As outlined in our section The NHS: What’s happening?, the 2012 Health and Social Care Act is radically changing the NHS, including who manages the finances, who makes decisions about what services are available on the NHS, and who provides them. Inevitably these changes will have an impact on the end user – that is you, the patient.
It’s possible that you will find some changes are for the better. But reports coming in, even before the new arrangements are fully in place, describe cuts in services, delays, or restrictions on treatments or medication that your GP might have recommended in the past.
If you are worried about the impact that these changes may have on your care, or you want to challenge aspects of the NHS ‘reforms’ that effect you or your community, it’s important to be aware of your rights as an NHS patient. With this knowledge you will be in a stronger position to resist some of the changes you may face.
The following information is largely based on statements, reports and links found on NHS official websites. Please note that this information refers to the NHS in England. (The position in other countries in the UK can be checked on their own official websites.)
The NHS as a free and universal service.
Announcing a public consultation on the NHS Constitution (currently underway), the Minister of State for Care and Support, Norman Lamb, stated: “With this Government, the founding principles of the NHS – free at the point of delivery to all, regardless of their ability to pay – will not only be supported, but reinforced…… This government will always make sure [the NHS] is free to all, no matter your age or the size of your bank balance.”
A cynic reading daily reports of reduced NHS services, restrictions on treatments, GP surgeries being bought by commercial groups, cuts in staff, closure of hospital departments (if not whole hospitals), and the privatization of core services may find this hard to believe – but there it is, a clear statement by the government that it is committed to free, universal and first class healthcare provision for us all. We should hold them to it!
The NHS Constitution
The main document that sets out our rights as patients is the NHS Constitution. It outlines the core principles and values on which the NHS is based. It clarifies what we can expect from the NHS, and what is expected from us in return. It states our legal rights and the pledges that the NHS is committed to achieve. It is there to protect the NHS and ensure that it provides quality health care that is free and available for all.
(The Constitution is currently being reviewed. The consultation period ends on 28.1.2013. If you want to send comments, you can find details of who to contact on page 28 of the document at: https://www.wp.dh.gov.uk/publications/files/2012/11/Consultation-on-strengthening-the-NHS-Constitution.pdf .)
Under the current version of the Constitution, our rights include:
- Right of access to health services, including
o the right to NHS services free of charge (apart from limited exceptions such as fees for dentistry or prescriptions for some);
o the right to expect your local NHS to assess the health requirements of the local community and to commission and put in place the services to meet those needs as considered necessary.
- Rights to a quality of care and environment;
- Rights to nationally approved treatments, drugs and programmes;
- Rights to respect, consent and confidentiality (including the right to privacy);
- Rights to informed choice, including
o the right to choose the organisation that provides your NHS care when you are referred for your first outpatient appointment with a service led by a consultant;
- Rights to involvement in your healthcare and in the NHS; and
- Rights to making complaints and receiving redress.
You will find much more detailed information about what you are entitled to receive under the Constitution, including statements on core values, in the Handbook to the Constitution at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132959.pdf
When your rights are infringed
If your experience of the NHS infringes your rights under the Constitution (e.g. if you are refused or asked to pay towards services that patients in other areas can access for free), making a complaint could be a useful way of formally documenting what is happening to the NHS, as well as possibly giving you some redress.
The process for making a complaint is as follows (details of the organisations mentioned are given later):
1. As soon as possible, discuss your concerns directly with the organisation involved, such as your GP practice;
2. Alternatively, raise the matter with your Primary Care Trust (or, in future, with your CCG) that commissions the relevant service provider – you can find details of your PCT or CCG on NHS Choices (www.nhs.uk);
3. If you need further help, or don’t feel confident about either Steps 1 or 2 above, contact your local Patient Advice and Liaison Services (PALS);
4. If you have tried to resolve matters at a local level but remain unsatisfied, contact the Parliamentary and Health Service Ombudsman.
