For all the talk of easing top-down control of trusts, the mandate mentions some levers that could hit providers.
The most significant of these is that hospitals with good scores under the friends and family test “will be financially rewarded”.
It is not clear if the financial “reward” will be under the existing Commissioning for Quality and Innovation (CQUIN) payments system or a different arrangement in the NHS standard contract between trusts and commissioners.
There are two versions of this test, one asking staff in the annual staff survey whether they would recommend the trust to a friend or family member, and one asking the same question of patients.
The latter system has already been trialled in the NHS Midlands and East strategic health authority cluster, where the response from hospitals has been mixed, with some dramatic fluctuations in trust performance.
The mandate confirmed the patient friends and family test would be rolled out to all acute hospital inpatients and A&E patients from April 2013 and, from October, “women who have used maternity services”.
It said it must then be introduced “as rapidly as possible” for all NHS services – although it is not clear if this will include NHS-funded care in the private or charitable sector.
A Department of Health spokeswoman said it would be for the commissioning board to decide exactly how the financial reward would be allocated.
The commissioning board will also have considerable power over many hospital trusts with its £12bn budget for specialised services, which commissioning board chair Malcolm Grant yesterday said would include chemotherapy.
The document issued this morning mentions “providing equally good access to care seven days a week” but only sets an objective to improve this “where possible”.
The mandate also formalises Andrew Lansley’s “four tests” for reconfiguration.
It said: “The commissioning board’s objective is to ensure that proposed changes meet four tests”, and sets out near identical wording to Mr Lansley’s, saying: “There should be clarity about the clinical evidence base underpinning the proposals, they must have the support of the commissioning GPs involved, they must genuinely promote choice for their patients and the process must have genuinely engaged the public, patients, and local authorities.”
Professor Grant told a conference in Manchester the mandate was intended to “get away from the Bevan culture of the Tredegar bedpan” - referring to a speech by the first secretary of state for health that the reverbarations from even a small care failing should be heard by central government.
He said: “Responsibility has to be taken at the point where resources are applied”, but added patients would be protected by the NHS constitution.
Government reveals ‘historic’ first mandate
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Trusts to be rewarded for friends and family test success