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Government publishes “radical” mandate for the NHS

13 November 2012

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The Government has published its first mandate to the NHS outlining what it and patients can expect from the service.

The Mandate is based on the National Outcomes Framework and details the areas of focus for the NHS Commissioning Board’s (NHS CB) £95 million budget.

The priorities include saving potential 20,000 lives a year by reducing mortality rates in cancer, liver and lung disease, improving diagnosis and treatment of dementia and improving access and information for patients.

The Secretary of State for Health, Jeremy Hunt, said it sent a “strong signal that we are very ambitious and optimistic about how the NHS can improve in areas which are priorities for patients”.

“This is the first time that we have tried to represent the operational independence of the NHS by disciplining ourselves as ministers to condense what we want the NHS to focus on in a document of 28 pages,” he said.

He defended the lack of targets in the document as it “would mark a return to the old system” and would force the NHS CB to “micro-manage” clinical commissioning groups.

Chief Executive of the NHS CB, David Nicholson said the Mandate’s relentless focus on outcomes was new for the NHS and that it would give more “clout to patients”.

“It’s the most ambitious and radical document I have seen in my time in the NHS.

“The obsession with improving outcomes is not something we have seen… it’s more radical that the structural changes we’ve seen and getting and NHS focused on outcomes will be a great thing for us to do.”

He said the NHS CB’s role is to deploy its 4,000 staff to support localism – clinical commissioning groups, health and wellbeing boards and patients – to make the NHS “be the best it can be”.

In response to the publication of the mandate Dr Charles Alessi, Interim Chair of NHS Clinical Commissioners said: “We welcome the board’s objective to strengthen the local autonomy of clinical commissioning groups and to hold the Board to account for delivering  this. Without this the system would not have been able to escape the old style top-down management which has so stifled clinical innovation.”  

Dr Mark Porter, Chair of BMA Council, said: “The BMA is keen to discuss the practical implementation of some areas of the mandate, such as how the NHS takes advantage of new technological and IT developments. These proposals will require significant resource and technical commitments that must be considered if they are to become a reality. It is also vital that any changes that affect patient records do not in any way compromise patient confidentiality, especially if they may be placed online. The NHSCB must consider this matter very carefully before any implementation.”

NHS Confederation chief executive Mike Farrar said: “It was really important that the Government avoided stuffing the mandate to the gunnels with detailed targets for every condition under the sun.  While that might have looked superficially attractive, it would have meant more top-down prescription and less innovation and responsiveness to local needs.
“The real challenge for the Government now is to stay true to its word and use the mandate to give the NHS stability, rather than use it as a tool to reset priorities on a regular basis.”