Recommendation 4

Prioritising patients in the NHS Constitution

The core values expressed in the NHS Constitution should be given priority of place and the overriding value should be that patients are put first, and everything done by the NHS and everyone associated with it should be informed by this ethos.

In the statement of common purpose, all the leaders of the health and care system have personally committed to the values of the NHS Constitution.

The Constitution sets out the following values for the NHS:

  • working together for patients and dignity
  • commitment to quality of care
  • compassion
  • improving lives
  • everyone counts.

The Constitution notes that these values should underpin everything the NHS does and ‘provide common ground for co-operation to achieve shared aspirations, at all levels of the NHS’.

In response to this recommendation, the Department of Health brought forward the values section in the updated constitution, published on 26 March 2013, so that it appears early in the document, and re-ordered the values so that they start with ‘working together for patients‘.

The text of this value explicitly states that ‘patients come first in everything we do.’  The work we are currently undertaking with stakeholders to increase awareness levels of the constitution, as well as increase its impact, seeks to ensure that everyone is informed by the ethos that patients come first.

The government notes that principle 4 of the Constitution currently states that ‘the NHS aspires to put patients at the heart of everything it does.’  The Department of Health will consult on how this statement might be strengthened when we next update the constitution.


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.