NHS Commissioning Board directors have criticised the draft “mandate” they have been set by government for being confused, too detailed and over-reaching its main purpose.
Directors discussed the document at their July board meeting in Leeds yesterday, and resolved to work with the Department of Health to rewrite the document.
Board chair Malcolm Grant said it was “impossible to underestimate the importance” of the mandate, parts of the document “completely fit with the government’s objective of ‘liberating’ the NHS, and specifying desired improvements in outcomes”.
However, “there are other parts where you might find the mandate goes further than you would have wished,” he said.
“I hope we would, over the coming weeks, have an opportunity to review those parts and to have a constructive discussion… as to how we can ensure that we do deliver the government’s over-riding objective for the mandate, which is a liberated NHS.” He added that clinical commissioning groups must be given the freedom to improve services through trial and error.
Professor Grant said: “Given that it is so unique an opportunity, it would be immensely powerful as a document were it to seize the transformation agenda, to understand that he whole point of these difficult reforms has been to transform the quality of healthcare for patients… in other words a document that sets out quite simply what the high level objectives are.”
He said the board could work with the department to create a mandate “which would not be not more of the same, but something quite inspirational”.
Chief executive Sir David Nicholson said: “There is something here we can work on but it is some way from where we need it to be.
“Where you have process-driven targets you need to be really clear about how, and why, and what for. Just listing things down is difficult to communicate and difficult to work with people on.
But, he concluded: “We can work on this and get it into a much better place for patients, and the system we want to run.”
Tim Kelsey, the board’s director for patients and information, said: “If this document does not provide the kind of manifesto for a very positive but real disruption in the service of patients, then we’ve just lost a massive historic opportunity.”
Policy director Bill McCarthy said the final document must ensure CCGs have the “headroom” that will enable them to make the right decisions locally, and to be creative and innovate.
A board paper in his name said: “The NHS Commissioning Board intends to give CCGs freedom to innovate, which we can only do if the government allows us that freedom.”
A statement by Professor Grant added: “I am convinced that the best way to [enable clinicians to innovate locally] is to keep the mandate focused on improving overall outcomes for patients, rather than clogging it up with a range of narrowly conceived targets.”
The full mandate consultation document is 104 pages long. The draft mandate contains 22 objectives, each with details on measures for assessing progress.
It also includes an extensive “choice framework”, setting out where patients were entitled to choice in NHS services. Non executive director Lord Adebowale said putting the two together was “a bit confusing”, although welcomed the document’s emphasis on reducing inequalities.
Ciaran Devane, also a non executive director, said he had been “pleasantly surprised” by a passage which placed mental health on a par with physical health.