Clarity of values and principles

Accepted in principle.
It is important that employers are able to recruit and retain the caring and compassionate staff the NHS needs. NHS Employers will support NHS organisations in developing and strengthening local policies and guidance so that there is a clear link between the values in the NHS Constitution and their own local values.
The Department of Health will commission NHS Employers to support NHS organisations in strengthening local policies on appraisal and performance management are strengthened so that there is a clear line of sight between the NHS values, the Constitution and performance and appraisal systems.
Steps have already been taken to improve performance and appraisal systems and agreement has been reached that, with effect from March 2013, pay progression will be linked more strongly to performance for the 1.1 million staff on Agenda for Change pay, terms and conditions. The agreement makes clear that:
• Employers must reference the NHS Constitution in local performance arrangements;
• Knowledge and experience are not the only factors which employers should considerer when they develop local performance standards;
• Employers now have the flexibility to consider not only what staff do for patients, but how they care for patients, encouraging the right behaviours and values.
Staff appraisal is a critical part of staff performance and should be used to hold staff to account on how their behaviour demonstrates the values of the NHS and/or their organisation. The evidence shows that where staff performance is regularly and effectively reviewed, outcomes for patients are better.

No systematic arrangements were put in place through contractual terms, but all regulated health care professionals are required, by their regulators, to practice in a way that is consistent with professional values. These professional values are themselves consistent with the values of the NHS Constitution.

The NHS Terms and Conditions (last updated August 2024) require that local appraisal policies are consistent with the NHS Constitution for England (para 53). This applies to all staff.

For Board-level leaders, Regulation 5 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014, specifies that service providers must only appoint executive and non-executive directors if they comply with the Fit and Proper Persons requirements. In September 2024, NHS England published the Fit and Proper Person Test Framework to strengthen accountability and transparency for individual Board members. This framework is underpinned by the values set in the NHS Constitution. To support this, NHS England has developed the NHS Leadership Competency Framework for Board members (February 2024). This is based around six competency domains which reflect the NHS values. An independent evaluation is planned for 2025.

Professional behaviours and values are further mandated by professional regulatory bodies, such as the Nursing and Midwifery Council.

Sir Robert Francis QC was clear in his Inquiry report that the principal message of the NHS Constitution should be that patients and their safety come first. In Hard Truths, the Department of Health committed to strengthening the NHS Constitution to make this clearer for patients, staff and the public. To this end, The Government has launched a consultation into, amongst other things, refreshing the NHS Constitution to reflect the recommendations made by Sir Robert Francis QC. The key elements are:
• duty of candour;
• safe care and avoidable harm;
• staff guidance, and;
• a patient-centred NHS.

This recommendation was accepted by the Government in principle.

In the January 2014 Hard Truths report, the Government said the Department of Health would commission NHS Employers to support NHS organisation in strengthening local policies on appraisal and performance management so that there was a clear line of sight between the NHS values, the NHS Constitution and performance and appraisal systems.

It is unclear whether any amendments to contracts of employment were made.