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					Summary – Given the spread of the consultation, the response rate was not high,
with 13 on line responses, and comments provided by 5 email correspondents.
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?
The majority of Reponses from the on line survey agreed with this; however only 6 (of
13) respondents agreed that the 18 week waiting time was appropriate. There was
greater agreement by respondents with the idea of creating a waiting time entitlement of
2 weeks for urgent cancer referrals.

In the comments received concerns focused on costs, the system of redress and how
the right would clearly articulate clinical judgment and patient responsibility. The issue
of how the rights are interpreted and implemented to ensure that they are enjoyed by all
parts of the community (specifically those with learning difficulties) was raised across the
range of questions.

Should GPs provide specified information to patients on their rights around a two
week referral?
The comments regarding information supplied by GPs to patients relating to the 2 week
referral supported the notion that patients should be informed.

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?
Again the majority of Reponses from the on line survey agreed with this. The comments
received however raised a number of concerns regarding the costs of implementing
such a right, and the impact on the health budget.

Do you agree we should explore potential future rights for patients and the public
in the following areas?
There was a mixed picture regarding the expansion of rights into other areas, possibly
reflecting a lack of general information about some of the possible entitlements
proposed.

Most support and comments received related to GP access (9), access to NHS dentistry
(10); a right to choose to die at home and access to 1 week diagnostics were supported
but only by approximately half of the on line survey respondents. Comments focused on
the practicability of the expand entitlements into these areas.

Do you agree the role of the Constitution champion should be determined locally
by PCTs?
Opinion as to who should determine the role of the Constitutional champion was evenly
divided amongst on line respondents, and no clear preference emerged.
The comments were largely in favour of a local determination of the role. This may be
because the majority of the respondents who made comments were NHS employees.

Do you think there are any particularly important aspects of the role?
These comments reflected the belief expressed by correspondents that the role should
be determined locally.
       Detailed Responses
 Question                                       Response
1. Should a right in respect of waiting         (from web site questionnaire)
times be established and included in a          Yes 10
revised NHS Constitution?                       No 2
                                                Don‟t know 1

If so, should the right include                 (from web site questionnaire)
The current standard for treatment              Yes 6
within 18 weeks?                                No -
                                                Don‟t Know 1
                                                No Response 6

2. The current standard for urgent              (from web site questionnaire)
referrals of suspected cancer to be             Yes 11
seen by a specialist within two weeks?          No 1
                                                Don‟t Know 1
                                                No Response -

3. Should GPs provide specified                 (from web site questionnaire)
information to patients on their rights         Yes 11
around a two week referral?                     No 1
                                                Don‟t Know 1
                                                No Response -

Comments on GP letters :
“The standard letter they already send”
“It should be standardise”
“It should appropriate to situation”

Other comments received via email

“Patients should be informed why they are being referred for a two week wait pathway.”

“This is a very important issue which has cropped up recently. It is very important that
GP‟s clearly indicate to patients that a referral is being made under the two week wait
scheme so that patients opt for the earliest possible appointment. I don‟t see how
creating a right for patients would help with this if the GP hasn‟t informed the patient of
the urgency in the first place then the patient won‟t know he/she has a right to an
appointment within two weeks. The real issue but the wrong way of dealing with it.”


4. Any further comments on the proposed waiting times rights?

“Patients should also be allowed to choose to wait over 18 weeks if they want to be seen
later of if they only want a specific time or day”

“Concern about cost of providing a function to ensure that patients are found alternative
providers if waiting times not met by provider of choice. Costs will be incurred by PCT or
a provider taking on this role as this is a new function. Is it affordable in the current
climate? Planned communication to patients about their rights around waiting times is
important. Most of public are confused currently. This alone will drive improvement
significantly.”
Other comments received via email

“Right to be treated within a specified time. I imagine the important issue for patients will
be how does redress work? For example, would the patient have a choice of alternative
providers, and could we end up with a situation where a patient has sub standard care -
see para 2.23 in the consultation document. “

“I do not believe it is necessary to enshrine this as a legal right – what I do not
understand is how the legal system will deal with the 10% that for clinical reasons cannot
be treated in 18 weeks. The current standard is 90% which reflects this small group for
whom 18 weeks is not appropriate. With rights come responsibilities and so are they
proposing we can take legal redress when a patient doesn‟t fulfil their responsibilities
e.g. „Do Not Attends‟ their appointment?”


“If a right in respect of waiting times is established, it must be absolutely clear that the
clinical judgement of the referring clinician is the determining factor for making a referral-
ie patients must not confuse a waiting time right with a right to be referred if the clinical
need for referral is in question.”

It is right that patients should have responsibilities and the constitution promotes patient
empowerment. One example (2.31) „Patients should keep appointments…‟ This is good
in principal, however if the GP, or other health professional does not fulfil their
responsibility and communicate with the patient in a manner that they can relate to (eg
accessible letter or telephone call) this further disempowers the patient. Much more work
will need to be done with our health partners to enable all patients to access the NHS
Constitution on an equal footing.(raised in relation to patients with learning difficulties).

