The draft NHS constitution has stirred only apathy in many quarters.

Its collation of existing patient rights may look like motherhood and apple pie, but if the rights were achieved, the NHS could feel radically different to its users.

The constitution says patients should have the right to full information about all available treatments, and the right to be involved in discussions and decisions about their care.

Responses from three patient experience surveys which the Picker Institute co-ordinated for the Healthcare Commission in England show that for very many patients these rights are a long way from reality, with little improvement over time.

The first chart shows that in 2008, 30 per cent of primary care patients said they were not as involved in decisions as they wanted to be - just two points better than 2004. A whopping half (49 per cent) of all hospital inpatients in 2007 said they were not as involved as they wanted to be, worsening from 48 per cent in 2004.

New prescriptions

The most common treatment decision is the prescription of a new medicine. More than half of primary care patients got new medicines in 2008, but only 60 per cent felt as involved in the medication decision as they wanted to be. It matters crucially. The next-stage review says patient experience is central to quality. And at the heart of patient experience is informed involvement in decisions.

Information helps involvement. The second chart shows how being given good information about medicines helps patients to feel more involved in treatment decisions.

The majority of both primary care and inpatients who said they were as involved in decisions as they wanted to be also said they were told "completely" about the purposes and side-effects of their medicines (blue bars). Patients who were not as involved in decisions as they wanted to be said they were more poorly informed, especially about side-effects (red bars).

Involvement in decisions generates patient satisfaction. The third chart compares the levels of satisfaction of primary care patients, inpatients and recent users of maternity care. In each case, the more involved the service user, the higher their overall satisfaction with their care.

In this light, the rights in the draft NHS constitution should not be seen as irrelevant, but as a dramatic challenge to the NHS for the next 10 years of reform.

*081023/data briefing