Consultation period on NHS Constitution starts

The Department of Health and Social Care has published its eight-week consultation on amendments to the NHS Constitution. The proposed changes form part of the statutory 10 year review which the Secretary of State is obliged to carry out under the Health Act 2009.

The NHS Constitution sets out the principles, values, rights and pledges underpinning the NHS as a comprehensive health service, free at the point of use for all who need it. We highlight some of the new and significant proposed changes to the NHS constitution. The changes reflect and reinforce amendments made in 2015 following the recommendations made in the Francis report.

  • Rapid Review: A new pledge based on ‘Martha’s rule’ for patients and the public under ‘Involvement in your healthcare and the NHS’

“The NHS pledges to provide patients (and their families, carers and advocates) who are in acute or specialist provider sites a structured approach to providing information about their or their loved one’s condition at least daily and if they have concerns about physiological deterioration that are not being responded to, access to a rapid review by appropriate clinicians from outside their immediate care team.”

  • Environment: A new pledge on NHS value and environmental responsibilities

“We play our part in achieving legislative commitments on the environment. We do this by improving our resilience and efficiency, while always prioritising value for money. We will never compromise standards of care or the needs of patients in pursuit of these targets.”

  • Culture: A strengthening of the commitment on leadership and the important roles that leaders and senior managers can play in creating “an open and fair culture”
  • Sex and Gender Reassignment

There are quite a few proposed amendments in this area:

A new pledge under the “Access to health services” to state that:

“Patients can request intimate care be provided, where reasonably possible, by someone of the same biological sex”

(Readers will know that same-sex care is recognised through accompanying CQC statutory guidance to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The guidance sets out how providers should act when providing intimate or personal care.)

New additional wording to the pledge on sleeping accommodation:

“if you are admitted to hospital, you will not have to share sleeping accommodation with patients of the opposite biological sex, except where appropriate. The Equality Act 2010 allows for the provision of single-sex or separate-sex services. It also allows for transgender persons with the protected characteristic of gender reassignment to be provided a different service - for example, a single room in a hospital - if it is a proportionate means of achieving a legitimate aim.”

New pledge under the “Access to health services” to make clear patients have a right to expect that NHS services will reflect their preferences and meet their needs, including the differing biological needs of the sexes.

“You have the right to expect that NHS services will reflect your preferences and meet your needs, including the differing biological needs of the sexes, providing single and separate-sex services where it is a proportionate means of achieving a legitimate aim.”

  • Carers and Volunteers

New pledges to better recognise their important roles.“We pledge to recognise and value your caring responsibilities.”

“The NHS recognises the incredibly important work volunteers undertake in making a difference to staff, patients and their families. Volunteers complement the NHS workforce; they do not replace it. The NHS will support and encourage volunteers in all aspects of their roles.”

A new additional right to “Involvement in your healthcare and the NHS” by putting patients and their families, carers and advocates at the heart of decision making, and strengthening links between NHS services.

“You have the right to be involved (with patient consent) at the earliest available opportunity when plans are being made to discharge the person you care for from hospital.”


The NHS constitution applies to all those who use its many services, its staff, regulators, other NHS organisations (Integrated Care Boards) and providers, both NHS and independent healthcare providers. The Department of Health and Social Care want to hear from people across this broad spectrum.

You can read the full consultation here and respond online by 25 June when it closes.

An updated NHS Constitution is due to be published later in 2024 and a revised NHS Constitution handbook will be published alongside (but there will not be a consultation on it).

Our content explained

Every piece of content we create is correct on the date it’s published but please don’t rely on it as legal advice. If you’d like to speak to us about your own legal requirements, please contact one of our expert lawyers.

Posted by


Mills & Reeve Sites navigation
A tabbed collection of Mills & Reeve sites.
My Mills & Reeve navigation
Subscribe to, or manage your My Mills & Reeve account.
My M&R


Register for My M&R to stay up-to-date with legal news and events, create brochures and bookmark pages.

Existing clients

Log in to your client extranet for free matter information, know-how and documents.


Mills & Reeve system for employees.