Likewise with redress. The situation is improving but it is still very difficult for people with
learning difficulties to know how to access or make a complaint about their negative
experiences to people who do not have skills in communication or access to accessible
paperwork. As an organisation, or with local services, I rarely see services being
promoted in an accessible format, or documents written that use accessible language.
We need to actively change this”

5. Do you agree that a right to a NHS            (from web site questionnaire)
Health Check every five years for those          Yes 11
aged 40–74 should be established, with           No -
effect from April 2012, and be included          Don‟t Know 1
in a revised NHS Constitution?                   No Response 1

Comment:
Other comments received via email
“Health Checks - personal opinion this, but I don‟t think, at a time of spending cuts, we
should be investing in an expanded health checks programme”

“I don‟t think it would be helpful to create a right to a NHS Health Check every five years.
The unintended consequence of this may be that PCTs will not be able to target
resources for the CVD agenda to health inequalities, especially given the future financial
climate. I think it would be better for there to be a right to expect that an NHS Health
Checks programme will be in place in each PCT.”
“In principle, this right is reasonable. The implication of making this a right is that
providing this sort of health check would be an absolute pre-commitment for NHS
spending. We would have to be clear that this is the very best use of resources.”

6. Do you agree we should explore potential future rights for patients and the
public in the following areas?

Evening and weekend access to GPs 9 responded positively

Access to NHS dentistry 10 responded positively

Personal health budgets 1 responded positively

Choosing to die at home 7 responded positively

Access to key diagnostic tests within one week 6 responded positively

Comments:
Other comments received via email

   “Of the opportunities for additional patient rights, I think that those about personal
   health budgets and the right to die at home are the most interesting, (and
   challenging). “

   “I do not support the notion of legal rights – I think targets, constitutions and charters
   take us far enough”

   “I agree that access to evening and weekend GP services should be a legitimate
   expectation. I think that PCTs should be left to determine how this is locally
   achieved- eg it may be through extending access to GP led health centres rather
   than all general practices. I think that the right to choose a GP practice needs to be
   much better defined as well as the unintended consequences eg implications for
   home visits, continuity of care, in a more competitive environment practices may start
   to try and „attract‟ patients by complying with patient demands in a time when we are
   going to have to be much stronger on demand management

   A binding right to NHS dentistry has to be demonstrably affordable
   Personal Health Budgets- defining parameters will be important
   Right to die at home is supported”

“Evening and weekend access to GP‟s

       If practice boundaries are abolished and patients have good information about
        what GP‟s offer then patients already have the ability to choose a practice
        offering what they want. Creating a right will not improve this.
       To be meaningful, any right would have to define what is meant by evenings
        and weekends.
       There will be very little value in creating this as a right: patients can already
        choose which they value most: localness, relationship with a particular doctor or
        extended hours. There would be much more benefit in working with all practices
        to achieve greater patient satisfaction.
       This does have the potential to increase inequalities. There is likely to be more
        demand for weekend and evening access amongst busy working people. There
        are much more important access issues in deprived areas and these are less
        likely to translate into a need for evening and weekend appointments.
       This is not part of the nationally negotiated contract with GP‟s so this will always
         be an additional cost. Is this a sensible use of resources?
       It may be more sensible to focus on making sure that patients can access
         extended hours GP services through walk in centres, APMS centres, etc.

Choosing to die at home

I strongly support the process of allowing people to die at home if that is their choice but
making it a right is problematical:

       Exactly what would the right imply? The right could be met by, for example,
        discharge to home just before death rather than being cared for at home over a
        longer period.
       Some patients (a very few) will have needs which would be enormously
        expensive to meet. Would this be a right whatever the cost? Would this be a
        sensible use of resources?”

7. Do you agree the role of the                 (from web site questionnaire)
Constitution champion should be                 Yes 4
determined locally by PCTs?                     No 4
                                                Don‟t Know 5
                                                No Response -

8. Do you think there are any particularly important aspects of the role?

Not convinced that this role should be stand alone. Surely the constitution rights are part
of a wider quality agenda. I would rather see this become part of a quality champion role
rather than carve a few issues out (as in the constitution) for particular focus


Other comments received via email
“I think that consultation champion should be determined locally by PCTs, and I think
that the most important part of the role is helping to ensure effective redress but I think,
at a time of spending cuts, that we need to be able to demonstrate that we can provide
this out of existing resources.”

“None beyond what is described – though what is described suggests it sits best with an
executive rather than NED”

“Role of constitution champion should be defined locally.”

“It is my personal view and relates specifically to learning difficulties. It impacts on all of
the consultation questions, which I‟m confident are well intentioned, but particularly on
the role, skills and responsibilities of constitution champion. My feeling is that if the NHS
constitution is going to be implemented in its true spirit, that this role is crucial, enormous
and likely to need more than one person. I think how this role is developed should be
determined locally”

General Comment:

“Some of these rights, rather like some targets, don‟t cover the quality of the patient
experience which is an issue I think. The emphasis upon improving communication with
patients is to be welcomed, but I would not underestimate the work involved in doing that
effectively for all patients.”
I note that the guidance mentions „equality‟ once. I think the need to consider the
requirements of vulnerable populations warrants more than one reference. Considerable
change in local practice is going to have to be realised for the entitlements to be met.

We will have to work VERY HARD to ensure that the NHS constitution does not further
marginalise communities that are already disadvantaged in access to health services

				
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