Commissioning board mandate could lead to government clashes

The board will take over full responsibility for the NHS’s £80bn commissioning budget from April 2013. A DH consultation on its first mandate is due to begin in June or July this year.

The mandate will set the service’s funding and what it should deliver during that year and, very probably, beyond.

HSJ understands senior figures at the board fear the DH and other parts of government – in particular Number 10 – will take it as an opportunity to load the NHS with a “list of instructions” and targets.

The commissioning board is instead arguing for it to be a short and “high level” document and to include mainly “aspirations” for improvement in outcomes.

It is also likely to call for expectations of improvement on NHS outcomes framework indicators not to be set unrealistically high.

One senior commissioning board source said there was a danger “everyone tries to get their thing in the mandate because they think otherwise it won’t get done”.

Another source expressed concern that if the mandate included too many specific targets the commissioning board would in turn have to direct clinical commissioning groups to achieve them.

The board is in the early stages of developing a planning and accountability framework for CCGs and intends to give CCGs much more flexibility to set their own priorities than primary care trusts.

However, it is more likely to have to issue “top down” priorities if there are specific targets in the mandate.

A source close to health secretary Andrew Lansley said his office would resist pressure to “load it up with lots of non-
outcomes based indicators”, but recognised there were likely to be calls for requirements from “across government” and from interest groups.

The source said as well as setting priorities the DH would use the mandate to make sure the commissioning board was not “taking too much power”, for example by requiring it pass a certain level of funding to CCGs rather than retaining it.

Bassetlaw Clinical Commissioning Group chair Steve Kell said: “If the NHS is national we should expect some national priorities.

“[However] the mandate needs to give flexibility to have local priorities. That’s the point of local clinical commissioning.”

The Richmond Group of the largest charities was due to call today for the mandate to include “specific actions” to address themes include co-ordinated care, patient engagement and early intervention.