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Constitutional reform

Responses to the proposed changes in the NHS Constitution for England are due in this month. Lynn Eaton finds out more

Is anyone who’s studied history or politics knows, Britain, unlike the USA does not have a written constitution.

Perhaps that’s why the NHS constitution, first launched in 2009, has not become as ingrained as the government might have hoped.

Whatever the reason, the first NHS constitution didn’t gain – as the Department of Health (DH) would call it – sufficient ‘traction’.

Only in one part of the country – the East of England – did the idea really take hold, and only because senior managers there made sure to push it.

The NHS constitution brings together ‘the principles, values, rights and responsibilities’ that underpin the NHS. Norman Lamb, minister for care and support, announced a review in November last year to understand what more could be done to improve sign-up to the policy.

The CSP, which has always supported the concept of an NHS constitution, is among many organisations finalising its comments before the deadline closes at the end of January.

Pressure for the review of the original constitution came from the NHS Future Forum. Although the CSP was not directly involved with this, the society did have input through the Social Partnership Forum.

Lesley Mercer, the CSP’s director of employment relations and union services, is a member of this group, which has a remit to enable NHS Employers, NHS trade unions and the DH to discuss the implications of policy.

But what will the revised constitution mean for CSP members – and their patients?         

Making a difference

Steve Field, chair of the NHS Future Forum and former chair of the Royal College of General Practitioners, is confident the new look constitution definitely will make a difference: ‘It’s not a matter of if: it’s a matter of when,’ he says, acknowledging that, before, ‘there wasn’t a big communication plan to get it across to the whole country’.

Claire Sullivan, CSP assistant director, agrees more needs to be done to give the constitution traction: ‘The society agrees that it has not had the necessary profile to make it really effective.’

The CSP has welcomed the review.

In its response it will call for more feedback to be given to staff and patients, for more early intervention in occupational health services for NHS staff, a commitment to the development of the future workplace (including student placements and rotations for newly qualified physios), and the right to be represented by an independent trade union.

Professor Field acknowledges the role of the health unions in drawing up the revised constitution.

‘I wanted to make sure that the constitution spoke to staff,’ he said. ‘My fundamental belief is that if you have motivated and inspired staff they will provide a better experience for patients.’

Professionalism – and empowering staff to blow the whistle if they are aware of bad care – is something to the front of ministers’ minds with publication of the Francis report on Mid-Staffordshire imminent.

A new duty of candour will be placed on the NHS in the constitution to ensure openness about patient safety. This will also be included in the NHS Standard Contract for providers delivering services on behalf of the NHS.

The CSP has welcomed this proposal although wants clarity on how this duty will be enforced on providers working on a contractual basis for the NHS.

Professor Field is laid-back about the inevitable links between the constitution and the Francis report. ‘We’ve got one eye on Francis, obviously,’ he says.

But, had the NHS constitution been enshrined in staff thinking then all patients would be treated with respect and compassion, he argues. As a consequence, ‘we wouldn’t have the problem we have’.

However, to balance this view, it must be noted that the NHS constitution’s potential impact on staff’s attitude to patients is only one of many issues likely to be discussed in the wake of the Francis report.

If staff have a clear understanding of their rights and responsibilities it might help on an individual basis, but is unlikely to be the only answer to what went wrong in Mid-Staffordshire.

Every contact counts

The proposal that all health professionals should take every opportunity to help improve public health and reduce health inequalities - ‘making every contact count’ - sits well with the CSP’s agenda.

If accepted, physiotherapists will be among those members of staff who are encouraged to support not just patients but their colleagues too in improving health and well-being.

The CSP remains concerned that the recommendations of the 2009 review by Steve Boorman, calling for more support to keep NHS staff in work after a period of ill health, have not been progressed as quickly as they might.

Patient data is another area under examination. The proposals include details of how and when it is appropriate to share confidential patient data, including where the patient is taking part in research.

The CSP has welcomed this move, and wants to see more responsibility given to staff about sharing data where it is in the patient’s interests to ensure joined up care.

Professor Field, who works as a GP in Birmingham, is clearly committed to tackling inequalities in health care. He quotes Mahatma Gandhi as he underlines just how important the new constitution will be to really making a change – for everyone who uses NHS health care:

‘We must – as Gandhi said – become the change we want to see in the world. I recognise we are working in very difficult times. I’ve had fantastic experiences of physiotherapists in the NHS and private sector, and in my own GP practice.

‘For the vast majority of physios, the constitution won’t mean anything extra for them.

All the physios I’ve ever worked with make great leaders. A lot of doctors and nurses could learn a lot from them.’ fl

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