Earlier this year, NHS Commission Board chair, Professor Malcolm Grant quipped he wanted a mandate that was succinct enough to be published in The Sun newspaper. At 37 pages, the draft mandate published last week won't be sitting alongside page 3 but it's a good effort for a document that could so easily have become everyone's ‘my three wishes' list.
So, here's what I think are the interesting bits.
The mandate can only be changed in-year ‘in certain circumstances' eg a general election or ‘exceptional circumstances'. Will politicians really be able to keep their hands out of the NHS for a whole year? Probably not. But use ‘exceptional circumstances' too often and we're back to politics in the NHS again.
Page 4 makes clear the Government's commitment to NHS principles including ‘free at the point of use, based on need, not ability to pay.' Always good to read those words in a week when I've heard some GPs – interestingly not those heavily involved in commissioning – moot the idea of charging for GP appointments.
There are a lot of Xs still to be filled in with regards to the outcomes it sets. Fill in the blanks.:
Secure an additional X life years for the people of England by 2015, 2018 and 2023
Increase number of QALYs for people with LTCs by 2015, 2018 …
Improve recovery from illness by X, Increase the proportion of patients who rate their experience as ‘good' by an additional X, Improve patient safety and QALYs lost through avoidable harm by X
The next questions is - how will these indicators be measured?
The indicators will put mental health ‘on a par with physical health' it claims citing schizophrenia as an example where life expectancy is up to 20 years less than the general population.
And the board will have a role in ‘maintaining or improving performance' on existing service standards – for example 18 week wait times.
It says the Government is committed to ‘extending the range of choices at every stage of patients' care'. Fragmentation is the word that quickly comes to mind on this.
A fair playing field for providers is mentioned and reconfigurations must respect the principle of a ‘fair playing field, ensuring all potential providers have the opportunity to contribute to proposals for providing care to the local population'.
Tariffs must be used to the maximum and where non-tariff payments are used must be ‘justified transparently'.
The role of clinical senates and networks is defined as ‘sources of advice but CCGs should be free to make their own arrangements collectively or individually'.
And finally, it wants personal health budgets to be offered ‘wherever appropriate'. And from April 2014 people receiving NHS continuing healthcare will have the right to ask for a personal health budget.
In London alone, continuing care costs the NHS £310 million a year. Not sure CCGs will have the capacity yet to see this pledge through in less than two years' time.
Personal budgets and tariffs – your time has arrived. For clinical senates it looks like it's over before they began.
Sue McNulty is editor of Practical Commissioning.
The July/August edition of Practical Commissioning will include expert analysis of the draft mandate.
