Nhs constitution handbook 2010

By providing a concise statement of what patients can expect from the NHS, the constitution makes it easier for service users to ask questions and provide challenge at the point of care. If you would like to raise a concern or provide feedback about services received from your primary care provider for example, a GP, dentist or pharmacist or secondary care provider for example, a hospital you can do so by contacting them directly.

If you would like to raise concerns or provide feedback on your local public health services, you can contact the Director of Public Health at your local authority. Healthwatch England is the national consumer champion for both health and social care, and represents the views of patients, service users and the public at the national level. Local Healthwatch ensures that people's views and experiences inform the commissioning, provision and scrutiny of local health and social care services, including through its seat on the local Health and Wellbeing Board.

A Health and Wellbeing Board is in place in each upper tier and unitary local authority in England. It brings together local government elected councillors and senior officers , the local NHS and other key local partners, to provide strategic leadership for the local health and wellbeing system. It is therefore a forum in which leaders from the local health and care system work together to improve the health and wellbeing of their local population, and to reduce health inequalities. The public's views and concerns about their local health and social care services help build a valuable picture of where services are doing well and where they can improve.

Local Healthwatch can also alert Healthwatch England or the CQC to concerns about specific health and care issues and providers, and can provide people with information about local services and what to do when things go wrong, including on how to complain. The NHS has arrangements in place, allowing patients to complain if they are dissatisfied with the services they receive.

You have the choice of making a complaint to either the service provider or the body that arranged for that service to be provided — the local CCG or NHS England.

You can also seek assistance in making a complaint from the Complaints Advocacy Service. If you remain unhappy with the local resolution of your complaint, you can ask the Parliamentary and Health Service Ombudsman to look into your case.

Local authorities are responsible for the provision of public health services. If you wish to complain about public health services provided through local authorities, you should raise this directly with either the service provider or the local authority in the first instance.

If, after exhausting the provider's or local authority's complaints procedure, you are not satisfied with the outcome of your complaint, you can complain to the Local Government Ombudsman who can investigate complaints about local authorities in a fair and independent way. In addition to complaining to the local authorities and providers directly or to the Local Government Ombudsman, you can also tell your Local Healthwatch about the nature of your complaint.

Under Section 2 c of the Local Government and Public Involvement in Health Act , Local Healthwatch has a legal obligation to obtain the views of local people about their experiences of local care services, and also to make those views known to service providers, commissioners, Healthwatch England and the CQC.

Patients and staff can also seek legal redress if they feel that NHS organisations have infringed the legal rights described in the NHS Constitution. For patients and the public, this could be in the form of a judicial review of the process by which an NHS organisation has reached a decision. To contact NHS England email england.

The Healthwatch England website has contact details for Local Healthwatch. The NHS complaints guidance includes information on the NHS complaints arrangements, and what patients can expect when they make a complaint about their care or treatment.

To contact the Parliamentary and Health Service Ombudsman , visit its website or call the helpline on You may also use the textphone Minicom : or text 'call back' with your name and your mobile number to To contact the Local Government Ombudsman for advice or to make a complaint, visit the website or call the Local Government Ombudsman Advice Team on You should contact your line manager in the first instance about any concerns you may have, and your organisation will also have formal routes for raising complaints that you may use.

You may also provide anonymous feedback about services via the NHS website , which is then published. All feedback submitted to the website is checked to ensure it meets house rules , which includes making sure that it does not put patients at risk, respects rights to privacy, and is not defamatory.

The NHS encourages service providers to respond publicly and to use the feedback in service development. If there is anything in this handbook which is unclear, or anything is missing, please let us know so we can improve it. You can get in touch by using the online contact form or fax: Please use the online contact form above instead if you can. This section explains the common values that underpin the NHS.

The values are integral to creating a culture where patients come first in everything the NHS does. These values are not intended to be limiting. Individual organisations should use them as a basis on which to develop their own, adapting them to local circumstances. The values should be taken into account when developing services with partner organisations, patients, the public and staff. The value of 'working together for patients' is central to guiding service provision in the NHS and other organisations providing health services.

