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Analysis: NHS mandate – does it do the job?

The NHS mandate is an essential piece of policy in ensuring the new NHS delivers a locally determined and sensitive health system with patients at the heart.

It outlines 22 key objectives for the first two years of the NHS Commissioning Board and wider ambitions to be achieved over the next five to ten years.

This includes detail on performance standards through the NHS Outcomes Framework, ensuring progress towards reducing inequalities as well as improving integration of care, and outlining incentives for commissioners in the form of a quality premium.

The proposals in the mandate are not perfect. In many respects the mandate could be viewed as a lost opportunity to restate loudly and clearly the differences in functions and governance between the old and new NHS. But it is a start.

In the mandate, the new CCGs have a duty to deliver the best healthcare they can within their allocated resources and to do so they must prioritise care sensitive to the needs of their patients. 

They do not, unlike the PCTs that preceded them, have a prime responsibility to manage the local health economy. 

This is quite a difference in approach and it means that clinicians from primary and secondary care should be working together to find the best way to manage their patients and determine exactly what they want to achieve and how it can be done. 

When rules for contracting will not allow for this, CCGs are encouraged to adopt local solutions.  In essence, it means if the rules do not fit well then rewrite the rules. 

CCGs are in the best place to make the decisions and to do so they need to become autonomous and have the oxygen they need to breathe and develop and succeed. 

Which brings us to the most important bit of the mandate – the duty of the board to promote the autonomy of commissioners and health service providers. 

They need to be the enablers of change and innovation not the schoolteachers you need to ask for permission before you act, but there is a risk of this in the current mandate.

We are still no clearer on what proportion of the administrative budget will be developed to the quality premium, or how the NHS Commissioning Board will performance-manage practices. Some of the ideas on extending patient choice are interesting, but it is unclear how they will be applied in practice.

Through the consultation we need to build on the proposals within the mandate by making sure we clearly point out what bits are missing and what bits need to better reflect what CCGs actually need.     

Dr Charles Alessi is chair of the NAPC