NAVCA response to The NHS
Constitution:
A consultation on new patient rights
February 2010
NAVCA (National Association for Voluntary and Community Action), The Tower, 2 Furnival Square, Sheffield S1 4QL
Tel 0114 278 6636 ● Fax 0114 278 7004 ● Textphone 0114 278 7025 ● navca@navca.org.uk ● www.navca.org.uk
Registered charity no. 1001635 ● Company limited by guarantee ● Registered in England no. 2575206 ● Registered office as above
NAVCA
The Tower
2 Furnival Square
Sheffield S1 4QL
Tel 0114 278 6636
Fax 0114 278 7004
Textphone 0114 278 7025
navca@navca.org.uk
www.navca.org.uk
Registered charity no. 1001635
Company limited by guarantee
Registered in England no. 2575206
Registered office as above
NAVCA is the national voice of local third sector infrastructure in England. We aim to ensure
communities are well served by the local third sector by supporting our members and their work
with over 160,000 local groups and organisations. NAVCA believes that local voluntary and
community action is vital for healthy and inclusive communities.
We provide our members with networking opportunities, specialist advice, support, policy
information and training. NAVCA is a vital bridge between local groups and national
government.
Our specialist teams take a lead on the issues that matter most to local third sector
infrastructure organisations. We influence national and local government policy to promote local
voluntary and community action.
For more details about the full range of ways that NAVCA can help you please go to
www.navca.org.uk or call us on 0114 278 6636.
Should a right in respect of waiting times be established and included in a revised NHS
Constitution?
If so, should the right include:
•
the current standard for treatment within 18 weeks?
•
the current standard for urgent referrals of suspected cancer to be seen by a
specialist within two weeks?
NAVCA strongly agrees with a right in respect of waiting times being established and included
in a revised NHS Constitution for both the current standard waiting time of 18 weeks and 2
weeks for urgent cancer referrals. However, we have two additional concerns. Firstly, that those
patients under the long term care of a consultant are not disadvantaged and end up having to
wait longer to see a consultant because the emphasis is on first appointments. Secondly, if an
18 week target is missed or is in danger of being missed resulting in an alternative quicker
appointment being sought for a patient by their PCT or the service provider, the patient should
not lose out. It should be written into the obligations of the PCT or service provider that the
patient is adequately supported in terms of acquiring appropriate additional transport, care
arrangements or other facilities that would not have been necessary if the original appointment
had gone ahead. The cost and practical implications of any additional arrangements should be
entirely borne by the PCT or service provider in this case.
Should GPs provide specified information to patients on their rights around a two week
referral?
Yes, NAVCA strongly agrees that information should be provided on patients’ rights to wait no
longer than 18 or 2 weeks. We believe that this information should be as clear as possible. It
should explain who the patient can contact to find out when their appointment will be due, what
rights they have if the targets are not met and how they will be supported if an alternative
quicker appointment needs to be arranged for them.
NAVCA’s members have connections with a large number and range of patient groups in local
areas, particularly those from communities which statutory organisations find hardest to reach.
Our members are therefore ideally placed to help promote awareness of these new rights, how
patients will be able to use them and what they should do if things go wrong. Many of our
members are also LINks host organisations, therefore have particularly strong health and social
care networks. However, other member organisations are small and under-resourced and would
need appropriate resources to enable them to raise awareness of the NHS Constitution, either
from their local PCT or through national NHS Constitution development support.
Do you agree that a right to a NHS Health Check every five years for those aged 40–74
should be established, with effect from April 2012, and be included in a revised NHS
Constitution?
Yes, we would support the right to a NHS Health Check every five years, provided this is
promoted in a way which targets those in higher risk groups. This includes those who are most
likely to need a check, and those groups and communities who are least likely to take up the
opportunity or visit their GP.
Do you agree we should explore potential future rights for patients and the public in the
areas set out in Chapter 3?
Evening and weekend access to GPs
NAVCA commends the NHS’s existing emphasis on improving ‘out of hours’ and ‘walk-in’
access to medical support. We strongly agree that future rights should be established for
patients to have greater and more flexible evening and weekend access to GPs, and at a
location of the patients choosing. At the same time we are concerned that this new flexibility
could have potential negative effects for patients, which must be addressed as new and
additional services are being put in place.
These concerns include firstly, the availability of patient records and background information to
any appropriate medical staff, particularly if the patient is receiving treatment or advice from a
service other than their normal surgery or by ‘out of hours’ staff. Secondly, if follow up treatment
or community support is needed to be accessed in a different area from where the patient
received the original diagnosis or treatment plan, we believe there needs to be an improvement
in services. These improvements needed are in communication, access to services and coordination between different services. Lastly, great anxiety or stress can be caused for patients
with ongoing chronic or long term conditions who have to see unfamiliar medical staff. This is
because of the variety of ideas those patients can encounter about treatment regimes, varying
awareness of conditions or understanding of patients ability or right to make decisions about
how they should be treated.
