The NHS Commissioning Board may be rated annually for its commitment to autonomy by a survey of clinical commissioning groups, according to its first “mandate” from the government.
The Department of Health’s mandate document sets out what the board will be expected to achieve and how it will be monitored.
A draft of the first mandate - to run from 2013-15 - was published on Wednesday for consultation.
Although it contains only 22 formal “objectives”, most of them include several subsidiary aims and a set of “key measures for assessing progress”.
The commissioning board will also be asked to show improvement against each of the 60 indicators of the NHS Outcomes Framework.
One of the objectives in the draft is to “transfer power to local organisations and enable the new commissioning system to flourish”. This includes requirements to ensure CCGs are established and authorised, have “full control over where they source their commissioning support” and that “there is a transparent, principle-based system for the board’s interactions with CCGs”.
Detailed annexes accompanying the mandate consultation say in judging these items the DH will expect, “evidence of progress towards all the components of the objective, for example evidence from surveys of CCGs”.
The NHS Alliance and others involved in clinical commissioning have been calling for an annual “360 degree” review of the commissioning board by CCGs, in which they have a chance to give their views about how it is functioning. They are concerned it could be too centralising and dictating to CCGs.
Conversely, the mandate appears to indicate the commissioning board will have an “active” role in service reconfiguration - both in “leading work to redesign services that it commissions, or supporting groups of CCGs in handling complex or large-scale service changes”.
Meanwhile, the mandate reiterates that the board should offer “incentives for commissioners, through a quality premium”, while revealing that, “funding for the quality premium will come from within the overall administration costs limit set in directions for the NHS commissioning system”.
Funding the controversial bonuses from the admin budget could make them more palatable to the public, and mean they will have to be smaller than if they came from patient care budgets. The DH has said the total NHS admin cost limit - which will also have to pay for running costs for the whole system - will be £3bn by 2014.
The draft is likely to be seen as a compromise between the desire of the commissioning board for a short mandate containing only clinical outcomes, pressure in government for a much longer list of specific priorities, and health secretary Andrew Lansley’s wish to use it to push through implementation of his commissioning reforms.
Patient group umbrella organisation National Voices praised the DH for keeping it reasonably succinct, but called for a greater emphasis on patient involvement in their care, rather than on choice of provider and personal health budgets.
National Voices director of policy Don Redding praised the mandate’s inclusion of an objective promoting integrated care, and another promoting parity between mental and physical health.
However he said: “Our biggest disappointment is there is no big objective about engagement of people in their own care. All the emphasis is on having a choice. The mandate is strong on choice but weak on [patient] voice.”