The Patient's Charter and You - a Charter for England

Introduction

The Patient's Charter puts the Citizen's Charter into practice in the NHS. It is helping the NHS to

listen to and act on people's views and needs;
set clear standards of service;
provide services which meet those standards.

This document

sets out your rights and the standards of service you can expect to receive;
tells you what the Charter has helped the NHS to achieve so far;
introduces a number of new national standards;
sets out how you can help the NHS to make further improvements to the standards of service it provides.

Throughout this document we refer to:-

RIGHTS - which all patients will receive all the time; and

EXPECTATIONS - these are standards of service which the NHS is aiming to achieve. Exceptional circumstances may sometimes prevent these standards being met.

Rights and Standards throughout the NHS

ACCESS TO SERVICES

You have the right to:

receive health care on the basis of your clinical need, not on your ability to pay, your lifestyle or any other factor;
be registered with a GP and be able to change your GP easily and quickly if you want to;
get emergency medical treatment at any time through your GP, the emergency ambulance service and hospital accident and emergency departments; and
be referred to a consultant acceptable to you, when your GP thinks it is necessary, and to be referred for a second opinion if you and your GP agree this is desirable.

You can expect the NHS to make it easy for everyone to use its services, including children, elderly people or people with physical or mental disabilities.

If your child needs to be admitted to hospital, you can expect them to be cared for in a children's ward under the supervision of a consultant paediatrician. Exceptionally, when a child has to be admitted to a ward other than a children's ward, you can expect a named consultant paediatrician to be responsible for advising on his/her care.

PERSONAL CONSIDERATION AND RESPECT

You have the right to choose whether or not you want to take part in medical research or medical student training.

You can expect all the staff you meet face to face to wear name badges.

You can expect the NHS to respect your privacy, dignity and religious and cultural beliefs at all times and in all places. For example, meals should suit your dietary and religious needs. Staff should ask you whether you want to be called by your first or last name and respect your preference.

PROVIDING INFORMATION

You have the right to:

have any proposed treatment, including any risks involved in that treatment and any alternatives, clearly explained to you before you decide whether to agree to it;
have access to your health records, and to know that everyone working for the NHS is under a legal duty to keep your records confidential;
have any complaint about NHS services (whoever provides them) investigated and to get a quick, full written reply from the relevant chief executive or general manager. The new complaints procedure means this will be within four weeks;
receive detailed information on local health services. This includes information on the standards of service you can expect, waiting times and on local GP services;

The NHS now gives you more information than ever before.

Many health authorities and hospitals have their own charters, adding to and improving on national standards.
Your hospital should openly display information on their Charter performance in public places.
Your Health Authority produces an annual report on your local hospitals' Patient's Charter performance (which includes the name of someone you can write to with any comments).
The annual NHS Comparative Performance ("League") Tables were published for the first time in June 1994. These show how local hospitals and ambulance services are doing against some of the national standards. Copies are available from the Health Literature Line on 0800 555777.

The Patient's Charter and You - GP Services

REGISTERING WITH AND CHANGING DOCTORS

You have the right to be registered with a GP.

You can expect your local Health Authority to find you a GP within two working days. The NHS now achieves this standard fully.

You have the right to change your GP easily and quickly.

You can expect your local HA to send you a list of doctors within two working days together with details of how to change doctors.

If you have changed GP, you can expect your local HA to send your medical records within two working days for urgent cases and six weeks for all other cases.

The NHS now meets this standard in 8 out of 10 urgent cases and in over 7 out of 10 routine cases.

You have the right to receive information about the services your GP provides and to see on request a copy of your GP's practice leaflet, which sets out this information.

HEALTH CHECKS BY YOUR GP

You have the right to

be offered a health check when you join a GP practice for the first time;
ask for a health check if you are between 16 and 74 and have not seen your GP in the last three years; and
be offered a health check once a year in your GP's surgery, or at your own home if you prefer, if you are 75 or over.

DRUGS AND MEDICINES

You have the right to be prescribed appropriate drugs and medicines. If you fall within certain categories including being a pensioner, a person aged 60 or over, a child under 16 or under 19 in full time education, a pregnant or nursing mother, suffering from one of a number of specified individual conditions, or on income support or family credit, you have a right to get your medicines free.

YOUR GP'S PRACTICE CHARTER

We are working with GPs and their health care teams to encourage them to produce GP practice charters. They will tell you about the standards of service you can expect from your surgery or health centre and the ways in which you can help the practice.

