Unlocking the NHS Constitution John Tingle
A
The report The Patients Association (PA) recently published a report on patient and public awareness of the NHS Constitution (PA, 2014). The PA found a number of important failings and made recommendations to address these. The report is based on findings from a survey carried out by the PA in England to assess awareness of the NHS Constitution’s existence and content. An 18-question survey was distributed to the PA’s member database, Twitter followers and other members of the public. The report states that 1007 responses were collected between February and June 2014. A similar survey was carried out in 2012. A third survey took place in August 2014 and its results are also included in the 2014 report. This column will discuss key questions asked in the survey.
John Tingle is Reader in Health Law, Nottingham Law School, Nottingham Trent University
188
Experiences of the NHS and awareness of the NHS Constitution Q2. Have you ever heard of the NHS Constitution? A total of 60% of respondents (986 answered this question) said they had heard of the NHS
Constitution. In 2012, 24% reported awareness of the Constitution. This figure of 60% represents a significant improvement on the 2012 finding. The PA comment on this finding was that awareness of the document should, at least in theory, be greater because: ‘(a) The Health and Social Care Act 2012 requires all providers of NHS care not only to have an obligation to regard the NHS Constitution in their work, but also a duty to inform patients in their care of the NHS Constitution and their rights, and ‘(b) 97.4% of respondents (N=993) had used NHS services in the last two years.’ (PA, 2014: 11)
Q5. Had you heard of the NHS Constitution before you used these services? In total, 5.6% of respondents said they had heard of the NHS Constitution before they used treatment services. In 2012 only 1.8% of respondents had been made aware of it during the course of their treatment.
Q6. What information have you had or seen about the NHS Constitution in the last two years? Respondents were given a choice of different sources of information. A significant finding is that only 2.7% of people received information directly from their healthcare provider. The PA makes the following hard-hitting comment: ‘The number of respondents claiming to have received information about the NHS Constitution directly from a healthcare professional is incredibly low. As of 2012, the Health and Social Care Act requires healthcare professionals to provide this information by law, and while 97.4% of respondents have used healthcare services in that time, the fact that just 2.7% received this information directly from their healthcare provider shows just how little regard there is for this element of the Act. ‘However, there has been an improvement, since our 2012 survey revealed that just 1.8% of respondents had received any information regarding the NHS Constitution.’ (PA, 2014: 13)
Understanding the NHS Constitution and using it Q9. Have you made use of the NHS Constitution in any way in the last 2 years? The report states that although just 13% of respondents have made use of the Constitution in the last 2 years, this is a significant increase since 2012, in which just 3.6% had actively
© 2015 MA Healthcare Ltd
In this two-part column John Tingle discuss a recent report from the Patients Association on patient and public awareness of the NHS Constitution ll major organisations seem to have noble-sounding mission statements, stating that the important things matter to them, and how they will relate to those they serve and their employees. Many organisations post statements or pledges.These public statements of intent and behaviour are generally to be welcomed as organisations can be called to account if these are transgressed. These statements or pledges are useful mechanisms of public accountability and transparency. Many people, however, just see them as marketing tools or pieces of political rhetoric with little substance.‘We will use fewer trees in our products’, an organisation may state, but what does that actually mean in reality? Not many people seem to pursue these pledges or read the small print, but they look good at first glance. The NHS in England has a mission statement or pledges in the form of the NHS Constitution (Department of Health, 2013), and there is much debate as to its actual worth. Is the NHS Constitution seen by the public and its employees as just a piece of political rhetoric, or does it reflect the true drive, direction and aspirations of the NHS and those it serves? This is a matter of intense conjecture, but the NHS Constitution seems to be becoming more widely known. The signs suggest it is a positive document that will greatly serve the public good. It has become clear, however, that improvements can be made.
British Journal of Nursing, 2015, Vol 24, No 3 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 129.059.095.115 on September 22, 2016. Use for licensed purposes only. No other uses without permission. All rights reserved.