5. If all else fails, you can in some circumstances seek legal redress. You have the right to claim a judicial review, for example, if you feel that the Secretary of State or an NHS organisation have infringed your legal rights, as described in the NHS Constitution. (See http://www.publiclawproject.org.uk/AdviceGeneral.html for helpful information sheets about judicial review).
(You can also visit http://www.nhs.uk/choiceintheNHS/Rightsandpledges/complaints/Pages/NHScomplaints.aspx .
ORGANISATIONS THAT MAY BE HELPFUL
Patient Advice and Liaison Services (PALS)
PALS provide an identifiable person for patients to turn to when they feel the NHS is not delivering what they need. Working on behalf of service users/patients, there is a PALS office within every hospital to liaise with staff, managers and, where appropriate, other locally- or nationally-based support organisations. One of the advantages of PALS is that they should have direct access to the relevant Trust’s chief executive and the power to negotiate immediate solutions. Through the knowledge they gain about patient experience, they can also help bring about improvements to the way that services are delivered. You can find your local PALS office by visiting http://www.pals.nhs.uk/officemapsearch.aspx .
Independent Complaints Advocacy Service
The Independent Complaints Advocacy Service (ICAS) is free, independent and confidential. Its aim is to provide advocacy support for people who wish to make a complaint about the service, or lack of service, that they have had from the NHS. You can contact your local ICAS office through the hospital manager or PALS, or by phone on 0300 456 2370 or email to email@example.com.
The Parliamentary and Health Service Ombudsman.
The Ombudsman service is free and open to anyone. The Ombudsman investigates complaints that individuals have been treated unfairly or have had poor treatment from government departments or public organisations, including the NHS in England. You need to have tried to get your complaint resolved locally before approaching the Ombudsman. The service tries to put matters right and share the lessons learnt so that health services can be improved. For the Ombudsman Helpline, phone 0345 015 4033 or a complaints form can be downloaded from http://www.ombudsman.org.uk/make-a-complaint/how-to-complain/what-can-we-help-with
The Care Quality Commission.
The Care Quality Commission (CQC) was set up to regulate standards in hospitals and care homes, both NHS and private. Members of the public can read and compare CQC reports, for example when choosing a care home for a relative or gathering information as the basis for requesting referral for treatment. Although the CQC don’t deal with individual complaints, anyone with concerns about quality of care in hospitals or care homes can notify them. However, the CQC has been repeatedly criticized as ineffectual, with its performance so far described as ‘a failure’ (see http://www.bbc.co.uk/news/health-17553901). If you decide to contact them you can phone 03000 616161, email them at firstname.lastname@example.org or view their website http://www.cqc.org.uk .
The Citizens Advice Bureau
The CAB provides support and free, impartial advice across the country on the whole range of social, health and financial issues. It also regularly publishes reports and briefings based on CAB clients’ problems and this evidence is used to campaign for changes in government policies and services (for example see http://www.citizensadvice.org.uk/index/policy/policy_publications.htm) One of the CAB’s great strengths is its independence. But inevitably, at this time of social change and cuts, it is over stretched and underfunded and it may be difficult to get the range of services advertised on its website. Nevertheless the CAB is a highly respected organisation whose staff and volunteers have a huge range of knowledge and experience including on patients’ rights and dealing with problems connected with NHS treatment or care.
The CAB has 3,500 branches (see www.citizensadvice.org.uk for your local one), Advice and support is also available by phone 08444 111444. Or you can download their advice guides from www.adviceguide.org.uk . Advice Guides come in several languages besides English.
Feedback on your local services
As well as following the complaints process, it’s important to feedback what is happening to local services to
- organisations such as your local Healthwatch, (http://www.healthwatch.co.uk/about-us from April 2013);
- campaigning groups such as
- False Economy, which collects details of cuts across different service sectors including Health (see http://falseeconomy.org.uk) and
- The NHS Support Federation, which is collecting information on the impact of the Health and Social Care Act and the privatisation of services. (see http://www.nhscampaign.org/NHS-reforms/tracking-privatisation.html)
- Your Member of Parliament
- Your local paper
For more details of action you can take, see also our section Getting involved locally.