CNK has responded to the Department of Health Consultation on changes to strengthen the four-year old NHS Constitution.

The proposals are the result of a review by Professor Steve Field and the NHS Future Forum, whose recommendations Care Minister Norman Lamb MP has 'accepted in full'.

The Minister of State said:

"The Constitution should be woven into the fabric of everything the NHS does so that the expectations of patients, staff and the public can be met first time, every time...

"The Constitution is an enduring document. The threshold for making changes to it is- rightly- set high. Any changes should be clear and compelling... But the Constitution also needs to move with the times- to reflect changes to the law and to ensure it applies to all those involved in delivering NHS services."

CNK's response welcomes the overarching principles of the proposed changes. These are built around: patient involvement; feedback; duty of candour; end of life care; integrated care; complaints; patient data; staff rights, responsibilities & commitments; and dignity, respect & compassion.

A key area of concern is the limited prominence given to end of life care- despite being a stated 'key area'- and the CNK response asserts that, in the light of controversies such as that over the Liverpool Care Pathway, end of life care should be covered by a distinct, dedicated section.

Other key points are:

• Treatment and care must continue to be based on a 'dialogue of two experts';
• The patient's need should take precedence over any other agenda;
• There should be more mention of spiritual care, a concept now recognised by NHS institutions and the GMC;
• The Constitution is currently little known among both the public and the medical profession.