NAVCA is concerned that the potential for these situations to arise will be greatly increased if
greater flexibility in access to medical support is made available. To combat this we believe
there needs to be radical improvement in training and awareness of all staff within the NHS who
have any level of patient or carer/family contact, not just clinical and administrative staff. This
should ensure patients are treated with dignity and respect and that any thoughts, suggestions,
ideas or wishes they have about the way they wish to be treated, are respected and upheld
wherever possible.
NHS dentistry
NAVCA welcomes the intention to extend NHS dentistry to anyone who might need to access it.
NAVCA members tell us that access to NHS dentistry is particularly difficult for those people
who do not live stable lives, have no fixed address or who cannot get into the large number of
physically inaccessible premises. Consequently we further hope that this right will include
addressing the needs of those people who need to access mobile or more flexibly accessible
dentistry services.
Personal health budgets
NAVCA supports the idea of extending existing personal budgets for social care into health
care. Our recent joint submission with Regional Voices outlines our ideas on how this scheme
should work in detail. However we look forward to seeing how the pilot projects progress. In
particular we wish to see how local voluntary organisations are involved in supporting patients
to make the most of personal health budgets, while also ensuring that they receive appropriate
opportunities to provide services to patients receiving the payments. It is a key role of NAVCA’s
members to provide support to local frontline voluntary organisations to engage with this work,
so we hope that the pilots will provide an adequate level of resources to allow our members to
provide this support.
Choosing to die at home
NAVCA agrees with the principle of establishing a right to choose to die at home, but we also do
not underestimate the developments needed to be able to put this in place effectively. We are
conscious of the need for NHS staff to be skilled in dealing sensitively with difficult issues to
support good quality end of life decision-making, which respects the emotional needs,
preferences and cultural beliefs of patients and their families.
Do you agree the role of the Constitution Champion should be determined locally by
PCTs?
NAVCA supports the role of Constitution Champion being established within PCTs. We agree
that how this role operates should be determined locally to reflect local structures. However, we
also think there should be national statutory guidance to support this role. This guidance should
set out the expectations placed on the Champion and the level within the organisation that the
Champion should already hold in their substantive post. It should also ensure local ringfenced
resources are in place to enable Constitution Champions to promote the constitution locally,
ensure local people are aware of their rights and responsibilities and ensure there are the
appropriate resources and mechanisms to support people who find their rights under the
constitution have been not been met.
Do you think there are any particularly important aspects of the role?
As noted above NAVCA believes that the constitution will only be effective if resources are
available locally to ensure that:


it is widely promoted and understood within local communities
local people are aware of their rights and responsibilities

appropriate resources and mechanisms are in place to support local people effectively if
they find that their rights under the constitution have been violated or have failed to be
met.
If appropriate resources were made available, NAVCA members could greatly assist the local
NHS in achieving these aims. This is because it is their role to support local voluntary
organisations that provide direct services, advocacy, advice and campaign support to local
citizens, particularly those individuals and communities who statutory organisations traditionally
find hard to reach.
NAVCA’s members support local voluntary organisations in co-ordinating feedback from
patients and the public on a variety of topics essential to improving the health of local
populations on a range of statutory organisations boards, joint planning structures and overview
and scrutiny activities. Because of these existing responsibilities, local connections and
involvement in strategic level health and social care structures, our members and the
organisations they support are ideally placed to help local and national NHS bodies monitor the
effectiveness and impact of the constitution locally and to suggest further developments to
promote its increased effectiveness over time.
Thirty percent of Local Involvement Networks (LINks) are hosted by NAVCA members.
Consequently these members are in a particularly strong position to be able to support local
people in understanding and ensuring their rights under the constitution, as well as supporting
community and patient groups to feed back about the operation of the constitution to health and
social care bodies.
Implications for funded third sector organisations
It is clear that third sector organisations providing NHS services under contract will be required
to take account of the NHS Constitution in their decisions and actions. However, the
implications are less clear for third sector organisations which are funded in other ways by NHS
bodies, or which are funded to deliver other types of services, such as information and advice.
These organisations may be funded through grants, rather than under contractual
arrangements. It would be helpful for the Department to provide clarification as to the
application of the NHS Constitution to funded third sector organisations which are not delivering
NHS services as such and those which are funded through grants rather than contracts.