PATIENT SAFETY used the Constitution to challenge the NHS. The PA makes an important observation relating to the demonstration of patient understanding of what the Constitution actually means: ‘Despite a great increase in the level of awareness of the NHS Constitution, in order for it to be truly effective, patients must not only be aware but also have a comprehensive understanding of how it can be put into practice for their benefit, and the confidence to do so when necessary. One of the worrying trends in the comments from this survey is the lack of confidence patients have in their abilities to defend their own rights, and indeed of staff ’s awareness or adherence to the Constitution.’ (PA, 2014: 15)
Perception of the NHS Constitution Q10. Which of the following phrases best describes what you think of the Constitution? The PA asked respondents what they thought of the NHS Constitution. Nearly a quarter (24.2%) believed it to be pretty meaningless. But not all is doom and gloom. The report states that the 2012 survey showed that 48.3% indicated the NHS Constitution can be described as serving some positive purpose. In the 2014 survey this proportion dropped to 31.9%. This indicates that confidence in the NHS Constitution may have dropped over the last 2 years. This finding can still be viewed as a fairly positive one overall.
Q7. Which NHS services were you using when you heard about the NHS Constitution? The report states that, although 52.1% of respondents indicated they found out about the NHS Constitution by using an NHS service, 47.9% found out about it in other ways. This raises the question of the patient’s perception of whether NHS staff are actually making them aware of the NHS Constitution: ‘It must be remembered that the answers to these questions are the respondents’ perceptions; it may be that NHS staff are making patients aware but it is the patients’ perception that they are not.’ (PA, 2014: 18)
Q11. What do you think the NHS Constitution contains?
© 2015 MA Healthcare Ltd
The most popular responses to this question were: responsibilities for NHS staff, a list of legal rights for patients, responsibilities for patients. The report states: ‘It is reassuring to note that of those who answered the question (n=545) they got the answers largely correct and do have a fairly good understanding of what the NHS Constitution contains. A few respondents questioned the ‘legal’ nature of the document.’ (PA, 2014: 20) The report gives excerpts from respondents that give context to the discussion, revealing how ordinary people feel about NHS Constitution matters:
British Journal of Nursing, 2015, Vol 24, No 3
‘Except that the legal rights are illusory.’ ‘There is a significant issue concerning the status of the “pledges”, and the vagueness about how binding these “pledges” are is a significant weakness in the Constitution.’ ‘Are they legal rights? There is a difference of opinion amongst us over how the “rights” are viewed in law and how meaningful the “pledges” are. It also contains “rights” of staff which are certainly not being met currently.’ (PA, 2014: 20)
Q14. Which of the following issues do you think are the most important issues for the NHS Constitution to cover for patients and carers? This question gave a number of answer options including the right to maximum waiting times for treatment, the right to complain, the right to be treated in a safe environment and in a safe way. The top answers were the following rights: ■■ To be treated with dignity and respect (78%) ■■ To be given information about your treatment (76.5%) ■■ To be involved in decisions about your treatment (76.2%) A telling quote from a respondent is stated in the report: ‘The Constitution is a great idea; however it is a great pity that the staff in the NHS seem to be totally oblivious about it. ‘Medical and nursing staff need to remember that not all patients are articulate and should not come away from treatment or a consultation feeling they have been dismissed.’(PA, 2014: 22) The report contrasts these findings with the 2012 survey: ‘In two years it appears priorities have changed slightly with the Right to be treated with dignity and respect now being the single most important issue. It is not possible from the data to say why. However, it can be speculated that the media’s coverage of stories relating to dignity and respect issues have become more commonplace, and therefore service level expectations raised and noticed and noted when lacking.’ (PA, 2014: 23)
Conclusion It is positive that awareness of the NHS Constitution is increasing but there appears, according to the report, to be evidence of a lack of in-depth understanding of it. There is also a lack of understanding of how to use the NHS Constitution effectively. It is good to see respondents identifying priority rights to be treated with dignity and respect, particularly after the terrible events identified in the Francis Report. Part 2 of this column will discuss other questions in the report and the PA’s BJN recommendations for change.
Department of Health (2013) The NHS Constitution for England. http://tinyurl. com/d7sa3wq (accessed 20 January 2015) The Patients Association (2014) Patient and Public Awareness of the NHS Constitution. http://tinyurl.com/pxyjtn5 (accessed 20 January 2015)
189 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 129.059.095.115 on September 22, 2016. Use for licensed purposes only. No other uses without permission. All rights reserved.