Patients must come first in everything the NHS does. All parts of the NHS system should act and collaborate in the interests of patients, always putting patient interest before institutional interest, even when that involves admitting mistakes.

As well as working with each other, health service organisations and providers should also involve staff, patients, carers and local communities to ensure they are providing services tailored to local needs. Every individual who comes into contact with the NHS and organisations providing health services should always be treated with respect and dignity, regardless of whether they are a patient, carer or member of staff.

This value seeks to ensure that organisations treat people as individuals, valuing and respecting different needs, aspirations and priorities and taking them into account when designing and delivering services.

The NHS aims to foster a spirit of candour and a culture of humility, openness and honesty, where staff communicate clearly and openly with patients, relatives and carers. 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. Quality should not be compromised — the relentless pursuit of safe, compassionate care for every person who uses and relies on services is a collective endeavour, requiring collective effort and collaboration at every level of the system.

The delivery of high quality care is dependent on feedback; organisations that welcome feedback from patients and staff can identify and drive areas for improvement. Compassionate care ties closely with respect and dignity in that individual patients, carers and relatives must be treated with sensitivity and kindness. The business of the NHS extends beyond providing clinical care and includes alleviating pain, distress and making people feel valued and that their concerns are important.

The core function of the NHS is emphasised in this value — the NHS seeks to improve the health and wellbeing of patients, communities and its staff through professionalism, innovation and excellence in care. This value also recognises that to really improve lives the NHS needs to be helping people and their communities take responsibility for living healthier lives. We all have a responsibility to maximise the benefits we obtain from NHS resources, ensuring they are distributed fairly to those most in need.

Nobody should be discriminated or disadvantaged and everyone should be treated with equal respect and importance. The guiding principles set out in the constitution are the enduring high-level 'rules' that govern the way that the NHS operates, and define how it seeks to achieve its purpose. They are underpinned by the core NHS values and are made by regulations in Parliament. Like the NHS Constitution itself, the principles should be embedded at every level within the health service and among those organisations providing NHS services.

The NHS provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity, or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard.

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.

This principle makes clear that the NHS covers every branch of medical and allied activity, and that it exists to address both mental and physical health. NHS services should be available to everyone: no individual should be excluded from receiving NHS services based on the characteristics cited.

The protected characteristics set out in this principle are the same as those listed in the Equality Act Legal duties require NHS England and each CCG to have regard to the need to reduce inequalities in access to health services and the outcomes achieved for patients. This principle is mindful of the NHS's integral role in alleviating health inequalities, which the World Health Organization defines as 'differences in health status or in the distribution of health determinants between different population groups.

This principle states unequivocally that NHS services should be free at the point of use, except where charges are expressly provided for in legislation for example, prescription charging and dentistry.

Any decision to introduce new charges would need to be sanctioned by Parliament. This principle highlights the standards of excellence and professionalism that all parts of the NHS should aspire to when providing high quality care. The Health and Social Care Act provides a further legal basis to this principle, placing duties on the Secretary of State, NHS England and CCGs to secure continuous improvement in the quality of outcomes achieved by health services.

This principle also recognises that the NHS is dependent on its staff, and that it is only when staff are valued and supported that patients receive excellent care.

This goes beyond education, training and development and includes, for instance, being listened to and treated with respect and understanding. It also emphasises the importance of patients being treated with respect, dignity, compassion and care. The importance of innovation and medical research is underscored by this principle as integral to driving improvements in healthcare services for patients. The NHS should support individuals to promote and manage their own health.

NHS services must reflect, and should be co-ordinated around and tailored to, the needs and preferences of patients, their families and their carers. The NHS will ensure that in line with the Armed Forces Covenant, those in the armed forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area they live.

Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. The NHS will actively encourage feedback from the public, patients and staff, welcome it and use it to improve its services. This principle enshrines the NHS as a patient-centred service, emphasising that patients will be at the heart of everything the service does.

