The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [15]
The Constitution:
outlines the purpose of the NHS and the principles of the NHS, which are the enduring high-level ‘rules’ that govern the way that the NHS operates and define how it seeks to achieve its purpose
details NHS values that inspire passion in the NHS and should guide it in the 21st century
makes explicit rights and pledges. One of the primary aims of the Constitution is to set out clearly what patients, the public and staff can expect from the NHS and what the NHS expects from them in return
makes explicit rights and pledges for staff, as well as their responsibilities.
Explanations of these are found in Box 1.3.
Box 1.3 Definition of terms in the NHS Constitution
A ‘right’ is a legal entitlement protected by law. The Constitution sets out a number of rights, which include rights conferred explicitly by law and rights derived from legal obligations imposed on NHS bodies and other healthcare providers. The Constitution brings together these rights in one place but it does not create or replace them.
A ‘pledge’ is that which the NHS is committed to achieve, supported by its management and regulatory systems. The pledges are not legally binding and cannot be guaranteed for everyone all the time, because they express an ambition to improve, going above and beyond legal rights.
‘Responsibilities’ are the expectations of how patients, the public and staff can help the NHS work effectively and ensure that finite resources are used fairly.
(DH 2010a)
Economic factors
Globally financial resources to pay for healthcare are under considerable constraint. In England for the year 2010–11, ‘The Department of Health and the NHS announced that it will deliver £4.35 billion of savings, as their departmental contribution towards £11 billion of savings that are being made across government’ (Budget statement, March 23rd 2010).
NHS healthcare providers are responding to this in a variety of ways. These include refining processes of care, ensuring that delays and unnecessary bed days for patients are at a minimum. The distribution of care activities has also been scrutinized across the workforce.
Cost-effectiveness
With increasing emphasis on cost-effectiveness, the necessity of a Registered Nurse to carry out all procedures is constantly questioned. A study entitled Improving the Effectiveness of the Nursing Workforce (Centre for Health Economics 2003) has highlighted the shift in roles at the other end of the novice-to-expert continuum, with healthcare assistants taking responsibility for an increasing number of procedures that historically have been the professional domain of nursing (O’Dowd 2003).
Currently in the acute NHS there is no national standard preparation for these roles, nor any regulations governing what healthcare assistants can or cannot do. The Nursing and Midwifery Council is currently looking into options for regulating them (Santry 2010). Whatever happens, nurses continue to be accountable for the patients in their care.
Accountability
Accountability means that if a nurse is delegating care to another professional, healthcare support staff, carer or relative, they must delegate effectively and are accountable for the appropriateness of that delegation. This means that they must:
establish that anyone they delegate to is able to carry out their instructions
confirm that the outcome of any delegated task meets required standards
make sure that everyone they are responsible for is supervised and supported.
(NMC 2008a)
Some of the procedures included in this edition could be carried out by a healthcare assistant (HCA) (Table 1.2). However, it will always be the nurse responsible for those patients on a shift who must