What is The NHS Code of Practice?

The National Health Service (NHS) in England operates under a complex framework of laws, professional codes, ethical principles, and specific guidance documents, rather than a single “NHS Code of Practice”. This framework guides how information, behaviour, and services are managed to ensure high-quality, safe, and ethical care. Key components include Acts of Parliament (like the Data Protection Act 2018, Equality Act 2010, Health and Safety at Work etc. Act 1974), common law duties (like confidentiality and duty of care), the NHS Constitution, codes from professional regulators (GMC, NMC, HCPC), CQC regulations, and specific NHS policies.

This framework aims to ensure consistency and high standards across the diverse network of hospitals, clinics, GP surgeries, and community services. It provides the foundation for safety, confidentiality, and integrity in health and social care.

Confidentiality

Maintaining patient confidentiality is a fundamental legal and ethical obligation within the NHS, underpinned by the Common Law Duty of Confidentiality, the UK General Data Protection Regulation (UK GDPR), the Data Protection Act 2018, the NHS Constitution, and professional codes of conduct.Patients trust healthcare professionals to safeguard their sensitive personal information (medical history, treatments, personal details). Breaching this trust can be damaging.

Clear rules and principles guide staff on handling patient information:

• Sharing patient data only when necessary for their care or other lawful purposes.
• Seeking consent where required before disclosing details (though other legal bases often apply for direct care).
• Using secure systems for storing and transferring data.
• Ensuring only authorised staff access patient records (role-based access).

NHS staff receive training on data protection and confidentiality requirements.

The Duty of Care

Every NHS staff member has a duty of care, a legal and ethical obligation established through common law (negligence), to ensure patient safety and well-being. This duty covers all aspects of patient interaction, requiring professionals to act reasonably to avoid causing harm.

This fundamental duty is reflected in professional responsibilities and regulatory requirements (like the CQC Fundamental Standards), including:

• Following clinical guidelines and best practices.
• Reporting incidents or risks that could compromise patient safety.
• Regularly reviewing care to ensure it meets patient needs.
• Upholding patient dignity and respect.

Failure to meet the required standard of care can lead to professional misconduct proceedings or legal claims. This responsibility applies broadly across all roles within the NHS.

Informed Consent

Patients have the right to make decisions about their own healthcare. This principle of informed consent is enshrined in common law, professional ethical guidance, and the Mental Capacity Act 2005. Healthcare professionals must provide patients with clear, accurate information about proposed treatments or investigations, including potential benefits, risks, and reasonable alternatives.

For consent to be valid, it must be:

• Voluntary – Given freely, without pressure or coercion.
• Informed – Based on sufficient understanding of the relevant information.
• Given by a person with Capacity – The individual must be able to understand, retain, use, and weigh the information to make the decision at that time (as defined by the Mental Capacity Act 2005).

Written consent is common for significant interventions, while verbal or implied consent may suffice for routine procedures (e.g., extending an arm for a blood pressure reading implies consent). Staff must respect patient decisions and support them in the decision-making process.while offering guidance and support to help patients feel empowered in decision-making.

Promoting Equality

Equality, diversity, and inclusion are fundamental principles within the NHS, mandated by the Equality Act 2010, the associated Public Sector Equality Duty, and reflected in the NHS Constitution. Every patient has the right to fair access, treatment, and outcomes, regardless of protected characteristics (age, disability, gender reassignment, marriage/civil partnership, pregnancy/maternity, race, religion or belief, sex, sexual orientation).

NHS staff must respect individual differences and strive to eliminate discrimination, harassment, and victimisation. This involves:

• Designing and delivering services that are accessible and meet diverse needs.
• Providing necessary support, like interpreters or information in alternative formats.
• Actively tackling bias and discrimination.
• Promoting an inclusive culture for both patients and staff.

Complaint procedures exist for individuals to raise concerns about discrimination.nt procedures allow both patients and staff to report discrimination cases anonymously.