It accentuates that, rather than being passive recipients of healthcare, patients also play a key role in managing their own health and should be actively supported by the NHS to do so. It recognises the need for patients, along with their families and carers, to be involved in discussions about their care, where it is appropriate to do so. The importance of individuals being involved in their own care and treatment is set out in the Health and Social Care Act , which placed duties on commissioners to do this.

This principle also highlights that NHS services should be co-ordinated around and tailored to the needs and preferences of patients. The Health and Social Care Act also places duties on commissioners to promote integration. Finally, this principle makes clear that the NHS will encourage and welcome feedback from patients, the public and staff.

It recognises that service improvement is dependent on feedback. As part of this principle and in line with the Armed Forces Covenant , the NHS will ensure that members of the armed forces community including those serving, reservists, their families and veterans are supported, treated equally and receive the same standard of, and access to healthcare, as any other UK citizen in the area where they live.

For those with concerns about their mental health who may not present for some time after leaving service, they should be able to access services with health professionals who have an understanding of armed forces culture.

Veterans who have lost a limb as a result of their service will be able to access prostheses that reflect their clinical need. Veterans, reservists while not serving and armed forces families receive their healthcare from the NHS and are encouraged to identify themselves to their GP as members of the armed forces community.

For further information on what you can expect if in the armed forces community see Section C. For families of serving personnel moving around the country, any time taken on an NHS treatment waiting list will be taken into account in their new location.

The Armed Forces Covenant sets out the relationship between the nation, the government and the armed forces community.

The covenant aims to ensure that those who the armed forces, whether as regular personnel or as a reservist, their families and those who have served in the past veterans , should face no disadvantage compared to other citizens in the provision of public and commercial services. Special consideration is appropriate in some circumstances.

The Armed Forces Covenant looks to address a wide range of issues impacting on the armed forces community, including health, education, housing, care and family life. This principle makes clear that patient interest comes before institutional interest, and that organisations involved in delivering NHS services including local authority public health services must work with each other and with other organisations if they are to achieve genuine improvements in the population's health and wellbeing.

In addition, the NHS should work with the full range of local authority services, for example social care services, children's services and education services. The NHS should also work with other public sector organisations, for example, the police and criminal justice system, as well as private and voluntary sector organisations. As the NHS is funded by public money, this principle highlights the importance of using this funding fairly in a way that benefits everyone the NHS serves.

The NHS seeks to maximise benefits within the constraints of limited resources. This principle recognises that as a taxpayer-funded service, the government is accountable to Parliament for the outcomes and spending of the NHS.

There are various levels of responsibility and accountability for the NHS, and these must be clear to the public, patients and staff. The government is required to explain how these accountabilities work in the Statement of NHS Accountability.

The fundamental standards apply to all registered persons registered with the CQC. Most providers of health services are required to register with the CQC — including, for example, NHS bodies and local authorities. The fundamental standards set the line below which care and treatment must never fall. They are clear outcomes about the quality and safety of care that all registered health and adult social care providers must meet.

The fundamental standards are legal requirements that NHS hospitals, NHS foundation trusts, GP practices, ambulance services and other providers of NHS services must meet when providing healthcare and treatment. It is the CQC 's role to make sure that providers meet the requirements contained in the fundamental standards, and to take action against providers who fail to meet them.

The CQC can prosecute providers of health services for a breach of some regulations. Individual patients cannot enforce the fundamental standards directly through the courts, but if providers are not meeting their legal duties under the fundamental standards, the CQC can take action against that provider. Where rights contained in the fundamental standards are reflected elsewhere, there may be an alternative mechanism that enables individuals to enforce these rights. For example, one of the fundamental standards protects the right to safe care and treatment.

Although individuals cannot enforce the fundamental standards directly, the law of negligence imposes on providers of healthcare a duty to take reasonable care and skill in the provision of treatment or other healthcare. If those providing your care do not take reasonable care to ensure that you receive safe treatment, and you are injured as a result, you may be able to bring an action in the courts for negligence.

