Recommendation 7

Staff commitment to the NHS values and Constitution

Accepted in principle
All NHS staff should be required to enter into an express commitment to abide by the NHS values and the Constitution, both of which should be incorporated into the contracts of employment.

It is important that employers are able to recruit and retain the caring and compassionate staff the NHS needs. NHS Employers will support NHS organisations in developing and strengthening local policies and guidance so that there is a clear link between the values in the NHS Constitution and their own local values.

The Department of Health will commission NHS Employers to support NHS organisations in strengthening  local policies on appraisal and performance management are strengthened so that there is a clear line of sight between the NHS values, the Constitution and performance and appraisal systems.

Steps have already been taken to improve performance and appraisal systems and agreement has been reached that, with effect from March 2013, pay progression will be linked more strongly to performance for the 1.1 million staff on Agenda for Change pay, terms and conditions.  The agreement makes clear that:

  • employers must reference the NHS Constitution in local performance arrangements
  • knowledge and experience are not the only factors which employers should considerer when they develop local performance standards
  • employers now have the flexibility to consider not only what staff do for patients, but how they care for patients, encouraging the right behaviours and values.

Staff appraisal is a critical part of staff performance and should be used to hold staff to account on how their behaviour demonstrates the values of the NHS and/or their organisation.  The evidence shows that where staff performance is regularly and effectively reviewed, outcomes for patients are better.


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.