Data Protection and Information Sharing

NHS staff handle vast amounts of sensitive patient data. Managing this information safely and appropriately is governed by data protection legislation (UK GDPR and Data Protection Act 2018), the Common Law Duty of Confidentiality, the Caldicott Principles, and specific NHS information governance policies. This framework balances the need to protect patient privacy with the necessity of sharing information for safe and effective care, service improvement, and research.

Responsible information handling includes:

• Sharing relevant patient information securely between professionals and services involved in their direct care.
• Using anonymised or pseudonymised data for purposes like research, audits, or service planning wherever possible.
• Complying with legal requirements for reporting certain information (e.g., infectious diseases) while protecting identity where feasible.
• Implementing robust technical and organisational measures (e.g., secure systems, access controls, staff training) to prevent unauthorised access or breaches.

Breaches of data protection law or confidentiality can lead to significant consequences, including regulatory action, legal claims, and disciplinary procedures.. Breaching data protection laws can lead to fines, dismissal, or even criminal charges.

Professional behaviours

High standards of professional behaviour are expected from all NHS staff, as outlined in codes of conduct from professional regulators (like the GMC, NMC, HCPC), the NHS Constitution, and local employer policies. Staff are trusted to act ethically and treat patients, colleagues, and the public with respect, courtesy, and consideration.

Key expectations include:

• Acting with honesty and integrity.
• Maintaining appropriate professional boundaries and avoiding conflicts of interest.
• Collaborating effectively and treating colleagues respectfully.
• Being open and honest when things go wrong (Duty of Candour – also a regulatory requirement).

Professionalism is crucial for patient safety, effective teamwork, and maintaining public trust in the NHS.en staff meet these standards, they demonstrate the values of the NHS clearly to all.

Raising Concerns

NHS staff have a professional duty and a right to raise concerns about issues that could impact patient safety, care quality, or workplace integrity (e.g., unsafe practices, resource shortages, bullying). This process, often called “whistleblowing,” is vital for identifying risks and driving improvement.

Staff who raise legitimate concerns in the public interest are legally protected from detriment or dismissal by the Public Interest Disclosure Act 1998 (PIDA).Every NHS organisation must have clear policies and procedures to enable staff to raise concerns safely and confidentially, without fear of reprisal. Encouraging an open culture where staff feel able to speak up is essential for a safe NHS.

Health and Safety Responsibilities

Creating and maintaining a safe environment for patients, staff, and visitors is paramount in the NHS. This is governed by extensive health and safety legislation, primarily the Health and Safety at Work etc. Act 1974 and its supporting regulations, alongside CQC Fundamental Standards (especially Reg 12 Safe care and treatment, and Reg 15 Premises and equipment).

Responsibilities include:

• Conducting risk assessments and implementing control measures.
• Preventing and controlling infections (adhering to infection prevention and control policies).
• Ensuring safe use of equipment and substances.
• Providing appropriate training and personal protective equipment (PPE).
• Reporting incidents, injuries, and hazards promptly.

Health and safety is a shared responsibility across the organisation.

Supporting Staff

Supporting the health, well-being, and development of the NHS workforce is recognised as crucial for delivering high-quality patient care. While not dictated by one specific code, principles of fair treatment and support are embedded in NHS strategies (like the NHS People Plan), employment law, and organisational policies.

This includes providing access to resources like occupational health services, well-being programmes (e.g., counselling), flexible working opportunities where feasible, and continuous professional development. A well-supported, engaged, and healthy workforce is better equipped to meet the demanding challenges of healthcare.

Final Thoughts

The comprehensive framework of legislation, common law duties, professional codes, the NHS Constitution, and specific NHS guidance steers the delivery of care in England, aiming for trust, fairness, and excellence. These combined elements – covering everything from patient rights and confidentiality to equality, safety, and professional conduct – reflect the core principles and values of the NHS.

By adhering to this robust framework, NHS professionals work to ensure safe, effective, person-centred care, thereby building and maintaining public trust. This multi-faceted governance structure plays a vital role in shaping the NHS’s commitment to continuous improvement and accountability, reflecting societal expectations for high-quality, responsible healthcare. For patients, this framework provides reassurance about standards of care, while for staff, it offers clear legal, ethical, and professional boundaries within which to practice confidently and improve lives.