How ready are we for the NHS constitution? Subject to the Health Bill being passed, all providers of NHS services will be under a legal duty to have regard to the new contract. Legal duties already in law will have to be fulfilled too and we will need to work to bring the pledges to life.
However, the real prize with the constitution is not the legal minimum it establishes, but the ambition it inspires - an ambition to achieve high quality services and improve them through new relationships between leaders and staff, and between staff and the public. It is not simply about staff engagement, repeating old messages or gimmicks that will not last, it is about fundamental change and partnerships that work. It is about a change in the deal, a change that frees staff to provide services that work, but also allows them to be held to account by local people.
For this to be more than mere rhetoric it needs to happen alongside the difficult challenge of equipping communities to shape local services confidently, and of empowering staff to challenge the status quo.
It will require leadership, partnership and sustained commitment from everyone across the service and for changes to happen nationally. The National Quality Board, the National Leadership Council and policies around innovation, commissioning and education are already starting to foster these changes.
What does it mean for you? This is about staff who are committed, trained and honoured, and working in a relationship with their organisations where they can take real ownership for quality towards a vision that puts patient care at its centre. It is also dependent on the skills of employees and how they live the NHS values.
The vision around staff in the constitution is clear: “All staff should have rewarding and worthwhile jobs, with the freedom and confidence to act in the interest of patients. To do this they need to be trusted and actively listened to. They must be treated with respect at work, have the tools, training and support to deliver care and the opportunities to develop and progress.”
Respect and dignity
This is a bold aspiration that challenges the way we build ownership, empower patients and communities, and demonstrate commitment to the development of staff. As Work Foundation chief executive Will Hutton said: “No other British organisation analogous to the NHS has gone this far”.
To deliver this, the constitution makes pledges to staff: an NHS-wide commitment to provide high quality workplaces designed with staff so they can provide high quality care for patients. All NHS employees should have clear roles and responsibilities, rewarding jobs, personal development and support to succeed, good health and wellbeing as well as being empowered to improve services. It is through all these things that we can increase how we value and respect staff so they report back through the staff survey that the system gets in their way less often.
The pledges and principles are supported by a set of NHS-wide values. These include treating colleagues and patients with respect and dignity. Organisations are also developing their own values drawing on national values but based on their own local spirit and purpose.
Staff legal rights have been brought together for the first time, and to reiterate the mutuality of the relationship the constitution also outlines the legal duties of staff members and the responsibilities of patients.
We are acting fast to deliver a system that enables the constitution. The levers that NHS trusts respond to are being transformed to promote the rights, responsibilities and pledges. For example, for staff, the Care Quality Commission’s annual review pulls directly from survey responses on delivery of the pledges. For patients we are developing NHS terms of business to ensure providers reflect the constitution in the services they deliver.
Higher quality care
Research conducted just before the constitution was launched this year showed that even then, almost half of NHS staff were aware of it. Our next challenge is to build confidence among them to really understand and respond to the aspiration of the constitution. As we have seen above, with this message comes responsibility.
Staff need to understand what the constitution means to them. But it is equally important they are able to answer any questions patients might have about rights and responsibilities, and the pledges their organisation is committed to delivering.
With this understanding, staff will be able to develop the new relationships that are required to achieve the visions of the next stage review for higher quality care for all, within the values the NHS constitution outlines.
Clare Chapman is NHS director general of workforce.