How can our NHS Constitution help vulnerable people?

Professor Steve Field, Chair of the NHS Future Forum, asks how to raise awareness of the NHS Constitution among NHS staff so that it is at the forefront of everything they do

The NHS belongs to us all. The first of our NHS Constitution’s seven guiding principles states that the NHS provides a comprehensive service, available to all.

These are fine words. But sometimes the NHS fails to live up to this principle and excludes some of the most vulnerable people in our society, those whose circumstances may make it much harder for them to access services than for most.

Recently I visited a hostel where the wonderful person looking after the residents showed me a letter from her local general practice. That letter, on headed notepaper, told her that the practice only a few hundred yards away would no longer register any of the hostel residents because they didn’t turn up for appointments or comply with treatment. That made me very sad. Indeed, I was angry. As GPs, we must not turn away vulnerable people. Even if they are more demanding, we need to work with them. Clearly, the values and principles of the NHS Constitution were not being lived by that practice.

Clearly, the values and principles of the NHS Constitution were not being lived by that practice

The NHS Constitution should be at the forefront of all health professionals’ minds when commissioning and delivering services. We know that around a half of all NHS staff know about the NHS Constitution and that more needs to be done to raise awareness. Everyone working for the NHS should know that the NHS Constitution exists – and should espouse the principles and values it contains in their day-to-day work.

In my recent engagement work on the Constitution I’ve met a number of wonderful GP practices providing care for vulnerable people and numerous charities helping people, such as those who are homeless, to navigate the health system. I’ve been hugely impressed by the imaginative work of these organisations. This includes the Luther St Practice in Oxford, providing holistic primary care in difficult circumstances. I’ve also seen the work of St Mungo’s and Midland Heart, supporting people in London and the Midlands.

Another example is Groundswell, which aims to help homeless and vulnerable people take more control of their lives, influence services and play a full role in their communities. Groundswell’s work includes the innovative Homeless Health Peer Advocacy project. This trains people who were previously homeless, who have a greater knowledge of how to access health services, to offer one-to-one support to other homeless people, for example, by accompanying them to health appointments. Groundswell also wants to help health professionals meet the needs of homeless people more effectively. They believe that reducing inappropriate care for homeless people will in turn cut NHS costs.

If the NHS Constitution was at the heart of everything the NHS did, it would make health professionals think more clearly before they acted in a way that excludes people

Talking to those working in these practices, to charity workers and to homeless people themselves, I now have a better understanding of how valuable the NHS Constitution could be when helping people access services they have a right to receive. We are fortunate to have such dedicated people helping those who are most vulnerable in our society. But, while we need to raise the profile of the Constitution among those working with vulnerable people, we should not rely solely on these organisations to help navigate barriers that health providers often put in place. If the NHS Constitution was at the heart of everything the NHS did, it would make health professionals think more clearly before they acted in a way that excludes people – often unintentionally.

So, my question to you is: how do we raise awareness of the NHS Constitution among NHS staff so that it is embedded into their work and at the forefront of everything they do?

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2 Responses to How can our NHS Constitution help vulnerable people?

  1. Dr Theresa Eynon says:

    If all doctors read The Citadel by AJ Cronin http://en.m.wikipedia.org/wiki/The_Citadel_(novel) perhaps our idealistic leaders would realise that human behaviour isn’t changed by exhortation.

    We would have less need to rally the faithful to the banner of a belated ‘NHS Constitution’ if the public service ethos of the NHS had not been fractured by the unwarranted introduction of a flawed Act by a greedy Government.

  2. @MakeABetterOne says:

    Rather than trying to promote the constitution, would a simpler starting point perhaps be engendering a culture of respect for colleagues and patients? Introduce two or three minimum service standards (printed on a business card every health professional must keep on their person) and empower everyone to challenge their peers when they see these fail to be met. The first standard should be simple: “never bad-mouth a colleague or patient”.

    That might make it harder to consider groups who present challenges in a negative light and give us a way to manage those who fail to demonstrate a willingness to focus on the ideal outcomes for the vulnerable and work backwards to overcome the “how?” of accessibility