The NHS Constitution was established in law by section 1 of the Health Act 2009. It applies only in relation to the health service in England (which is provided for mainly by the National Health Service Act 2006, as amended). The first version of the NHS Constitution was that published by the Department of Health on 21st January 2009. A revised version was published in 2010, and a further revised version was published on 8th March 2012. It is that version which was in force when these Regulations were made. Any revision to the seven guiding principles contained in the NHS Constitution (which have until now remained unchanged) must be made by Regulations. These Regulations substitute four of the guiding principles: the other three remain unchanged.