Government reveals ‘historic’ first mandate

13 November, 2012 | By Dave West

The government has published its first mandate for the NHS, in what it said was a “historic” moment.

The document sets the priorities and funding for the independent health service, run the by the NHS Commissioning Board, for two years.

See HSJ’s full analysis of the mandate revealing:

How the mandate does not include specific targets for numeric improvement, which appears to allow leeway for clinical commissioning groups’ freedom. However, some old style targets remain.
The mandate requires the commissioning board to guarantee CCG autonomy.
How the mandate has rejected the use of fixed national targets in order to avoid perverse incentives.
Providers will be judged on integration and deaths from poor care.
A information technology revolution will take place.
How the DH has earmarked £2bn for the running costs of the new commissioning system.
Hospitals with good scores under the friends and family test “will be financially rewarded”.
DH earmarks £2bn for commissioning system running cost.
NHS managers, doctors and nurses can expect to be put under greater scrutiny over the next two years in order to ensure better and safer care for patients. The mandate makes repeated references to the NHS needing to become one the best health services in the world in terms of patient outcomes.
Providers of NHS mental health services could be expected to meet new waiting time standards to drive improvements in access.

Readers' comments (8)

Stephen Dalton | 13-Nov-2012 1:51 pm
Well done to Norman Lamb for ensuring there's significant reference to Mental Health. This is a great start and demonstrates real ambition beyond the rhetoric. What we need to see from the Commissioning Board now is that this is about improving Mental Health services via a partnerhip between providers and commissioners,each party playing their full part, and not a "challenge" just for providers.
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Anonymous | 13-Nov-2012 3:00 pm
Intellectually I'm comfortable with no set targets, however we need to be sure that at an operational level performance is not allowed to slip under 'difficult' circumstances.
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Anonymous | 13-Nov-2012 3:03 pm
The avalanche of feedback to the draft was that there were already plenty of targets in other parts of the system and that the mandate should draw these together rather than add yet more. Interesting to see how many people are now commenting that there aren't enough targets!
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Anonymous | 13-Nov-2012 3:23 pm
Sadly we've seen (under Lansley) that the removal, or even de-emphasising, of targets has led to backward steps in performance. So, it's hardly a surprize when people are worried that we'll get the same behaviour - particularly when Hunt seems so concerned about being seen to directly manange performance..
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Martin Rathfelder | 14-Nov-2012 10:30 am
Does this mean that Ministers can no longer go around saving hospitals in the run up to the general Election?
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Lisa Rodrigues | 14-Nov-2012 1:38 pm
Well said, Stephen. And judging by the conversations on social media, it is a massively popular move to give parity to mental health. Today's report from Rethink shows what has happened because mental health commissioners and mental health services, have, just like their patients, been discriminated against for many years.

Commissioners of my trust's services have been far-sighted - we've achieved 4 week waits or less for several years, plus had our patient feedback initiatives hard-wired into CQUIN.

But parity means parity. Mental health services need payment by results ie if we do more work of the right quality we should get paid for it. Mental health interventions reduce demand for physical care so we need investments to save coming from physical commissioning budgets please. Mental health commissioners get treated unfairly and are expected to rob Peter to pay Paul. Liaison psychiatry a la RAID is a case in point.

People with serious mental illnesses need high quality physical and mental care, including excellent mental hospitals, brilliant community services and fast access to evidence based psychological therapies. We've been some of the most successful part of the NHS at reconfiguration, but recently we have seen 1% reductions compared to physical care. Success should be rewarded.

As mental health is around 25% of NHS care, how about 25% of the resources, rather than around 12% (and falling) as now?

C'mon mental health commissioners and providers (and I don't just mean trusts). Let's be the mice that roared!
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Anonymous | 14-Nov-2012 4:47 pm
I have worked in mental health for 20 years through thick and thin. We are being destroyed... The CIPS to come with disinvestment etc are ripping our services apart... It's not ok. Far from it... I have always stayed and fought through the pain, in the interest of our patients and their carers and families. But what we are on the brink of now, makes me question whether I have the stomach to rip apart what has been years in building.. Good people, who are kind and show kindness and compassion are being put in the position to make bad decisions. There is no efficiency in mental health, I see destruction. What do they say about good men and women who stand by and say and do nothing..... I am saying it, but will you listen and ask questions. We need your help
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Anonymous | 15-Nov-2012 11:05 pm
I agree that the mandate is hysterical. Meaningless twaddle. I'm amazed to see intelligent people waste their energy on debating it.
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