News: the NHS Constitution

Senior politicians and policy makers recently signed the NHS’ first ever constitution. It sets out what patients and staff should expect from the health service and what they should do for it in return. Information and IT will be essential to deliver its rights and pledges. Lyn Whitfield reports.

Delivering more information to staff and patients to support choice and improve quality is a “major priority” for the NHS in England, according to its first constitution.

Prime Minister Gordon Brown, health secretary Alan Johnson and NHS chief executive David Nicholson signed the constitution at Number 10 Downing Street last week (21 January 2009).

The idea of a constitution was supported by Lord Darzi’s year-long Next Stage Review of the NHS, which reported last summer. It argued that a constitution could enshrine the “values and principles” of the health service and generate support for reform.

The NHS Constitution for England that was signed last week brings together the rights that patients and staff already have as a result of European and British legislation of various kinds. It also sets out a set of pledges that the NHS is now committed to delivering, alongside a set of responsibilities that users have to the health service in return.

A handbook issued to support the constitution says this means it will not be a “lawyers’ charter.” Instead, NHS chief executive David Nicholson, who led the work programme to develop the document, said it would encourage a new era of co-operation between staff and patients.

“I am sure it will be a powerful driver for change in the system and help us to deliver care fit for the 21st century,” he added, while Mr Johnson said it would “protect the NHS for generations to come.”

Information is power

The constitution promises that new information and IT services will support the rights and pledges at every level of the NHS.

So, it says that people have a “right to be involved in the planning of healthcare services” and “any changes” to services – and backs this up with a commitment to giving people “the information you need to influence and scrutinise the planning and delivery of NHS services.”

The handbook says this will be achieved through the guide to local services that primary care trusts are obliged to publish and watchdog reports.

But Microsoft’s healthcare strategic marketing manager, Mark Treleaven, points out that some PCTs are already going further by exploring the sophisticated customer relationship management tools that businesses already use to manage interaction with stakeholders.

The constitution says that patients have a right to choose their GP and where they go for hospital treatment. The handbook says this choice will be supported by information published on the NHS Choices website – and, increasingly, through kiosks and mobile services.

The constitution also says that patients have the right to be involved in discussions about their care and “to be given information to enable you to do this.” In a potentially far-reaching pledge, it commits the NHS to providing care services “in a clean and safe environment that is fit for purpose and based on best practice.”
The handbook says the NHS will “monitor the effectiveness and outcomes of care more systematically” through new metrics. It also repeats the Darzi review promise that the National Institute for Health and Clinical Excellence will establish an NHS Evidence portal to spread information about best clinical practice and models of care.
However, Mr Treleaven says this is another area in which some trusts are already going further, by adopting systems that bring information together from disparate systems and deliver it to staff in useful ways through “dashboards” and mobile devices.

For staff as well as patients

The constitution picks up on public and patient concerns about information governance and security. It says they have a right to privacy and that they should “expect” the NHS to keep their personal details safe and secure. It also says patients have a right to see their medical records and repeats the promise first made in the NHS Plan in 2000 that letters about their care will be copied to them.

Finally, it lays out some potentially important rights and pledges for staff. As well as proper employment rights and a safe working environment, it commits the NHS to providing staff with “personal development, access to appropriate training for their jobs and line management support to succeed.

This could potentially deliver a boost to IT training, which was identified as a priority by the recent Health Informatics Review. "The way we treat our workforce is going to be really important for us in the future,” said Mr Nicholson. “Managers do need to get onto this.”

Reaction to the constitution has been muted but generally positive. Niall Dickson, chief executive of the King’s Fund think-tank said: “The NHS Constitution in itself will not transform healthcare in this country. But... for the first time in one document, patients will be able to see what they can expect from the NHS, so it has the potential to empower them to demand a better service and will be useful for patients and relatives.”

And Steve Barnett, chief executive of the NHS Confederation, which represents NHS organisations, said: “This is a starting not an end point for the NHS, but it is important because it lets people know, clearly and simply, how the NHS should work and what they can expect from it.”

Organisations that deliver NHS-funded care will have a legal duty to take account of the constitution when the Health Bill now before Parliament becomes law later in the year.