right direction to highlight that services should be based around patients rather than patients based around services. However, the proposals are high level and aspirational and it is difficult to convey a clear message of how this will be achieved at a local level and what it will actually mean to patients, their families and carers.
Complaints
Q6. Do you think it is helpful for the NHS Constitution to set out these additional rights on making a complaint and seeking redress?
Yes, the College feels it is helpful to set out these additional rights in the constitution as they should help assure patients that the complaints process is transparent and consistent. Inclusion of these rights in the constitution will give patients confidence by reminding them of what they should expect at each stage of the complaints process. On the staff side, there should be comprehensive training programmes to ensure the NHS responds appropriately.
Q7. Do the additional new rights make the complaints process easier to understand and make clear to patients what they should expect when they make a complaint?
Yes, as discussed above in Q6.
Patient data
Q8. Do the proposed changes to the NHS Constitution make clear how the NHS will safeguard and use patient data?
This is a complex issue with data protection regulations setting out absolute rights and discretionary use under certain circumstances. The proposed changes provide clarification on how the NHS will handle patient data on a day to day basis and should provide some reassurance to the public that the use of their data is controlled and appropriate. However, there is high public awareness of difficult instances reported in the media where, for example, a data stick is misplaced with patients’ personal details, and the College is uncertain whether the changes will aid understanding significantly.
Staff rights, responsibilities and commitments
Q9. Do you agree with the proposed changes to the wording of the staff duties and the aims surrounding the rights and responsibilities of staff? What do you think about the changes to make clear to staff around what they can expect from the NHS to ensure a positive working environment?
These proposed changes are aspirational and welcome, but it is unclear how this will be translated into practical support for staff to encourage them in the quality improvements signalled in the revised constitution (placing more of an emphasis on involving patients in decisions, engaging compassionately with them, being proactive about providing feedback to employers, taking opportunities to make “every contact count” etc).
Parity of esteem between mental and physical health
Q10. Do you agree with the wording used to emphasise the parity of mental and physical health? Are there any further changes that you think should be made that are feasible to include in the NHS Constitution?
The aspiration to give parity between physical and mental health are to be welcomed, although the changes focus more on mental well-being rather than on mental health services. Perhaps this is the Department of Health’s intention?
Dignity, respect and compassion
Q11. What are your views on the wording used to highlight the importance of ensuring that the tenets of dignity, respect and compassion are sufficiently represented in the NHS Constitution?
The proposed changes to the constitution offer significant reinforcement that the tenets of dignity, respect and compassion are fundamental principles of the NHS.
Q12. Do you agree with the suggestion of including a new pledge for same sex accommodation?
As a pledge, this is to be welcomed, as long as the public understand that a pledge falls short of a right and is an aspiration which exceptionally may not be achievable, particularly at times when specialist in-patient services are stressed.
Local Authorities role
Q13. Do the proposed changes to the NHS Constitution make it clear what patients, staff and the public can expect from local authorities and that local authorities must take account of the Constitution in their decisions and actions?
The changes are clear to those who understand the role of public health professionals within local authorities, but may be less obvious to the wider public.
Raising awareness and embedding the Constitution
Q14. Have you seen further examples of good practice in raising awareness and embedding the NHS Constitution that should be taken into account in these plans?
No comment.
Q15. Do you have further recommendations for re-launching, rolling out and embedding the Constitution from next spring?
If the updated NHS Constitution is to have any impact it must be widely circulated, publicised and promoted across the NHS and local authorities, through staff themselves in interaction with patients and through advertising in a variety of different mediums.
Giving the Constitution greater traction
Q16. To help shape our future consultation, do you have views on how the NHS Constitution can be given greater traction to help people know what they should do when their expectations of the NHS are not met?
Much of the NHS Constitution is high level and aspirational, and in such a short document it is not possible to define accurately or realistically how these pledges and rights will be delivered or how patients can achieve redress where appropriate. Cross referencing to another (longer) handbook may not be effective for some patients. The NHS Constitution is already too long and further consideration should be given to how to present easy guidance for patients.
Equalities
Q17. How can we ensure the NHS Constitution is accessible and useable to individuals of different backgrounds and to different sections of society?
No comment.
Q18. Are there any ways in which the proposed changes set out in this consultation could have an adverse impact, directly or indirectly, on groups with protected characteristics? If so, how?
No comment.
General
Q19. Do you have any further comments about our proposals for strengthening the NHS Constitution?
No comment.