NHS Constitution for England
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| NHS Constitution for England | |
|---|---|
| Name | NHS Constitution for England |
| Caption | National Health Service logo used across England |
| Jurisdiction | England |
| Formed | 2009 |
| Preceding1 | National Health Service Act 1946 |
| Headquarters | Department of Health and Social Care headquarters, London |
NHS Constitution for England is a document that sets out the principles, values, rights and responsibilities that underpin the National Health Service in England. It describes entitlements for patients and staff and aims to make explicit the commitments of bodies such as NHS England, NHS Improvement, and the Department of Health and Social Care. The Constitution sits alongside statutes like the National Health Service Act 2006 and policy frameworks delivered by organisations including Public Health England and regulatory bodies such as the Care Quality Commission.
History and development
The NHS Constitution for England was published in 2009 following policy work by the Department of Health under the coalition of Prime Minister David Cameron and Deputy Prime Minister Nick Clegg's administration, building on reforms traced to the National Health Service Act 1946 and subsequent legislation including the National Health Service and Community Care Act 1990 and the Health and Social Care Act 2012. Development involved consultations with stakeholder organisations such as British Medical Association, Royal College of Nursing, King's Fund, Nuffield Trust, and patient groups like Healthwatch England, and was influenced by reports from commissions including the Wanless Report and inquiries such as the Francis Report. Revisions occurred in 2013 and were consolidated during the tenure of health ministers including Andrew Lansley and Jeremy Hunt, reflecting shifts in policy from bodies like NHS England and responses to events such as the Mid Staffordshire NHS Foundation Trust public inquiry.
Structure and contents
The document is organised into sections covering the NHS's core principles and values, rights and pledges for patients, and responsibilities for staff and partner organisations. It references statutory frameworks such as the National Health Service Act 2006, and links to operational guidance from NHS England, NHS Improvement, and regulators including the General Medical Council, the Nursing and Midwifery Council, and the Health and Care Professions Council. The Constitution outlines patient rights derived from instruments like the Human Rights Act 1998 and draws on equality duties under the Equality Act 2010. It also cross-references clinical governance standards from bodies such as the National Institute for Health and Care Excellence and commissioning guidance shaped by Clinical Commissioning Groups and integrated care systems promoted in the Long Term Plan era.
Principles, values and rights
The NHS Constitution sets out values influenced by foundational statements from the Nuffield Trust, the King's Fund, and professional charters such as guidance from the British Medical Association and the Royal College of General Practitioners. It articulates core principles including universality, comprehensiveness and equity as practised across services delivered by trusts like NHS Foundation Trusts and commissioned by organisations such as Clinical Commissioning Groups. Patient rights enumerated include access to services, quality of care, informed consent aligned with precedents from cases like Montgomery v Lanarkshire Health Board, and complaints procedures paralleling routes through Parliamentary and Health Service Ombudsman. The Constitution also sets out pledges on aspects such as confidentiality in line with standards from the Information Commissioner's Office and timely access consistent with mandates from NHS England.
Duties and responsibilities of NHS staff and organisations
The Constitution specifies duties for staff and organisations, referencing professional standards enforced by the General Medical Council, the Nursing and Midwifery Council, and the Health and Care Professions Council. It requires employers and managers, including boards of NHS Trusts and Foundation Trusts, to observe governance frameworks shaped by the Care Quality Commission and financial regimes informed by the Public Accounts Committee. Responsibilities include ensuring patient safety as guided by the National Institute for Health and Care Excellence and incident reporting standards exemplified by lessons from Francis Report investigations. The document also outlines staff rights such as access to learning and development aligned with initiatives from Health Education England and workforce planning referenced in publications by NHS Confederation and Kings Fund analyses.
Legal status and enforcement
The NHS Constitution is not primary legislation but a statement of principles and duties with moral and policy force; it operates alongside statutory instruments like the National Health Service Act 2006 and the Health and Social Care Act 2012. Its legal status has been considered in judicial review proceedings and policy disputes similar to other public documents scrutinised in cases before the Supreme Court of the United Kingdom and the Court of Appeal (England and Wales). Enforcement relies primarily on internal governance, regulatory oversight by the Care Quality Commission, professional discipline by the General Medical Council and complaint remedies through the Parliamentary and Health Service Ombudsman, rather than direct statutory sanctions.
Impact, reception and criticism
Reception of the NHS Constitution has ranged from endorsement by advocacy organisations such as Healthwatch England and think tanks including the King's Fund and the Nuffield Trust to criticism from professional bodies like the British Medical Association regarding clarity and enforceability. Analysts at the Institute for Fiscal Studies and commentators in the British Medical Journal have debated its practical effect on commissioning decisions made by Clinical Commissioning Groups and service delivery by NHS Trusts. Critiques often focus on the Constitution's non‑statutory nature, perceived gaps between pledges and resourcing highlighted by reports from the National Audit Office, and tensions visible during reforms associated with the Health and Social Care Act 2012 and policy shifts under ministers including Andrew Lansley and Jeremy Hunt.