Updating the NHS Constitution: an opportunity to set out a new vision

It’s over 15 years since Picker was among the key organisations helping the government to write and publish the first ever NHS Constitution. And, although it was conceived as a ‘living’ document that would evolve with developments in healthcare, since 2015 it has lain untouched. 

We have called for an update of the Constitution as part of our manifesto for a person centred NHS and so we welcomed the recent launch of a public consultation on its contents. Here, we summarise our response to that consultation, where we have advocated for a renewed drive to deliver person centred care that directly addresses the multiple pressures which the NHS is now under. 

Responding to the consultation

The Constitution’s role is to bring together in one coherent governing document the principles, values and pledges that the NHS makes to ‘the people’, and to make explicit the rights that patients have, drawn from laws, regulations and national agreements. 

In its consultation, the last government proposed various small updates, for example by recognising new rights of unpaid carers to be involved in decisions about the care of their loved ones. Picker welcomed most of these changes. By contrast, we did not support proposed changes that lacked a robust evidence or policy base, such as introducing new language relating to the ‘biological sex’ of patients. We believe that the role of the Constitution should be to bring together rights and principles already encoded elsewhere, not to create these afresh.  

More broadly, we noted that review of the Constitution would take place under a new government. This presents an opportunity to widen its scope and ambition to help tackle the multiple crises with which the NHS is struggling – and to help present the “compelling and holistic vision for the future of the NHS” that we have called for in our manifesto. At the heart of this vision should be a conscious prioritisation of person centred care: an adoption of the perspective of patients, service users and their families as the ‘organising principle’ that drives the organisation and delivery of healthcare. 

Prioritising person centred care

A dominant theme of patient experience in 2024 is that of waiting. Waiting not just for the agreed referrals and procedures that have ‘target times’ that are mentioned in the Constitution as patient rights, but also for initial access, to get appointments, to get tests and scans, to have promised reviews and monitoring. Poorly managed waits can exacerbate people’s existing conditions and contribute to stress, anxiety, and even depression – adding compound pressures on the NHS and worsening outcomes in a vicious cycle.

Waiting lists cannot come down overnight, but the new government and the NHS can tackle the burden of waiting now by funding and supporting personalised care interventions that were agreed in the NHS Ten Year Plan but have not progressed. These include education and support for ‘self management’, peer support, and personalised care planning. These are evidence based, low cost, effective and widely applicable ways to enable people to manage their conditions and their lives as successfully as possible. And because people who are more active in self-managing have lower use of a range of health services, these interventions will not only offer a more person centred service for users, but stand to reduce the pressure on care providers and professionals. 

By refocussing on person centred care, therefore, the government and the NHS can create benefits for patients, service users and their families, and help the NHS to manage its medium-term challenges in relation to demand and resources. 

Enabling change 

We have identified three key factors to support a renewed focus on person centred care.  

First, a leap forward in the use of data and insights about service user experience, to identify what works and to focus on areas for improvement. There is no shortage of data, but there is a dearth of time and staff knowledge to use it. It is time to establish a national centre of excellence for user experience to support organisations and their staff to understand, measure and act on this feedback. This can be transformative for the organisation of care, and supports the most appropriate use of resources for patient benefit. 

Second, building on initial work under the Ten-Year Plan, all staff should be trained and supported in person centred care. They too need the knowledge, skills, and confidence to practice shared decision making and to support people’s self management. This is about starting from the individual’s needs, values, and preferences and enabling their active participation. 

Third, clear communication with people using services is essential, so that they have the right information at the right time using appropriate channels and formats. User feedback can help improve approaches and identify where poor administration is impacting on patient care and wellbeing. Each NHS provider should have a senior person accountable for information to patients and the public, and they should be supported by a well-resourced central hub. 

Using and promoting the NHS Constitution 

The renewed Constitution could be a flagship for these new approaches and pledges – but this requires a bold commitment to a vision of a person centred NHS. The new government should embrace this opportunity to set out a transformative approach to restoring confidence in the service.  

Of course, it matters little what is written in the Constitution if people are not aware of it. At the last time of asking, in 2022, only 17% of patients and less than half (43%) of NHS staff said that they had heard of the NHS Constitution. Once changes have been made to the Constitution, the government should commit to a concerted communications campaign to create wider awareness of it, using it as a key resource in sharing a new vision – and enabling the public and the workforce alike to make active use of the person centred principles, values and rights enshrined within it.