1. 1 ALBs duties in relation to the NHS Constitution 7 April 2014

2. 2 Fulfilling ALB’s duties in relation to the NHS Constitution What is the NHS Constitution? The NHS Constitution brings together in one place the rights and responsibilities of staff and patients when using NHS services. It also articulates the values and principles that underpin the NHS. The rights in the NHS Constitution are legal entitlements protected by law. All organisations that provide NHS services are bound by the law that underpins the NHS Constitution and required to (variously) have regard to the Constitution and promote it.

3. 3 What are the challenges? Awareness of the NHS Constitution is low 18% public recognition by name 45% staff recognition by name (The 2012 Report of the Effect of the Constitution) In 2012 the NHS Future Forum recommended that the Constitution needs to be given greater traction. The Francis Report stated that “the NHS Constitution should be the first reference point for all NHS patients and staff”. Nine of the report’s recommendations were dedicated to the NHS Constitution. The Government accepted these recommendations. Ministers invited an Expert Group to give advice on how to achieve this. In the Statement of Common Purpose (part of the Government’s response to the Francis Inquiry), health system leaders reaffirmed their personal and organisations’ commitment to the values set out in the NHS Constitution. Fulfilling ALB’s duties in relation to the NHS Constitution Patients and staff are not using it to improve their care

4. 4 What legal duties does SofS have? SofS must: Have regard to the NHS Constitution in exercising his functions in relation to the health service; Ensure that the Constitution continues to be available to patients, staff and members of the public; Carry out a review of the Constitution at least once in any period of 10 years (involving consultation of patients, staff, carers etc.); Carry out a review of the Handbook to the Constitution at least once in any period of 3 years; Publish a report every 3 years on the effect of the Constitution. Fulfilling ALB’s duties in relation to the NHS Constitution

5. 5 Which organisations have legal duties in relation to the Constitution? Duty to have regard: SofS and certain Executive Agencies (e.g. PHE) NHS England CCGs CQC & Healthwatch England NHS FTs Monitor Local Authorities NICE HSCIC Health Education England Health Research Authority Duty to have regard contd.: MHRA NHS BTA NHS BSA NHS LA NHS TDA HFEA HTA Duty to promote: NHS England CCGs Health Education England

6. 6 Fulfilling ALB’s duties in relation to the NHS Constitution Duty to have regard: All bodies must take account of the NHS Constitution in their decisions and actions. Organisations can depart from it, but only if there are good reasons for doing so (except from the rights which have independent legal standing). If challenged in court, organisations would be expected to demonstrate that they had taken the Constitution into account Duty to promote: Specific organisations must promote awareness of the NHS Constitution among patients, the NHS workforce and members of the public. This duty is external rather than internal facing Specific organisations must act with a view to securing that health services are provided in a way which promotes the NHS Constitution. What are these legal duties?

7. 7 What could fulfilling the duties look like in practice? Duty to have regard: Having a regular item on board meeting agendas Aligning policies and activities such as annual reports or surveys with the Constitution Building the Constitution into policy making Duty to promote: Awareness raising publicity campaign to workforce and patients Putting the Constitution in contract terms with providers Promoting the Constitution to bodies that receive NHS funding Incorporating the Constitution into medical training Fulfilling ALB’s duties in relation to the NHS Constitution

8. 8 What did the Expert Group recommend? The Expert Group made ten recommendations, all of which were accepted by SofS and MS(CS), including: Recommendation 2: For DH to hold system to account and for others with accountability measures to exercise to ensure all bodies are fulfilling their duties in relation to the Constitution. Recommendation 3: To effectively monitor the extent to which rights and pledges are being met, tapping into existing sources of evidence. Recommendation 4: For DH, NHS England HEE and CCGs to deliver a patient and staff facing campaign to raise awareness of Constitution. Recommendation 7: For NHS England to continue working with patients locally to define behaviours associated with rights and values Recommendation 8: For NHS England to support patients in understanding their responsibilities as well as rights Recommendation 9: For the Healthwatch network to formulate plans to bring the content of the NHS Constitution to life Recommendation 10: For the Department to reconsider the legal enforceability of the Constitution in 2015 when it next reports on its effectiveness. Fulfilling ALB’s duties in relation to the NHS Constitution

9. 9 Reporting arrangements NHS England developing system-wide strategy – working with other ALBs to write and deliver ALB CEOs to meet MS(CS) in six months Report of the effect of the Constitution – publicly committed to doing this in late 2015 and a legal requirement SofS annual report Further actions will have to be considered if ALBs cannot demonstrate progress Enthusiasm for a system-wide monitoring expressed by all ALBs – annual reporting going forwards Francis – 1 year on Fulfilling ALB’s duties in relation to the NHS Constitution

10. 10 Discussion How can sponsor teams support ALBs in implementing the duties and the Expert Group’s recommendations? What are the processes for holding them to account? What do you need from us to help you with this? Other questions/ points of discussion Fulfilling ALB’s duties in relation to the NHS Constitution

11. 11 Next steps Sponsor teams Constitution team Fulfilling ALB’s duties in relation to the NHS Constitution