Recommendation 5

Expectations in the NHS Constitution


In reaching out to patients, consideration should be given to including expectations in the NHS Constitution that:

  • Staff put patients before themselves;
  • They will do everything in their power to protect patients from avoidable harm;
  • They will be honest and open with patients regardless of the consequences for themselves;
  • Where they are unable to provide the assistance a patient needs, they will direct them where possible to those who can do so;
  • They will apply the NHS values in all their work.

The NHS Constitution already addresses some of the issues highlighted in this recommendation, and when it is next updated the Department of Health will consult with stakeholders on how to best reflect other issues.

We agree that staff should be honest and open with patients, and the Constitutionalready makes clear that these are staff responsibilities.  The Constitution also includes an expectation that staff will raise concerns early, in the public interest about risk, malpractice or wrongdoing (such as a risk to patient safety, fraud, or breaches of patient confidentiality) and a pledge that their employer will support staff to raise these concerns and act upon them.  In addition, we are introducing a statutory duty of candour on all heath providers, making it a requirement for them to be open and honest where there have been failings in care (see recommendations 174 and 181 for more on our response about openness and candour).

We agree with the principle that patients should come first in everything the NHS does, and this is explicitly stated in the Constitution.  We do not propose to include the more explicit wording ‘staff put patients before themselves’ suggested by the inquiry, as we have heard concerns from stakeholders that such an expectation may also have a negative impact on staff safety and wellbeing.

 The Constitution also already states that its values should underpin everything the NHS does.

We agree with the importance of protecting patients from avoidable harm. The Constitution already includes an expectation that staff will raise concerns early, such as a risk to patient safety; however, there is scope to further reflect the issue of staff protecting patients from avoidable harm.  More broadly, as part of their code of conduct, regulated healthcare professionals already have a duty to comply with standardised procedures that protect patients from avoidable harm. Other work to help protect patients from avoidable harm includes introducing the new fundamental standards of care which will set out the level below which care should not fall (refer to the responses to recommendations 13-18 for more information), and ensuring that the NHS takes a zero tolerance approach to all healthcare associated infections (refer to the response to recommendation 107 for more information).

When the Constitution and the Handbook to the NHS Constitution are next updated, the Department of Health will consider, in consultation with stakeholders, how best to further reflect the importance of staff:

  • protecting patients from avoidable harm
  • directing patients to other sources of assistance, in situations where they themselves are unable to help.


Sir Robert Francis QC was clear in his Inquiry report that the principal message of the NHS Constitution should be that patients and their safety come first.  In Hard Truths, the Department of Health committed to strengthening the NHS Constitution to make this clearer for patients, staff and the public. To this end, The Government has launched a consultation into, amongst other things, refreshing the NHS Constitution to reflect the recommendations made by Sir Robert Francis QC. The key elements are:

  • duty of candour;
  • safe care and avoidable harm;
  • staff guidance, and;
  • a patient-centred NHS.