A
The report The Patients Association (PA) recently published a report on patient and public awareness of the NHS Constitution (PA, 2014). The PA found a number of important failings and made recommendations to address these. The report is based on findings from a survey carried out by the PA in England to assess awareness of the NHS Constitution’s existence and content. An 18-question survey was distributed to the PA’s member database, Twitter followers and other members of the public. The report states that 1007 responses were collected between February and June 2014. A similar survey was carried out in 2012. A third survey took place in August 2014 and its results are also included in the 2014 report. This column will discuss key questions asked in the survey.
John Tingle is Reader in Health Law, Nottingham Law School, Nottingham Trent University
188
Experiences of the NHS and awareness of the NHS Constitution Q2. Have you ever heard of the NHS Constitution? A total of 60% of respondents (986 answered this question) said they had heard of the NHS
Constitution. In 2012, 24% reported awareness of the Constitution. This figure of 60% represents a significant improvement on the 2012 finding. The PA comment on this finding was that awareness of the document should, at least in theory, be greater because: ‘(a) The Health and Social Care Act 2012 requires all providers of NHS care not only to have an obligation to regard the NHS Constitution in their work, but also a duty to inform patients in their care of the NHS Constitution and their rights, and ‘(b) 97.4% of respondents (N=993) had used NHS services in the last two years.’ (PA, 2014: 11)
Q5. Had you heard of the NHS Constitution before you used these services? In total, 5.6% of respondents said they had heard of the NHS Constitution before they used treatment services. In 2012 only 1.8% of respondents had been made aware of it during the course of their treatment.
Q6. What information have you had or seen about the NHS Constitution in the last two years? Respondents were given a choice of different sources of information. A significant finding is that only 2.7% of people received information directly from their healthcare provider. The PA makes the following hard-hitting comment: ‘The number of respondents claiming to have received information about the NHS Constitution directly from a healthcare professional is incredibly low. As of 2012, the Health and Social Care Act requires healthcare professionals to provide this information by law, and while 97.4% of respondents have used healthcare services in that time, the fact that just 2.7% received this information directly from their healthcare provider shows just how little regard there is for this element of the Act. ‘However, there has been an improvement, since our 2012 survey revealed that just 1.8% of respondents had received any information regarding the NHS Constitution.’ (PA, 2014: 13)
Understanding the NHS Constitution and using it Q9. Have you made use of the NHS Constitution in any way in the last 2 years? The report states that although just 13% of respondents have made use of the Constitution in the last 2 years, this is a significant increase since 2012, in which just 3.6% had actively
© 2015 MA Healthcare Ltd
In this two-part column John Tingle discuss a recent report from the Patients Association on patient and public awareness of the NHS Constitution ll major organisations seem to have noble-sounding mission statements, stating that the important things matter to them, and how they will relate to those they serve and their employees. Many organisations post statements or pledges.These public statements of intent and behaviour are generally to be welcomed as organisations can be called to account if these are transgressed. These statements or pledges are useful mechanisms of public accountability and transparency. Many people, however, just see them as marketing tools or pieces of political rhetoric with little substance.‘We will use fewer trees in our products’, an organisation may state, but what does that actually mean in reality? Not many people seem to pursue these pledges or read the small print, but they look good at first glance. The NHS in England has a mission statement or pledges in the form of the NHS Constitution (Department of Health, 2013), and there is much debate as to its actual worth. Is the NHS Constitution seen by the public and its employees as just a piece of political rhetoric, or does it reflect the true drive, direction and aspirations of the NHS and those it serves? This is a matter of intense conjecture, but the NHS Constitution seems to be becoming more widely known. The signs suggest it is a positive document that will greatly serve the public good. It has become clear, however, that improvements can be made.
British Journal of Nursing, 2015, Vol 24, No 3 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 129.059.095.115 on September 22, 2016. Use for licensed purposes only. No other uses without permission. All rights reserved.