These charters may cover:

opening times and how to make appointments and what you should do if you have to cancel;
arrangements for giving you the results of any medical tests;
arrangements to help you look after your health;
arrangements for obtaining repeat prescriptions;
facilities for parents with children;
facilities for people with disabilities;
when it is and is not appropriate to call on your GP for out of hours treatment;
services offered to people from minority groups;
in some cases, arrangements for dispensing drugs and medicines within the practice;
details of the way complaints and suggestions are handled within the practice.

More and more GP practices are producing their own charters for their patients. In June 1993 only 14% of practices had or were developing charters. Now itis well over half.

You can help the NHS by only calling out your GP at night if it cannot wait until the next day.

The Patient's Charter and You - Hospital Services

REDUCING WAITING TIMES

Most patients go into hospital quickly after a consultant has decided that treatment is needed. Nearly half of all NHS patients who have to wait are admitted within 5 weeks. The Government is determined to maintain this excellent performance.

In March 1991 over 50,000 patients were waiting 2 years or more to go into hospital. Now nobody waits this long (except for a handful of patients waiting for specialist fertility treatment).

For hip or knee replacements and cataract operations, a waiting time guarantee of 18 months has already been established.

In 1992 nearly 2,000 patients were waiting more than 18 months for hip, knee and cataract operations. Such long waits for these operations are now a thing of the past.

From April 1995, the NHS is broadening this 18-month guarantee to cover all admissions to hospital.

In addition from April 1995, you can expect treatment within one year for coronary artery bypass grafts and some associated procedures. (If your consultant considers your need for treatment is urgent, you can expect to be seen much more quickly than this.)

Your operation should not be cancelled on the day you are due to go into hospital or after you have gone in. If it is, (for example because the hospital is dealing with the victims of a major road accident), you can expect to be admitted again within one month of the cancellation.

OUTPATIENT APPOINTMENT WAITING TIMES

For the first time, the Government is introducing a national waiting time standard for a first appointment as an outpatient - when you are referred by your GP or dentist to see a hospital consultant.

From April 1995, when your GP or dentist refers you to the hospital, 9 out of 10 people can expect to be seen within 13 weeks. Everyone can expect to be seen within 26 weeks. The Government will be working over time to tighten this standard further.

Waiting times for outpatient appointments can be longer if, with your GP's agreement, you choose to see a particular consultant who is in great demand.

YOUR CARE IN HOSPITAL

If you go to an accident and emergency department you can expect to be seen immediately and have your need for treatment assessed.

In Accident and Emergency Departments, 9 out of 10 patients are now seen and assessed for treatment as soon as they arrive.

You can help the NHS by using your accident and emergency department properly. Consider whether your need for treatment is urgent or whether you could be better cared for by your GP.

When you go to an outpatient clinic you can expect to be given a specific appointment time and be seen within 30 minutes of that time.

In outpatient departments, more than 8 out of 10 patients are now seen within 30 minutes of their appointment time.

From April 1996, if you are admitted to hospital through an Accident and Emergency Department you can expect to be given a bed as soon as possible, and certainly within two hours.

You can help the NHS - and all other patients - by keeping to your appointment time or giving the hospital early warning if this is not possible, so that others can be seen sooner.

You can expect a qualified nurse, midwife, or health visitor to be responsible for your nursing or midwifery care. You will be told her name.

If you agree, you can expect your relatives and friends to be kept up to date with the progress of your treatment.

SINGLE SEX WARDS

Except in emergencies, you have the right to be told before you go into hospital whether it is planned to care for you in a ward for men and women. In all cases, you can expect single sex washing and toilet facilities. If you would prefer to be cared for in single sex accommodation (either a single sex ward or "bay" area within a larger ward which offers equal privacy) your wishes will be respected wherever possible.

There may be some cases, particularly emergencies, where a hospital cannot provide single sex accommodation. This is most likely to arise if you need to be looked after by a specialist nurse in an intensive care ward or in an observation unit. It is also possible that single sex accommodation may not be available at the time proposed for your admission. If this is the case, you have the choice of accepting the immediate admission or of waiting for single sex accommodation to become available.

CATERING SERVICES

From April 1995, if you have to stay in hospital, you can expect to be given a written explanation of the hospital's patient food, nutrition and health policy and the catering services and standards you can expect during your stay.

