Analysis: mandate may allow space for CCGs' freedom

The mandate sets out what the government requires the health service, run by the independent NHS Commissioning Board, to deliver.

It includes a long list of indicators of care quality but instead of including specific targets for each one it calls for general improvement across the board.

The mandate says “success will be measured” by “the average level of improvement [and] by progress in reducing health inequalities and unjustified variation” on indicators.

That contradicts the government’s plan in July to set specific “levels of ambition”.

Then health secretary Andrew Lansley told HSJ in the summer he wanted specific levels of ambition.

The decision not to do this may allow CCGs to have more freedom in their commissioning decisions, although the commissioning board will want to ensure across England on average there is improvement on all or most indicators.

Health secretary Jeremy Hunt, speaking at the launch of the mandate today, said he wanted to avoid the board having to “micro manage” CCGs.

Freedom

However, although the mandate does not include old-style process targets, it makes clear that some of these will still be important in the NHS.

It says: “Timely access to services is a critical part of our experience of care.” It highlights that patients’ rights in the NHS constitution must be delivered. They include high profile targets such as elective care waiting times. The mandate also says: “We want the board to work with CCGs to address unacceptable delays and significantly improve access and waiting times for all mental health services… We will work with the board to consider new access standards.”

While the mandate excludes some process targets which were in the July draft, such as the requirement to increase health visitor numbers, it also says it is “not exhaustive” and that “the board has agreed to play its full part in fulfilling pre-existing government commitments not specifically mentioned”. It is likely these include process requirements.

Meanwhile, the document affirms the government’s desire for an autonomous NHS, under its section headed “Freeing the NHS to innovate”.

The mandate says the board’s objective is to “get the best health outcomes for patients by strengthening the local autonomy of clinical commissioning groups, health and wellbeing boards, and local providers or services”.

It says that for any CCGs given conditions as part of their authorisation, the board will “set out a clear timetable and path to full authorisation”. It also says CCGs will be “in full control of where they source their commissioning support”.

Choice and integration

The mandate suggests CCGs will be required to introduce further choice and competition in some circumstances.

It says by 2015 the commissioning board will have extended patients’ rights to choice, which “includes offering the choice of any qualified provider in community and mental health services”, and to make NHS procurement “more open and fair”.

However, the mandate also calls for the board to “make measurable progress” in “better integration of services”. This could include “better measurement” and “new models of contracting and pricing which reward value-based, integrated care”.