NHS mandate welcomed by health bodies

14 November 2012

The new "historic" NHS mandate announced by the Health Secretary Jeremy Hunt has been welcomed by many of the key organisations in the health service.

Coming shortly after the positive reaction to the Department of Health's announcement of core values that GPs will be monitored against, the mandate will "help us all in health and social care as we move forward", the Association of Directors of Adult Social Services said.

President Sarah Pickup particularly praised its references to action following the abuse at Winterbourne View Hospital, as well as the commitments to improving the diagnosis, treatment and care for people with dementia.

While a single outcomes framework for the NHS, social care and public health services would be preferable, she said, with all agencies moving further and faster together, Pickup said: "This mandate sets out the expectations of the NHS Commissioning Board in a way that can accommodate common objectives and the ways in which we need to work together in order to achieve them."

She also welcomed the way key messages in the mandate were consistent with aspirations in the care and support white paper and that prevention and recovery are key themes with respect to physical and mental health.

"There is a welcome focus on promoting and supporting effective local commissioning and engagement with councils and others. And on achieving for individuals, rather than organisations, with the emphasis falling on maintaining health and wellbeing," Pickup said.

Anna Dixon, director of policy at The King's Fund, said it was clear that ministers had listened to the concerns that were raised about the need for a clearer and more focused set of objectives. She was particularly pleased to see that mental health had been given parity with physical health.

Dixon "strongly" welcomed the clearer focus on improving the health of older people and those with long-term conditions. The mandate should be a catalyst in moving integrated care from a subject for discussion in the policy arena to making it happen at scale and pace across the country, she said.

"The mandate includes a strong focus on decentralisation and freeing up local organisations to innovate," Dixon said. "[But] the real test will be how this translates into practice, especially given the tight financial climate and need to maintain financial control."

The NHS Confederation described the mandate as "a major sea change for the NHS" because it sets out a clear vision of what the public can expect from the health service.

Chief executive Mike Farrar said: "It was really important that the government avoided stuffing the mandate to the gunnels with detailed targets for every condition under the sun.  While that might have looked superficially attractive, it would have meant more top-down prescription and less innovation and responsiveness to local needs.

"The real challenge for the government now is to stay true to its word and use the mandate to give the NHS stability, rather than use it as a tool to reset priorities on a regular basis. The NHS Commissioning Board must take advantage of the opportunity it now has now been given to get power to the front line – the NHS has always wanted to have more freedom, now we have a chance to show we can make it work."

Farrar said the mandate provided an excellent opportunity for politicians to start a clear dialogue with the public about why some local NHS services need to change. It was important that NHS leaders and politicians explained clearly what patients can gain from service change, rather than focusing on what was being taken away.

Dean Royles, director of NHS Employers, also welcomed the mandate, especially the focus on staff health and wellbeing.

"Investing in safe, healthy workplaces not only increases productivity and raises morale, but it improves patient outcomes and experience," he said.

The mandate is based around five key areas where the government expects the NHS Commissioning Board to make improvements. These are: preventing people from dying prematurely; improving the quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury; ensuring people have a positive experience of care; and treating and caring for people in a safe environment and protecting them from avoidable harm.