The standards will mean that:

you have a choice of dishes, including meals suitable for all dietary needs;
you have to order no more than your next 2 meals in advance;
you have a choice of the size of portion you want;
you are given the name of the catering manager;
you have help, if you need it, to use the catering services; for example, menus printed in other languages and large print. This help should be readily available.

THE HOSPITAL ENVIRONMENT

You can expect enquiry points and clear signposting in all hospitals to help you and your visitors to find your way around.

You can expect to be cared for in an environment which is clean and safe.

During the time you spend in hospital you can expect reasonable measures to be taken for your personal protection and safety. You can also expect to have facilities to keep personal money and belongings safe. You can help the NHS by reporting any suspicious incidents or behaviour to members of staff.

LEAVING HOSPITAL

Before you are discharged from hospital, you can expect a decision to be made about how to meet any needs you may continue to have. Your hospital will agree arrangements with agencies such as community nursing services and local authority social services departments. You and, if you agree, your carers will be involved in making these decisions and kept up to date with information at all stages.

YOUR HOSPITAL'S OWN STANDARDS

You can also expect your health authority to set local standards on

waiting times for you to receive treatment in accident and emergency departments after your need for treatment has been assessed; and
waiting times for taking you home after you have been treated if your doctor says you have a medical need for NHS transport.

You can expect your hospital to display information on the Patient's Charter including these local standards and whether they are meeting them.

You can expect your hospital to make it clear to you how you can complain or make comments and suggestions whilst you are in hospital.

You can expect your hospital to publish regularly details of the number of complaints they have received and the time they took to deal with them.

The Patient's Charter and You - Community Services

APPOINTMENT TIMES

There are nurses, health visitors and midwives working in your community. From April 1995, if you need a home visit from one of these professionals, you can expect to be consulted about a convenient time. You can then expect a visit within a two-hour time band.

Exceptionally, your community nurse, health visitor or midwife may be unable to make this appointment or be delayed. In these cases, your community nurse, health visitor or midwife should let you know and make another appointment with you.

SEEING COMMUNITY NURSES AND MIDWIVES

You can expect to receive a visit from someone in the district nurse team or the mental health nurse

within 4 hours (in the daytime), if you have been referred to them as an urgent patient;
within 2 working days, if you have been referred to them as a non-urgent patient and you have not asked them to see you on any particular day; and
by appointment on the day you ask for, if you give the district nursing services more than 48 hours notice.

You can expect to receive a visit from your midwife if you and your midwife agree this is necessary. Together you and your midwife will discuss and agree the care you need both before and after your baby is born.

You can expect to receive a visit from your health visitor

between 10 and 14 days after the birth of a baby;
within 5 working days if you are newly registered with a GP and have children under 5 years old.

COMMUNITY CARE CHARTERS

In addition to these new standards for Community Services, the NHS is working with local authorities to help produce local community care charters which will cover the standards of service you can expect from, for example, homecare services, aids and equipment for daily living and day care.

Ambulance Services

If you call an emergency ambulance (999 call), you can expect it to arrive within 14 minutes in an urban area, or 19 minutes in a rural area. In 1993/4 over three quarters of ambulance services achieved these targets.

You can help the NHS by remembering that the emergency ambulance service is there for people in the most urgent need of hospital treatment. Irresponsible use of the 999 service can cost lives. Please call 999 only in emergencies.

An 'urban' area is one where the population density is over 2.5 people per acre. If there are fewer people, it is a 'rural' area: You can find out what type of area you live in from your local District Health Authority.

Dental, Optical and Pharmaceutical services

YOUR DENTIST

NHS dentists provide free treatment for some people, including children under 18, and subsidised treatment for others.

If you are not registered with an NHS dentist, your local HA will help you to find one. You can expect your local HA to respond to such requests within five working days.
You can expect your dentist to let you know the expected cost of a course of NHS treatment before that treatment begins.
If you are registered with a dentist, you have the right to receive advice in an emergency, and treatment if your dentist considers it necessary.
If you are not registered with a dentist, and have difficulty finding emergency treatment, your local HA will help you.

YOUR OPTOMETRIST

An optometrist (or ophthalmic optician) tests sight and prescribes glasses and contact lenses. Glasses and contact lenses are not supplied through the NHS but some people can get help with their costs.

