Arthritis Care responds to the NHS Constitution

Arthritis Care has this month responded to the Department of Health's consultation on the NHS Constitution.

The proposed Constitution outlines a series of principles and expectations that will guide how the NHS provides services for the public.

It includes principles such as "the NHS aspires to high standards of excellence and professionalism"; "NHS services must reflect the needs and preferences of patients, their families and their carers"; and "the NHS works across organisational boundaries and in partnership with other organisations".

Arthritis Care welcomes the formal establishment of these and other principles and will be monitoring the progress of the Constitution as it is finalised in response to the consultation.

You can find more information on the NHS Constitution by clicking here.

You can read the text of Arthritis Care's response below.

Arthritis Care

Response to the NHS Constitution consultation

Arthritis Care is the UK’s leading user-led organisation benefiting people with arthritis. Our mission is to offer the nine million people with arthritis in the UK the information and support they need to make informed choices about managing their arthritis, to reach their potential in society and participate in their communities.

Arthritis Care broadly welcomes the proposed NHS Constitution. Establishing a set of principles that will inform what service-users and the public can expect from their health service could make an important contribution to ensuring effective, universal, and patient-centred healthcare.

In particular, Arthritis Care welcomes the following principles:

• (4), that accepts that service-users must be centrally involved in their care pathway;
• (5), that acknowledges the role of third sector organisations in improving health outcomes; and
• (7), that identifies the importance of clear lines of accountability in ensuring that the needs of service-users and the public are met, regardless of condition or location.

Meeting the needs of people with arthritis

People with arthritis need to regularly access health services and in many cases will do so for a very large portion of their life. Examples of good practice can be found, in both supporting people with arthritis to manage their condition and in offering effective and timely treatment, but are by no means universal.

Where it does exist, health outcomes can be substantially improved and often provide benefits to the local health economy through savings to the health service, reduced co-morbidities and work retention. Ensuring that appropriate levels of care and support is available to all people with arthritis would be a substantial, and proper, benchmark for an NHS Constitution.

The following issues, however, must also be addressed to meet the needs of people with arthritis:

• Standards: The NHS Constitution represents an important opportunity for guaranteeing minimum standards of care. Health services for people with arthritis are extremely variable, with PCT spending on musculoskeletal conditions ranging from £15 million down to £1.9 million per 100,000 people. This is particularly relevant to the provision in the constitution that “You have the right to expect NHS organisations to monitor, and make efforts to improve, the quality of healthcare they provide, taking account of the applicable standards”. People with arthritis should have the right to expect services that are closely comparable across England and access to healthcare that meets the highest clinical standards.
  Instilling confidence that the Constitution will empower service-users and the public to demand minimum, high quality, standards would be better achieved within a legal framework.
• Information: Information is an extremely important element of managing arthritis. Existing provision of information for people with arthritis, and the support to use it, is poor and resources such as Arthritis Care are under-utilised. The Constitution says “the NHS will strive to offer you easily accessible information to enable you to participate fully in your own healthcare decisions and support you in making choices”. Arthritis Care believes this should be afforded the same status as the “rights” elsewhere in the constitution. This is particularly important in light of the benefits that good information can offer people with arthritis, the role it plays in managing arthritis and the contribution it can make to empowering service-users, identified as a key objective of the constitution.
• NICE: The Constitution sets out to remind people of their right to drugs and treatments approved by the National Institute for Health and Clinical Excellent (NICE). As the consultation document notes, PCTs already have a statutory responsibility to implement NICE guidance. Arthritis Care would like to see this provision strengthened through the Constitution. The right to have the drugs and treatments should, indeed, be restated, but the right to expect your local health service to be proactive in implementing NICE guidance should also be included. This would be similarly strengthened within a legal framework.
• A comprehensive service: The Constitution sets out the principle that the NHS should provide a comprehensive service to all. It is important that what constitutes comprehensive is clear and meaningful. People with arthritis need access to a range of services, including hydrotherapy, physiotherapy, and pain clinics etc. People with arthritis should be assured that the established benefits of these services are included within what local health providers consider to be a comprehensive service and to provide the appropriate resources to support their use.
• Engagement with the third sector: Identifying the role of the third sector in helping to support service-users and improve health outcomes is an extremely positive step. Arthritis Care would hope that appropriate resources are provided to match the increased demand of utilising the third sector and ensure that the quality of services is not compromised.
• Health data: In order for the NHS to make a meaningful assessment of health needs, as identified under “Access to healthcare services”, the nature and scope of data collection should also be assured within the Constitution. Service-users should expect that robust health data, which comes from both primary and secondary care settings and includes all long-term conditions, is actively collected and made available to service providers.