No set targets in revised mandate

The draft version of the mandate, put out for consultation over the summer, proposed setting targets in five areas, including improved overall life expectancy and an increase in the number of quality adjusted life years enjoyed by people with long term conditions.

However, the final version of the mandate, published today, says success will be measured by the “average level of improvement”, alongside progress in reducing health inequalities and unjustified variation.

There are also several objectives for the NHS to become “among the best in Europe”, for instance on the diagnosis, treatment and care of people with dementia, and the prevention of premature deaths.

Launching the document today, health secretary Jeremy Hunt said that if he had given commissioning board chief executive Sir David Nicholson a target of increasing life expectancy by 0.7 years within two years, it could mean “that we return to the old NHS”. This would see “Sir David will be under pressure to micro manage all the clinical commissioning groups, because I will be so determined I can stand up at the dispatch box and be accountable for a specific target”.

“We don’t think that’s the way we want the NHS to work,” Mr Hunt added.

“We want to give operational freedom so we’re measuring progress against a range of statistics.

“Measurable progress is more ambitious because it’s not just measurable against where we currently stand, but its measureable progress towards being the best in Europe. Other countries are improving their healthcare outcomes at the same time.”

Sir David added that the government was not setting out performance targets for the NHS to meet by a set date. Instead, the board will work with local NHS organisations to set out how they will progress locally.

HSJ understands that the Department of Health hopes the move will prevent perverse incentives arising where areas already meeting a target feel no pressure to improve.

Exactly how the mandate will lead to local improvements is a conversation that will start “tomorrow”, Sir David said, and will lead to CCGs producing a “prospectus” for improvement in their local areas.

He said: “By the time we get to February or March next year for each CCG you will have essentially what you might describe as a prospectus for the local population which will set out what they should expect from the activities of the local CCGs over the next year or so. [This] will be an important local document, and part of local accountability.”

The final mandate reflects the priorities set out by Mr Hunt in his speech to the Conservative party conference last month: quality, largely in terms of patient experience and basic standards; long term conditions; dementia services and reducing mortality for major killer diseases.

The mandate includes 13 patient experience measures, including two new indicators of under development on experience of young people and experience of integrated care, and measures on access to GP services and dental services.

Most of the indicators the NHS will be judged against under the mandate are already part of the outcomes framework. There are around six additional indicators, including excess under-60 mortality in adults with learning disabilities and health related quality of life for carers, which are expected to form part of the revised outcomes framework.

Longstanding quality measures such as rates of clostridium difficile, MRSA and hospital-related veneous thromboembolism are prioritised for improvement.

In terms of reducing mortality, the mandate tasks the commissioning board with reducing variation between hospitals in avoidable deaths by publishing “outcome data for all major services by 2015” at CCG level as well as “teams and organisations providing care”.  This suggests a renewed push on publishing speciality level mortality data.