You can expect to receive advice on whether you can get an NHS sight test and advice about vouchers towards the cost of glasses or contact lenses.
You can expect a thorough eye examination which should include checks for any disease or abnormality as well as checking your sight.
You can expect your optometrist to inform you if they find any indication that medical treatment or further investigation is necessary and to refer you to your GP accordingly.
Immediately after your eye test, you have the right to receive a signed, written prescription which you can use to get your glasses. You have the right to take this prescription to any optometrist or dispensing optician of your choice. If you do not need a prescription, you have the right to a written statement telling you this.

If you are fitted with contact lenses, you can expect:

to be given all the necessary information and instructions about their cost, use and maintenance;
to receive the necessary aftercare for a period of at least six months after fitting, and advice on how often you should then be seen afterwards.

YOUR COMMUNITY PHARMACIST

Pharmacists are health professionals, who are readily available to give advice on treating common problems.

While dispensing your prescription, your pharmacist will review and confirm that the medicine is appropriate and give you the information you need so that you can use your medicines properly.

A certificate in the pharmacy will show your pharmacist's name.

You have the right to

decide which pharmacy to use for your prescriptions;You can expect your medicines and medical appliances to be supplied in suitable containers and be labelled with clear instructions on how to use them.You can expect your pharmacist to explain these instructions to you if you are not sure.
have your prescription dealt with promptly;You can see a pharmacist without an appointment. At busy times of the day you may have to wait, but you can expect to be given an explanation for any delay and told when your prescription will be ready.Most prescription medicines will be dispensed from stock held in pharmacies. When any medicine is not in stock, you can expect to be told when it will be available. If you prefer, you can have the prescription back, so you can go to another pharmacy.If the pharmacy is closed, you can expect to find information about arrangements for getting prescriptions outside normal hours, including weekends, on the door or window of the pharmacy. Your local paper normally includes this information, too.

Warning - don't keep old medicines around the house. Please return them to your pharmacist for safe disposal.

The Patient's Charter and Maternity Services

The Government has published a special charter for pregnant women and new mothers. This explains your rights and the standards of service you can expect to receive during pregnancy, the baby's birth and post natal care. Among other things, it covers:

your choice about who will be responsible for looking after you; where you have your baby; the type of care you wish to receive, for example whether you wish to have your care led by a midwife, GP or consultant Obstetrician ;
what information you can expect to have to help you reach decisions about your care including information such as appropriate tests before the baby is born (ante-natal tests); and
the care of your baby.

These rights and standards are part of the Government's policy in "Changing Childbirth".

You can get copies of the Maternity Charter from your GP's surgery, ante-natal clinic, hospital, Health Authority, Community Health Council and the local library. Or you can ring the National Health Information Service on 0800 665544.

Learning from You

You can help the NHS by telling us about your experiences of the NHS - good and bad - so that we can improve the service it offers.

If you have a comment, suggestion, or complaint, the first step is to tell the people who provide the service - the doctor's surgery or health centre, the community nurse, the hospital. Their addresses and telephone numbers are in the phone book.

If you want to pursue a complaint about your GP, dentist, optician or pharmacist, contact your Health Authority. The HA aims to:-

acknowledge your comments, suggestions and complaints within two working days;
where appropriate, tell your GP of any complaint within two working days of getting it;
sort out informal complaints within one month of getting them;
sort out formal complaints within six months of getting them (formal complaints are handled under legal rules);
give you and your GP a progress report every month until your complaint has been sorted out.

If you want to pursue a complaint about hospital or community services, contact the general manager or chief executive of the hospital concerned.

You have a right to have your complaint investigated and to receive a full and prompt written reply from the general manager or chief executive.

Your local Community Health Council provides independent help and advice on making a complaint. Their number is in the phone book.

If you are not satisfied after a complaint has been investigated by the NHS, you can ask the Health Service Commissioner for England, (sometimes known as the Ombudsman) who is completely independent of the NHS, to consider investigating your case. There are some matters which he cannot investigate, and there is a separate leaflet explaining his powers. The Ombudsman's address is;

11th Floor
Millbank Tower
Millbank
London
SW1P 4QP

Tel; 0171 276 2035.

The Government intends to take further action to improve the NHS complaints procedures. The aim is to put matters right more quickly for the patient and to use their experience to improve the quality of service for everyone.

IF YOU WANT MORE INFORMATION

Ring the National Health Information Service. Call free on 0800 665544 for information on any NHS service - (UK only).

