NHS Confederation has said the first NHS “mandate” will spark public and political debate about the service’s priorities.
The mandate to the NHS Commissioning Board will set NHS funding and what it will be expected to deliver in the next year, and probably in a further year or two.
A consultation will begin on the first mandate, which will apply from April 2013, in June or July. The final version will be laid before Parliament.
Mr Farrar said it was likely to become the subject of public debate and politicians from across government outside would seek to influence it.
He said it may spark concern among interest groups and politicians, reflecting the debate about the Health Act before it was passed.
Mr Farrar said: “The mandate will have to reflect the public’s expectations of what the NHS should be doing rather than managerial expectations.
“It is likely to reflect things of public concern such as dignity in care, the quality of care for older people, and dementia.
“It is coming through a political process so it will be much more closely aligned to those issues. We shouldn’t underestimate the impact that will have.”
HSJ has previously reported the commissioning board’s fears the that government will put a large number of detailed requirements in the mandate, whereas it would prefer “high level” aims and outcome measures.
The confederation has discussed the mandate with members and Mr Farrar called for the first mandate to “be realistic”, reflecting the fact it is a new system with “new organisations [which] will be finding their feet”. He said setting expectations higher than can be met could damage confidence in the reformed system.
Mr Farrar also said the government’s requirements for improvement should be linked in the document to the funding available. “The emphasis has to be around what is achievable with the resources,” he said. “You can’t diverse the financial element when you set the functions.”
Mr Farrar also said the mandate should make clear what happens if the NHSCB does not deliver against its requirements, and said the government should ensure they match other NHS accountability regimes, for example those run by Monitor and the Care Quality Commission.
He said there was also potential for targets in the three outcomes frameworks for the NHS, social care and public health to conflict.
“If they are not aligned the NHS will find it difficult – the risk is quite high,” he said.