NHS services are generally provided free of charge. This includes access to local services like your GP, hospital or clinic, or health improvement services provided by your local authority, so you do not have to worry about payment.

There are some exceptions: for example, some people will have to pay for prescription charges and visits to the dentist. Overseas visitors may also have to pay charges. Section 1 of the NHS Act sets out the primary duty on the Secretary of State to promote a comprehensive health service and to exercise the Secretary of State's functions as to secure the provision of services for that purpose.

The section goes on to state that services provided as part of the health service must be provided free of charge unless charges are expressly provided for. The requirement to provide services free of charge applies in particular to hospital and community health services services commissioned by NHS England and CCGs under sections 3 and 3B of the Act and to public health services services provided or arranged by local authorities under sections 2A and 2B of the Act. For primary care services, including GP services, the legislation that governs the arrangements under which those services are commissioned by NHS England does not generally permit the charging of patients sections 83, 99, and of the NHS Act There is provision for local authorities to charge for certain services, but not those provided to an individual for the purpose of improving their health see regulation 9 of the Local Authorities Public Health Functions and Entry to Premises by Local Healthwatch Representatives Regulations NHS services will always be available for the people who need them.

No one can deny you the right to access these services because of your age, disability, race, gender or gender reassignment, sexual orientation, pregnancy and maternity, religion or belief, or marital or civil partnership status. Access to NHS services is not denied in situations where patients pay for additional private care separately.

If you are in the armed forces, the Ministry of Defence is responsible for your medical care. The Equality Act makes it unlawful for a public authority in the exercise of its functions, and for persons including public authorities providing goods, facilities or services to the public, to discriminate on specified grounds subject to exceptions. The National Health Service Act , as amended by the Health and Social Care Act , places duties on NHS England and CCGs to have regard to the need to reduce inequalities in access to, and outcomes from, healthcare services for patients, and to assess and report on how well they have fulfilled this duty.

In addition to the legislation on discrimination, therefore, it would be unlawful for those bodies to refuse access on unreasonable grounds. Your care and treatment needs and preferences should be assessed by people with the required levels of skill and knowledge for the task, and met where possible. This right should ensure that your care and treatment is well planned and that you are treated as an individual.

The plans for your care and treatment should be reviewed regularly and whenever necessary, for example when you transfer between services. There may be times when your needs and preferences cannot be met for some reason. In these instances, providers must explain the impact of this to you, and explore alternatives so that you can make informed decisions about your care and treatment. This right reflects the fundamental standard about person-centred care, which is set out in regulation 9 of the Health and Social Care Act Regulated Activities Regulations The purpose of the 'person-centred care' fundamental standard is to ensure that providers of health and adult social care services plan and provide patient care and treatment that is appropriate, meets their needs, and reflecting their preferences.

CCGs are responsible for commissioning most local health services. NHS England is responsible for commissioning primary care services including the services provided by your local GP surgery, community pharmacies, dental services, and NHS sight tests. NHS England also commissions 'specialised' services for the small number of people who have rare health conditions, together with prison health services and some health services for members of the armed forces community.

Local authorities are responsible for providing and commissioning public health services. All bodies commissioning services must assess the health requirements of the populations they serve, take account of inequalities in access to and outcomes from healthcare services, and commission the services that they consider necessary to meet the population's needs.

CCGs are working closely with local authorities, and their partners including Health and Wellbeing Boards and Local Healthwatch, to assess and address local needs across health, public health and social care through joint strategic needs assessments and local commissioning plans. The legislation under which NHS England, and CCGs commission services requires them to arrange for the provision of services for which they are responsible to such extent as they consider necessary to meet all reasonable requirements sections 3, 3B, 83, 99, and with some differences of the NHS Act Local authorities have a duty to take such steps as they consider appropriate to improve the health of the people in their area section 2B of the NHS Act and additional duties in relation to particular services see the Local Authorities Public Health Functions and Entry to Premises by Local Healthwatch Representatives Regulations These agreements provide entitlements to reciprocal healthcare cover to persons for whose healthcare the UK is responsible.