How you can Help the NHS

Throughout this document, we have explained how you can help the NHS by using its services responsibly, letting us know about your experiences and being prepared to help others. So please remember to

let us know as soon as possible if you cannot keep an appointment. This will help us to see someone else in instead;
tell your doctor or hospital if you change your name, address or telephone number;
return equipment such as wheelchairs, crutches, walking sticks or frames when you no longer need them so they can be used by other patients;
give us your comments and suggestions - so that we can improve services whenever possible;
give blood regularly - call 0345 711711 (local call charges) to find out about how to give blood in your own neighbourhood;
fill in and always carry an organ donor card and tell your relatives about this. The NHS has launched a new organ donation register. You can enter your name on the register by ringing the national freephone number 0800 555777 or by completing the registration form available with your driving licence registration or in a leaflet available from post offices, GP surgeries and other public places;
remember that you benefit if your GP has a good night's sleep, so please only call your doctor out at night if it cannot wait until the next day.

Charter Mark

If you think your local hospital, community trust or GP practice is doing a really good job and delivering excellent service, you may like to nominate them for one of this year's Charter Mark awards.

The Charter Mark award scheme tests and rewards excellence throughout the public services. Twenty two Charter Marks have been awarded to NHS services so far. The award scheme is run by the Prime Minister's Citizen's Charter Advisory Panel.

Write to:

The Charter Mark Awards
Citizen's Charter Unit
Cabinet Office
Horse Guards Road
London SW1P 3AL

or telephone: 0645 400444

Information

GET MORE COPIES OF/INFORMATION ABOUT THIS LEAFLET AND ETHNIC MINORITY, AUDIO CASSETTE, BRAILLE, LARGE PRINT AND SIGN LANGUAGE VIDEO VERSIONS

0800 555777

SORRY - UK ONLY

Author

Patient's Charter Unit, Department of Health

Copyright

History

The Patient's Charter, first published October 1991, aims to improve the quality of health service delivery to patients. The Charter sets out patients' rights in the NHS and the standards of service they can expect to receive in areas addressing, among others, waiting times; information about services and treatment; and privacy and dignity of the patient.

A revised Charter, issued in 1995, draws together the rights and standards set out in the original Charter together with improvements made since 1991. Dental, optical and community pharmaceutical services were also covered for the first time in the revised Charter.

This Charter applies in England. Separate charters have been drawn up for Northern Ireland, Scotland and Wales.

Catalogue number

H51/006 0870 2RP 500K Nov 96 (23) EP

If you want more information

Ring the National Health Information Service. Call free on 0800 665544 for information about the Patient's Charter or on any NHS service.

If you think your Charter rights are being denied, you can write to Alan Langlands, Chief Executive of the NHS, who will arrange to have the matter investigated and if appropriate put right. You can write to him at the address below.

Feedback

If you want to comment about anything mentioned in this Charter, or wish to make a suggestion, including new ideas for Patient's Charter standards, write to:

Patient's Charter Unit
NHS Executive HQ
4N34B Quarry House
Quarry Hill
Leeds LS2 7UE

Alternatively, use the standard feedback form http://www.doh.gov.uk/feedback.htm from this web site. Your comments will be passed to the Patient's Charter Unit.

The Patient's Charter and Maternity Services - (published April 1994) - explains the rights and services women can expect to receive during pregnancy, the baby's birth and postnatal care.

The Blood Donor's Charter (published 1995) - sets out donor's rights and the standards of service they can expect to receive from the National Blood Service.

The Patient's Charter and Services for Young People (published March 1996) - explains how the rights and standards in the Patient's Charter apply in particular to children's care.

The Patient's Charter and Mental Health Services (published 16 January 1997) - explains the rights and services adult mental health patients can expect from the NHS.

Annual NHS Comparative Performance ("League") Tables - show how local hospitals and ambulance services are doing against some of the national standards http://www.doh.gov.uk/tables96.htm

Copies of these publications, and the Patient's Charter, are available from the Health Literature line on 0800 555777 (UK only). Enquirers from abroad wishing to obtain copies of The Patient's Charter and related publications should write to the Patient's Charter Unit. Write to the Northern Ireland Office, Scottish Office or Welsh Office for copies of the Patient's Charters for Northern Ireland, Scotland or Wales.

Addresses for obtaining charters for Northern Ireland, Scotland and Wales

The Scottish Office
St. Andrew's House
Edinburgh
EH1 3DG

N.Ireland: HPSS Management Executive
Dundonald House
Upper Newtownards Road
Belfast
BT4 3SF

The Welsh Office
Cathays Park
Cardiff
CF1 3NQ

Other Resources

Department of Health home page http://www.doh.gov.uk/

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