The Teeth in the NHS Constitution

Many of the patient rights in the NHS Constitution will remain meaningless and lack ‘teeth’ unless new arrangements are put in place to support them, according to National Voices, the health and social care charity coalition.

In there new report, The Teeth in the NHS Constitution, the coalition states that for people to achieve their rights, each right needs:

• a robust evidence base to monitor the extent to which the right is being achieved;
• links to audits and patient surveys to check that NHS organisations are implementing it;
• clear communication so that patients themselves know about and understand their right; and
• a clear single route to redress if the right is not being achieved.

National Voices used literature reviews and a comprehensive survey of patient groups and organisations to try to establish whether people are achieving one of the clearest rights in the NHS Constitution, the right to receive clinically appropriate treatments that have been approved by NICE (the National Institute for Health and Care Excellence).

The patient groups surveyed reported that people in England are experiencing barriers to NICE-approved treatments, with at least 4,925 in the previous 12 months, according to the responses). However, reporting is hampered by widespread confusion among patient groups about what the right consists of, and what NICE-approved treatments are.

The barriers reported by patient groups included differing interpretations of NICE guidance generally; differing interpretations of NICE guidance by clinicians; bureaucratic delays; and prescriber policies which favour cheaper alternatives.

The principal barriers identified in the research literature related to systemic weaknesses in some NHS organisations that prevent or delay the implementation, including:

• failure to anticipate and absorb new guidance;
• lack of awareness and dissemination of new NICE recommendations through organisations;
• inability rapidly to provide the necessary staff, facilities or equipment for implementation; and
• failure to audit, review and change practice at the clinical level, and to tackle areas of non-compliance. 

However, a key conclusion overall is that they cannot actually tell how many patients are achieving this right, or the extent of any barriers in their way, because the information on them isn’t good enough. Other rights in the Constitution may suffer from the same issue.

To read the full report, which also offers a number of recommendations on NICE-approved treatments, visit www.nationalvoices.org.uk/sites/www.nationalvoices.org.uk/files/the_teeth_in_the_nhs_constitution_24-5-13_final.pdf.