NHS Constitution VSS POLICY BRIEFING

Transcription

1 VSS POLICY BRIEFING NHS Constitution The implications of the NHS Constitution for voluntary and community organisations who are delivering - or want to move into delivering - public services for children and young people

2 CONTENTS INTRODUCTION... 3 BACKGROUND... 3 THE PRINCIPLES & HOW THEY AFFECT THE THIRD SECTOR... 4 PATIENTS AND PUBLICS RIGHTS & RESPONSIBILITIES AND HOW THESE AFFECT TSOS... 5 PLEDGES... 6 VALUES... 6 THE HANDBOOK... 7 COMMISSIONING... 7 STATEMENT OF ACCOUNTABILITY... 8 SUMMARY... 9

3 INTRODUCTION This briefing seeks to highlight the key implications of the NHS Constitution, and its accompanying reports for third sector organisations (TSOs) in delivering services for children and young people. As such, it addresses the key areas of delivery of this important document both locally and nationally - and presents opportunities whereby TSOs can contribute to this delivery or ensure the principles that the Constitution aims to enshrine are woven through their activity. BACKGROUND The NHS Constitution was a key recommendation to come out of the report High Quality Care For All (2008) by Lord Darzi. A year-long process of consultation with clinicians, other NHS staff, patients and members of the public informed this report. It marks the 60 th Anniversary of the NHS, celebrates the achievements of the NHS and its provision of free healthcare for all, as well as making some recommendations for further improvements and modernisation. Darzi s priorities are i) to ensure a high standard of care from the NHS across the board (i.e. to remove variations in care quality); and ii) to work with and overcome the changes and challenges that the 21 st century is likely to bring society and health care systems around the world such as technological developments, advances in treatments etc. Darzi recommended an NHS Constitution which secures the defining features of the service for the next generation [and] help patients [understand] their legal rights they have in relation to the NHS. The Constitution is the first of it s kind in England. It establishes the principles and values of the NHS, the rights to which patients, public and staff are entitled and pledges which the service aims to achieve. It is published with a Handbook which essentially reiterates the Constitution the first part of which is for patients, and the second part is for NHS staff as well as a Statement of Accountability, which describes the system of responsibility and accountability for decision making in the NHS. The Health Act 2009 legislates for all NHS organisations to take account of the Constitution in performing their functions. It also stipulates that the Constitution remains available to all and is reviewed every 10 years (with the Handbook reviewed every three years).

4 THE PRINCIPLES & HOW THEY AFFECT THE THIRD SECTOR Outlined at the start are principles which guide the NHS. The NHS should: 1. Be available to all with extra attention paid to groups or sections of society who fair worse than others. 2. Be accessible to all based on need, irrespective of ability to pay 3. Provide high standards, good quality 4. Reflect needs and preferences with patients involved in decisions 5. Work across organisational boundaries in partnership with others 6. Deliver best value 7. Be accountable to the public (the way decisions are made is described in the Statement of Accountability) TSOs share many of these principles, which should facilitate joint-working; particularly in light of the fifth principle above. One of the features of many TSOs is how closely they work with local communities and their subsequent knowledge of need. Public health initiatives need to reach marginalized communities which public services find hard-toreach. Within such communities, there is often a TSO already connected with the local people who can work in partnership with the NHS to deliver health promotion activities, such as smoking cessation, breast feeding promotion, sports, vegetable-growing schemes and others. In addition, TSOs can support the NHS in garnering the views and preferences of children and young people who are patients and their families. This will help form a joint decision about care and treatment fulfilling principle four above. Often, children and young people will find it easier to give their views to someone who isn t involved in their medical treatment, and TSOs can promote themselves to NHS organisations as a facilitative partner in helping to gather such views. The Handbook specifies how this Principle can be worked through reminding us of the legal duty on NHS organisations to involve people and their representatives in decisions about services, the monitoring of how PCT s report back publicly on how they respond to local views, and other policies, such as

5 LINks 1 (Local Involvement Networks) and Local Authorities power to scrutinize local health services 2. The fifth principle that guides the NHS is to work across organisational boundaries and in partnership with other organisations. The third sector is specifically mentioned in this principle of the Constitution at both a national and local level which gives a clear indication that the government recognises that health improvements cannot be delivered by the NHS alone, but that must be delivered through partnerships. As has already been described, TSOs are in a unique position in being well-connected to local communities. In addition they often provide innovative and participatory services. Without being overlyrestrained by legal duties, or government directives, TSOs are invaluable in their ability to pilot different methods of service delivery and to innovate in working towards improving outcomes for children and young people. For example Family 3 Intervention Projects were started by TSOs, employing health visitors, psychologists, housing officers and other professionals, and are now being rolled out nationally. PATIENTS AND PUBLICS RIGHTS & RESPONSIBILITIES AND HOW THESE AFFECT TSOS This part of the Constitution sets out what patients and the public have a legal right to from the NHS, as well as a set of pledges that the NHS is making. These pledges aren t legally binding, rather they are NHS commitments. It also describes patients and the public s responsibilities. Rights described include: Access to receive services free of charge, not to be discriminated against, and to expect the local NHS to assess health requirements of the local community and plan in accordance with this. To be treated with a professional standard of care, by qualified staff in a registered organisation and for the quality of provision to be regularly monitored. To drugs and treatments that have been recommended by NICE 4 ; to have local decisions on funding (or not) of other drugs and treatments based on proper evidence and to be transparent; and to receive vaccinations as per the national immunization programme 1 Local Government and Public Involvement in Health Act Health and Social Care Act Respect Unit, Home Office 4 National Institute of Clinical Excellence