This includes funding for planned treatment also known as the S2 route in the countries covered by the agreement, where you meet the eligibility requirements.

This should be considered on a case-by-case basis and be subject to ongoing review until the treatment is received. Planned treatment only covers treatment from a provider in the state system. It will not cover private providers.

You should be treated as if you are insured under the legislation of the country treating you. This means that if patients from that country in the same circumstances have to make an additional payment for particular care, so will you. If you have to make such a payment, you may be able to request reimbursement of your costs from the NHS. Before going abroad for medical treatment, it is important to get enough information to enable you to make the right choices. You should consider:. Reciprocal healthcare benefits operate on the terms agreed with other countries under the relevant healthcare arrangement.

The Equality Act makes it unlawful for a person providing services to discriminate on various grounds listed above subject to certain exceptions. Individual health professionals are also governed by the standards set under the professional regulatory regime that applies to their profession. This right is also based on the fundamental standard of safeguarding service users from abuse and improper treatment as set out in regulation 13 of the Health and Social Care Act Regulated Activities Regulations If this is not possible, the CCG or NHS England, which commissions and funds your treatment, must take all reasonable steps to offer a suitable alternative provider, or if there is more than one, a range of suitable alternative providers, that would be able to see or treat you more quickly than the provider to which you were referred.

You will need to contact either the provider you have been referred to or your local CCG before alternatives can be investigated for you. Your right to start treatment within 18 weeks from referral will include treatments where a consultant retains overall clinical responsibility for the service or team, or for your treatment.

This means the consultant will not necessarily be physically present for each appointment, but will take overall responsibility for your care. The setting of your consultant-led treatment, for example whether hospital based or in a GP-based clinic, will not affect your right to start treatment within 18 weeks. The right to treatment is subject to various exceptions.

In particular, the right to treatment within 18 weeks from referral will cease to apply in circumstances where:. Patients can expect to be treated at the right time and according to their clinical priority. Patients with urgent conditions, such as cancer, will be able to be seen and receive treatment more quickly. Organisations' performance is monitored across all waiting time pledges. In addition, local authorities with public health responsibilities should bear in mind that it is best practice for the care of patients and their sexual partners to offer genito-urinary medicine appointments as soon as possible, and that the clinical evidence indicates a maximum of 48 hours.

NHS England and CCGs are responsible for involving their patients, carers and the public in decisions about the services they commission. Furthermore, CCGs must consult on their annual commissioning plans and any changes that may affect patient services. In addition to the legal duty on NHS organisations to involve people and their representatives about services, patients and the public are placed at the heart of local decision-making through health and wellbeing boards.

Local authority directors of public health have a duty to publish annual reports on the health of the local population. Transparency at local level is enhanced by the Public Bodies Admission to Meetings Act , which opened up meetings to the public, allowing members of the public and press to attend meetings of councils. Additionally, the Local Government Act provides people with access to information held by local authority executives, like leaders and elected mayors.

JSNAs and JHWSs must be published and health and wellbeing boards should consider a variety of means of disseminating these in a way that makes them accessible to the public. Among other things, the publication allows the health and wellbeing board to show the local community that their needs, inequalities and key priorities were considered properly and their views and feedback were listened to and acted upon.

Healthwatch works to ensure that the views and feedback from patients and users are an integral part of local commissioning. Both Healthwatch England and Local Healthwatch organisations must produce annual reports, which may include information about how their activities have had an impact on the design and delivery of health and care services.

Providing effectively integrated care, achieving better outcomes for service users in a cost-effective way is a key priority for the NHS. The NHS and partner organisations, such as local authority social services departments, are jointly responsible for delivering integrated care. The NHS has a duty to work in partnership with local authorities to provide you with effective and personalised services that meet your health and wellbeing needs.

