Recommendation 10

Staff compliance with guidance

Accepted in principle
The NHS Constitution should incorporate an expectation that staff will follow guidance and comply with standards relevant to their work, such as those produced by the National Institute for Health and Clinical Excellence and, where relevant, the Care Quality Commission, subject to any more specific requirements of their employers.

The NHS Constitution already sets out a legal duty for staff to ‘accept professional accountability and maintain the standards of professional practice as set by the appropriate regulatory body applicable to your profession or role’. This includes having regard to the relevant guidance or regulations of their regulatory bodies, and applies to staff in regulated professions. However, the Constitution does not include an expectation that all staff (whether in a regulated profession or not) should follow guidance and standards relevant to their work, nor does the existing provision in the Constitution encompass standards and guidance produced by non-regulatory organisations to which staff may be expected to have regard.

When the Constitution is next updated, the Department of Health will therefore consult on how best to reflect an expectation that staff will have regard to guidance, standards and codes that are relevant to their role. The Department will also consider how to reflect this issue in the Handbook to the NHS 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.