Ministers face ‘culture war’ claims over NHS Constitution plans

The Department of Health and Social Care (DHSC) has today launched a new consultation into changes to the NHS Constitution for England, a guidance document for the health service.

“Trans and non-binary patients are deserving of high-quality care like any other patient and changes to health policy should be done with them, not unto them”

Nicola ranger

The DHSC’s proposed changes include allowing patients to request that intimate care is carried out by someone of the same ‘biological sex’, where reasonably possible, and that transgender patients can be excluded from female single-sex wards.

But Professor Nicola Ranger, the Royal College of Nursing’s (RCN) chief nursing officer and deputy chief executive, highlighted that patients could already request that intimate care was carried out by a staff member of the same sex.

Under the government’s proposed change, a hospital would be permitted to place a transgender patient in single-room accommodation if another patient expressed a wish to be a in a single-sex setting.

In addition, the consultation suggested the NHS “embed” the right of patients and their loved ones to request a review of care in the case of deterioration, which is being missed by clinicians, something the health service had begun to roll out already this year in the form of Martha’s Rule.

Health sector leaders, including Professor Ranger, aired frustration at the focus of the NHS constitution review, which happens every 10 years, being on the presence of transgender patients in single-sex wards.

Professor Ranger said the DHSC’s announcement “sounds like it was made in a parallel universe” to the experience of NHS nursing staff.

“It’s also important to recognise that nursing staff treat all patients with the utmost respect and professionalism, no matter their gender,” said Professor Ranger.

The government said it hoped the consultation would improve the “dignity” and “privacy” of patients, with health minister Maria Caulfield claiming that it was about “putting patients first”.

Professor Ranger said: “Trans and non-binary patients are deserving of high-quality care like any other patient and changes to health policy should be done with them, not unto them.

“Nursing staff are caring for people in corridors, doorways and even store cupboards,” she said. “They will have little faith in ministers’ supposed commitment to the ‘privacy, dignity and safety’ of patients.”

Sir Julian Hartley, chief executive of NHS Providers, said: “It is vital that any proposed changes to the NHS Constitution have inclusivity and eliminating discrimination at their heart.”

Meanwhile, Matthew Taylor, the NHS Confederation’s chief executive, accused the government of trying to drag the health service into a “pre-election culture wars debate”.

Mr Taylor’s comment was in reference to the focus on transgender patients and the DHSC’s mentions of the term ‘biological sex’.

Some critics of the government have previously dismissed its policymaking on gender identity as an attempt to mobilise transphobia, often propagated on social media, in a “culture war”.

Mr Taylor said: “This is not where energies should be focused. This is especially true when health leaders and their staff already work hard every day to show fairness and compassion towards all their patients and colleagues regardless of their characteristics or needs.

“They recognise that everyone has the right to be treated with dignity and respect and to be protected from abuse and neglect,” he said.

“In particular, groups of people, including trans and non-binary patients, continue to receive some of the worst health outcomes of any group in our society and NHS leaders and staff will want to do all they can to support these patients, as well as their trans and non-binary staff to reduce inequalities.”

Mr Taylor added: “The opportunity to update the NHS Constitution should not be about grabbing headlines, but to strive to reach a consensus around upholding these core values and closing the gap between the waiting time standards it mandates and where performance levels are currently.”

Both Professor Ranger and Mr Taylor, however, gave their support to the reinforcement of Martha’s Rule in the NHS Constitution.

Mr Taylor said: “Our members support the introduction of new ways to improve patient safety and they have welcomed the piloting of Martha’s Rule.

“If the scheme is to be extended, questions will need to be answered about what resources hospitals and other providers will be given to ensure it can be delivered.”

The DHSC’s consultation also includes recommendations to “reinforce” the health service’s “commitment” to unpaid carers, make sure the NHS reduces disparities in health outcomes, strengthen patient “responsibilities” to cancel and reschedule appointments, and to reaffirm person-centred and coordinated care.

The consultation, which will run for six weeks, will collect responses from the public, clinicians, patients, carers and leaders in the health and social care sectors.

After that, the government said it would publish the results and enter the next phase of the consultation process.

Health and social care secretary Victoria Atkins said: “We want to make it abundantly clear that if a patient wants same-sex care they should have access to it wherever reasonably possible.

“We have always been clear that sex matters and our services should respect that,” she said.

“By putting this in the NHS Constitution we’re highlighting the importance of balancing the rights and needs of all patients to make a healthcare system that is faster, simpler and fairer for all.”