The government’s instructions to the NHS this year call for “concrete progress on local sustainability and transformation plans” and say it must deliver “the productivity and efficiency gains necessary to maintain financial balance”.

The Department of Health published its annual mandate to NHS England today, more than three months later than usual. One of the reasons for its delay was vexed debate between government and NHS England over delivery and accountability, particularly on STPs, financial performance and emergency care.

Parts of government have been disappointed that many STPs didn’t produce robust cost-saving actions in their first year. Many feel they didn’t make good progress. 

The document says in future “a number of metrics will be used to measure progress across STP footprints in delivering the Five Year Forward View, linking performance of the NHS at a local level more explicitly to national accountability”, though no further detail is given on these.

The document also states:

  • The four hour emergency waiting target should be met by the end of the 2018 calendar year - slightly later than the previous expectation.
  • Other headline targets must be met immediately - prompting NHS Providers to say the “gap between demands on the health service and the resources available in the coming year remains unbridgeable”.

In a foreword to the mandate, health secretary Jeremy Hunt says: “2017-18 should be the year in which we see concrete progress on local sustainability and transformation plans… As partof this effort, the government has already made £325m of capital funding available for the best STPs over the next three years. In the autumn a further round of local proposals will be considered.

“2017-18 should also be the year when the NHS delivers the productivity and efficiency gains necessary to maintain financial balance by tackling unwarranted variation, reducing waste, bearing down on the exorbitant costs of agency staff and better managing demand…

“I have been clear that a critical element of patient safety is A&E performance, and equally clear that there have been instances of unacceptable performance in some hospitals in recent months. That is why, central to this mandate, is delivery of the NHS’s A&E turnaround plan which should see hospitals return to meeting the four hour target.”

The mandate includes details of the emergency care improvement plan agreed between government and the national NHS bodies, revealed by HSJ earlier this month.

As part of this it includes a target to “reduce NHS-related delayed transfers of care in support of a total reduction of delayed transfers of care to 3.5 per cent by September 2017”.

Healthwatch England, which law requires is consulted on the mandate, welcomed the DTOCs target, which its chair Jane Mordue said could “help improve thousands of people’s experience of care and reduce the financial and human cost caused when discharge goes wrong”.

Other objectives in the mandate include:

  • NHS England must ensure “appropriate contingency funding is maintained and to make sure that commissioners discharge their duties in a way which enables all parts of the system (commissioners and providers) to meet their control totals”.
  • NHS England must, with NHS Improvement, “continue to support providers to develop and publish a board level service quality improvement plan that will achieve significant and measureable improvements in the quality of services, thereby reducing deaths, severe harm and other adverse outcomes attributable to problems in healthcare”.