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Why the NHS Constitution needs an update

Refreshing the constitution may mean making it shorter and simpler, writes Professor Steve Field.

The NHS Constitution, published three years ago, brought together for the first time what patients, staff and the public can expect from the NHS and from each other.  Its purpose: to safeguard the values of the NHS and empower patients and staff. It is a remarkable and important document. Its opening lines resonate with everyone I speak to, and I am proud to have played a part in helping to develop it.

Three years on, it is time for a stocktake –to consider how it can be strengthened for the future.  This is the task that the NHS Future Forum, which I chair, has been set by the Secretary of State.

Last week I wrote to the Secretary setting out the NHS Future Forum's conclusions about the effect of the NHS Constitution.  In my letter I noted thatwhen I talk about the constitution to patients and the public, their support for it is immediately apparent. However, our work so far reveals that the true power of the constitution has yet to be realised. It is not satisfactory that awareness of the constitution is low (just a quarter of the public and 54% of staff are aware) and that the constitution is rarely used by staff and even less so by patients and the public. Just 3% of NHS staff say they have encountered a patient using the constitution in this way.

In my work I have met many vulnerable people who tell me that they find it very difficult to access health services. I hear of people finding it difficult to sign on with a GP or not being treated with respect and dignity when they do get to see a doctor or a nurse in the community or in hospital. Where the NHS fails to live up to rights enshrined in the constitution, patients and staff need to know what to do and who to turn to, to ensure their expectations are met.

I believe there is also scope for strengthening the constitution itself and that is what the Secretary of State has asked the NHS Future Forum to consider next.

Over the summer, the NHS Future Forum will be talking to as many individuals and organisation as we can.  No doubt, there will be many ideas for strengthening the Constitution  but the same time, it is clear to me that the power of the constitution lies at least in part in being short and simple. If anything, it could be simpler still.

In a time of reorganisation and financial pressure, the NHS Constitution has assumed greater importance, perhaps more than its founders realised. In such times, the constitution provides important continuity.

Professor Steve Field is chair of the NHS Future Forum and a GP in Birmingham

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