PATIENT SAFETY used the Constitution to challenge the NHS. The PA makes an important observation relating to the demonstration of patient understanding of what the Constitution actually means: ‘Despite a great increase in the level of awareness of the NHS Constitution, in order for it to be truly effective, patients must not only be aware but also have a comprehensive understanding of how it can be put into practice for their benefit, and the confidence to do so when necessary. One of the worrying trends in the comments from this survey is the lack of confidence patients have in their abilities to defend their own rights, and indeed of staff ’s awareness or adherence to the Constitution.’ (PA, 2014: 15)
Perception of the NHS Constitution Q10. Which of the following phrases best describes what you think of the Constitution? The PA asked respondents what they thought of the NHS Constitution. Nearly a quarter (24.2%) believed it to be pretty meaningless. But not all is doom and gloom. The report states that the 2012 survey showed that 48.3% indicated the NHS Constitution can be described as serving some positive purpose. In the 2014 survey this proportion dropped to 31.9%. This indicates that confidence in the NHS Constitution may have dropped over the last 2 years. This finding can still be viewed as a fairly positive one overall.
Q7. Which NHS services were you using when you heard about the NHS Constitution? The report states that, although 52.1% of respondents indicated they found out about the NHS Constitution by using an NHS service, 47.9% found out about it in other ways. This raises the question of the patient’s perception of whether NHS staff are actually making them aware of the NHS Constitution: ‘It must be remembered that the answers to these questions are the respondents’ perceptions; it may be that NHS staff are making patients aware but it is the patients’ perception that they are not.’ (PA, 2014: 18)
Q11. What do you think the NHS Constitution contains?
© 2015 MA Healthcare Ltd
The most popular responses to this question were: responsibilities for NHS staff, a list of legal rights for patients, responsibilities for patients. The report states: ‘It is reassuring to note that of those who answered the question (n=545) they got the answers largely correct and do have a fairly good understanding of what the NHS Constitution contains. A few respondents questioned the ‘legal’ nature of the document.’ (PA, 2014: 20) The report gives excerpts from respondents that give context to the discussion, revealing how ordinary people feel about NHS Constitution matters:
British Journal of Nursing, 2015, Vol 24, No 3
‘Except that the legal rights are illusory.’ ‘There is a significant issue concerning the status of the “pledges”, and the vagueness about how binding these “pledges” are is a significant weakness in the Constitution.’ ‘Are they legal rights? There is a difference of opinion amongst us over how the “rights” are viewed in law and how meaningful the “pledges” are. It also contains “rights” of staff which are certainly not being met currently.’ (PA, 2014: 20)
Q14. Which of the following issues do you think are the most important issues for the NHS Constitution to cover for patients and carers? This question gave a number of answer options including the right to maximum waiting times for treatment, the right to complain, the right to be treated in a safe environment and in a safe way. The top answers were the following rights: ■■ To be treated with dignity and respect (78%) ■■ To be given information about your treatment (76.5%) ■■ To be involved in decisions about your treatment (76.2%) A telling quote from a respondent is stated in the report: ‘The Constitution is a great idea; however it is a great pity that the staff in the NHS seem to be totally oblivious about it. ‘Medical and nursing staff need to remember that not all patients are articulate and should not come away from treatment or a consultation feeling they have been dismissed.’(PA, 2014: 22) The report contrasts these findings with the 2012 survey: ‘In two years it appears priorities have changed slightly with the Right to be treated with dignity and respect now being the single most important issue. It is not possible from the data to say why. However, it can be speculated that the media’s coverage of stories relating to dignity and respect issues have become more commonplace, and therefore service level expectations raised and noticed and noted when lacking.’ (PA, 2014: 23)
Conclusion It is positive that awareness of the NHS Constitution is increasing but there appears, according to the report, to be evidence of a lack of in-depth understanding of it. There is also a lack of understanding of how to use the NHS Constitution effectively. It is good to see respondents identifying priority rights to be treated with dignity and respect, particularly after the terrible events identified in the Francis Report. Part 2 of this column will discuss other questions in the report and the PA’s BJN recommendations for change.
Department of Health (2013) The NHS Constitution for England. http://tinyurl. com/d7sa3wq (accessed 20 January 2015) The Patients Association (2014) Patient and Public Awareness of the NHS Constitution. http://tinyurl.com/pxyjtn5 (accessed 20 January 2015)
189 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 129.059.095.115 on September 22, 2016. Use for licensed purposes only. No other uses without permission. All rights reserved.
