Short CommunicationThe NHS Constitution values are not always clearly expressed on Trust websites in England
Introduction
Following the public inquiry into failings at Mid Staffordshire NHS Trust, England, Robert Francis QC's report1 blamed organizational culture and top down target chasing, and made wide ranging recommendations for change. Recommendation number 2 states that ‘the NHS and all who work for it must adopt and demonstrate a shared culture in which the patient is the priority in everything done’ which requires a ‘common set of core values and standards shared throughout the system’.1 The report prompted the government to reaffirm commitment to the values outlined in the NHS Constitution.2 It was subsequently updated in March 2013.3
Drafted originally in Darzi's 2008 NHS Next Stage Review,4 the Constitution sets out the purpose of the NHS, with six core values and seven guiding principles identified from extensive consultation with patients, staff and the public.4 These NHS-wide values (q.v. Table 1) were intended to strengthen the local values of individual organizations, as well as guiding behaviour when working across organizations.4 The NHS Institute was commissioned by the Department of Health to provide resource and support materials which would help NHS organizations develop and embed values locally, to drive improvement for both patients and staff.5
Darzi's vision for the NHS moved the focus from productivity to supporting and empowering frontline staff in order to improve the quality of care. However, the failures at Mid Staffordshire and other Trusts6 show that in spite of the initiative to encourage a value focus, in much of the NHS the intended culture shift has not yet happened. Although all NHS organizations have a statutory duty to have regard to the Constitution and to make it clear what they stand for,4 as the Francis Report highlighted, this common source of values and principles ‘has not as yet had the impact it should’.1
To examine the extent to which NHS Trusts in two regions of England give priority of place to the core values of the NHS Constitution, as recommended in the Francis Report, a study of their websites was carried out in summer 2013. During a 2-week period, the websites of the 15 acute Healthcare Trusts in the South West, the authors' region, were examined to determine the extent to which the values published there reflected the NHS Constitution. The websites of the 11 Trusts in the North East – a region chosen as being the most geographically distant and therefore possibly differing in its characteristics – were examined for comparison. Because of wide variation in the prominence given to values on the websites, and the wording by which they were expressed, the authors counted as positive incidences:
- •
clear statements of NHS-wide values, for example on the Home page or under the headings Mission, Values or Objectives;
- •
implicit expressions of the values found elsewhere on the website which describe relevant behaviours and activities of the Trust that indicate efforts to ‘embed’ or ‘live’ the values.
Section snippets
Differences identified between NHS Trusts
All six Constitution values were found on eight of the 15 South West Trust websites (53%) compared to only three of the 11 North East Trust websites (27%). The number of core values expressed somewhere on the websites ranged from 4 to 6 in the South West and 2 to 6 (mode = 5) in the North East.
Variation in the prominence given to values on the websites was considerable. Although all mentioned at least some values, determined searching was sometimes needed to find them. One site had reproduced
The concept of compassion
It was perhaps surprising that compassion was the least mentioned value (Table 1). In the words of the Constitution, the NHS ‘touches our lives at times of basic human need, when care and compassion are what matter most’.3 Compassion is also one of the ‘6 C’s’ underpinning the recently published vision and strategy for nurses, midwives and care staff. They are care, compassion, competence, communication, courage and commitment.8 Compassion is defined as ‘how care is given through relationships
The benefits of shared values
Establishing shared values is essential to the difficult process of transforming organizational culture, defined in the Francis Report as ‘the predominating attitudes and behaviour that characterise the functioning of a group or organisation’.1 The Constitution built on the core strengths of the NHS, as identified by stakeholders, and these represent the assets of the organization in terms of cultural capital. This describes the value which can be put on the ‘way of being’ of an organization in
What can be learned from this study?
In 2008 Darzi found the NHS to be adequately funded.4 Since then, however, the economic downturn, coupled with growing demand for increasingly costly services, has brought new challenges. The values focus of the NHS Constitution, building on what is good about the organization, and putting the emphasis firmly on quality and patient-centred care, is a crucial tool for tackling the dysfunctional culture which had evolved. By aspiring to shared values, members of the workforce at all levels are
Ethical approval
Approval for the study was given by the Clinical Audit and Effectiveness Manager, University Hospitals Bristol NHS Foundation Trust.
Funding
This study was supported by the Above and Beyond Charitable Trust, University Hospitals Bristol NHS Foundation Trust.
Competing interests
Laura Adcroft and Robin Philipp are employed in two different South West England NHS Trusts whose websites were searched for this study.
References (18)
Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry chaired by Robert Francis QC
(February 2013)Patients first and foremost. The initial government response to the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry
(March 2013)The NHS Constitution
(March 2013)High quality care for all. NHS next stage review
(June 2008)Living our local values
(December 2008)Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report
(July 2013)- et al.
Improved communication between doctors and with managers would benefit professional integrity and reduce the occupational medicine workload
Occup Med
(2005) Compassion in practice, nursing: midwifery and care staff; our vision and strategy
(December 2012)Valuing compassion through definition and measurement
Nurs Manag
(February 2011)
Cited by (2)
Person-job congruence, compassion and recovery attitude in Community Mental Health Teams
2021, Journal of Mental HealthAn exploration of creative expression in medical student art
2020, Perspectives in Public Health