In doing so, the NHS and partner organisations, should co-ordinate their health and social care services, where this is the best way of meeting your needs. UK sets out the areas of health and care where the government expects to see improvements. NHS staff must treat you with reasonable care this will be determined by the health professional's practice in your treatment or when providing other healthcare.

The staff who provide NHS services must be qualified and have the experience needed to do their jobs well. As well as taking reasonable care to ensure a safe system of healthcare and using qualified and experienced staff, NHS and private organisations which have to be registered must register with the CQC , and be responsible for meeting essential safety and quality standards on an on-going basis.

The law of negligence imposes a duty of care on providers of healthcare. This is a duty to take reasonable care and skill in the provision of treatment or other healthcare. For a health professional, what constitutes 'reasonable care and skill' will be determined by reference to professional practice.

In the case of an NHS body or private organisation, it must take reasonable care to ensure a safe system of healthcare — using appropriately qualified and experienced staff. If a provider breaches the duty and as a result causes injury to a patient, the patient is entitled to damages to compensate for the injury and resulting financial loss.

Regulations under the NHS Act governing the provision of GP and most other primary care services require practitioners to exercise reasonable care and skill in the delivery of obligations under their contracts. Under the Health and Social Care Act persons who carry out regulated activities in England, including NHS and private and voluntary providers, have to register with the CQC and meet these essential requirements of safety and quality.

This right is also based on the new fundamental standards which sets out the required level of quality and safety providers must meet fit and proper persons employed as set out in regulations 12, and 19, of the Health and Social Care Act Regulated Activities Regulations The CQC 's role is to encourage service providers to improve care by regulating and inspecting services.

The CQC ensures that only persons carrying out the regulated activity who have made a legal declaration that they meet the essential fundamental standards are allowed to provide care. The CQC actively works as part of the wider system to detect and address failing organisations, sharing its findings with other regulators, including NHS Improvement, and the commissioners of services.

The quality, design and general upkeep of healthcare premises has a material impact on the health and wellbeing of those using them. Those providing your care and treatment must take reasonable steps to ensure it is delivered in appropriate premises with adequate equipment.

This right applies to patients and services users as well as staff and visitors. Healthcare should always be provided in a clean, safe, secure and suitable environment. In practical terms this means that in addition to complying with specific legal requirements that are set out in health and safety legislation and the law relating to negligence, healthcare providers should:.

The extent to which your right to a clean, safe, secure and suitable environment applies may be dependent on the circumstances and where you are receiving care. For example, if you are in your own home or using your own equipment, your provider may not be responsible for the standard of cleanliness. Regardless of where you are receiving care or treatment, if you are concerned about standards of cleanliness for which your provider is responsible, let the staff know. The CQC will check that healthcare providers are meeting all these requirements and act against providers who fail to meet them.

This right is based on the specific fundamental standards of safe care and treatment, premises and equipment, set out in regulations 12, 15 and 17 of the Health and Social Care Act Regulated Activities Regulations The law of negligence also imposes a duty of care on providers of healthcare. Hide this message. Home Health and social care Public health Health improvement. Applies to England Documents. Explore the topic Health improvement Health protection.

Is this page useful? Maybe Yes this page is useful No this page is not useful. Thank you for your feedback. Report a problem with this page. What were you doing? You can change your cookie settings at any time. From autumn new agreements have come into force and so the NHS Constitution for England will be updated. The constitution sets out rights for patients, public and staff. It outlines NHS commitments to patients and staff, and the responsibilities that 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 the constitution in their decisions and actions. The constitution sets out a commitment for government to produce an up-to-date statement of NHS accountability to explain how decision-making works in the NHS.

The complaints guidance explains how patients can give feedback or make a complaint about NHS care or treatment. It includes information on the NHS complaints arrangements, and what patients can expect when they make a complaint. The guidance should be read alongside the NHS Constitution. The Department of Health has also produced supplements, including the NHS Constitution handbook, that explains in greater detail the rights and pledges contained in the constitution.