6 To accept or refuse treatment, to be given information about treatment in advance (including risks), privacy and confidentiality including keeping information about people safe and secure, to access your own health records To choose your GP practice, and be accepted by them unless there are reasonable grounds to refuse, to express preference for using a particular doctor, to make other choices about ones NHS care (being developed over time). To be involved in discussions and decisions about your own healthcare as well as in the planning and delivery of healthcare services across the community. To have complaints dealt with efficiently, and the outcome to be made clear, to take complaints to the Health Service Ombudsman, to judicial review, or seek compensation. Responsibilities include: Taking personal responsibility for own and families good health Registering with a GP Treating NHS staff and other patients with respect Providing accurate information about your health, condition and status Keeping to appointments Following course of treatment Participating in public health programmes, e.g. vaccinations Giving feedback about your care PLEDGES This section details NHS staff s rights and responsibilities, wherever they re working including in third sector or private organisations. These are, as should be expected, according to modern employment principles, and include staff s responsibilities in accepting professional accountability and maintaining their professional standards. NHS staff working within TSOs are therefore expected to be open with children and young people and their families and to listen to feedback and address concerns where they exist. There are a number of situations where staff employed by the NHS are delivering services through TSOs for example contraceptive and sexual health services (CASH) offered through voluntary youth clubs, or drug education offered within voluntary football clubs. These roles and responsibilities are important for staff working within the third sector, as well as third sector managers, to be aware of. VALUES The Constitution ends with a set of values by which to guide the NHS. These are: i) Respect and dignity ii) Commitment to quality of care

7 iii) Compassion iv) Improving lives v) Working together for patients, and vi) Everyone counts Providing greater transparency over these values, as well as the principles and the operations to deliver them, ensures everyone can review whether or not they re being delivered. Where they aren t, or an injustice is identified, the Constitution will provide the authority to set this right. THE HANDBOOK This document essentially fleshes out what s in the Constitution and applies it to staff, patients and stakeholders. It also links to existing responsibilities of the NHS and patients and highlights common themes. It also clarifies the legal underpinning of the Constitution, in that all NHS organisations, as well as third sector and independent organisations providing NHS care, should be legally required to take account of the NHS Constitution in performing their NHS functions. Such provision would apply to TSOs where the NHS has clearly commissioned a third sector organisation to perform it s functions such as proving mental health care in schools, or respite care for disabled children in their homes. This would not apply to general workers within a TSO who may be providing health-type services as part of their role. For the duties to apply, there would need to be a clear contract with the local NHS organisation, which from January 2010 would no doubt mention the Constitution and the need to have regard to it. In instances where no formal contracts are in place between the NHS and TSOs, it is recommended that those TSOs providing health-care type services are familiar with the Constitution not only to empower families using their services with information about it, but also to work with the same ethos as the valuable principles the Constitution enshrines. COMMISSIONING World class commissioning is transforming the way the NHS commissions services from all providers, including the third sector. It ensures that the NHS operates in a business-like way, meeting its goals in the most effective and efficient manner that represents best value for money. In practice it means a tightening of commissioning cycle processes including needs assessment and contract development. TSOs providing NHS services can expect a very different relationship with their commissioners in the future which will include the need to meet the demands of the new NHS Constitution. TSOs who can demonstrate that they re working to the principles of the Constitution will be far more likely to

8 benefit from successful partnerships with NHS organisations than those that can t. World class commissioning and the NHS Constitution will make working with the Children s Trust and other partnerships easier for the VCS as there is now much greater transparency as to the functions of NHS organisations. STATEMENT OF ACCOUNTABILITY This describes the system of responsibility and accountability for taking decisions in the NHS giving a summary of the current structure and functions of the English NHS. The NHS currently spends around 100 billion per year nearly 2000 per person in the country. PCT s are responsible for commissioning services using the majority of these funds. Provider services include: hospital trusts, mental health trusts, GP practices, dental practices, community pharmacies, ambulance trusts, and NHS direct. The independent sector and third sector also provide NHS services. All providers are held to account by the PCT through contractual arrangements and by the regulators (the Care Quality Commission and professional bodies). Strategic Health Authorities are the regional NHS and are responsible for overseeing the performance of PCTs. The NHS is also accountable at a local level through a range of mechanisms many of which have been described above. These include the legal duty NHS bodies are bound to, to involve people who use health services in decisions about those services. It also includes NHS foundation trust membership (a board of governors), LINks, and Local Authority overview and scrutiny committees.

9 SUMMARY 1. The NHS Constitution is a landmark development and will make working in partnership with the NHS more transparent and easier. 2. The Constitution will empower children, young people and families by providing better information about its services, as well as the standard of care that can be expected. 3. TSOs looking to deliver NHS services will be better informed about the priorities and policies of the NHS by familiarising themselves with the Constitution this will ensure a clearer route to becoming a commissioned provider should a TSO wish to provide NHS services. 4. TSOs are in a unique position to be able to test or pilot innovative health services particularly health improvement services as they aren t subject to the same legislative boundaries as the NHS. 5. The NHS recognises that TSOs often have strong relationships with local communities and therefore should consider commissioning TSOs to support them to meet their duties in using (and reporting back on) the views of the public. 6. The Constitution makes clear the service patients should expect to receive from the NHS. TSOs can work with local recipients of NHS services to ensure these standards are delivered locally, and where they aren t, work with local, regional and national bodies of the NHS to amend this.