The final Mandate, which establishes the strategic objectives for the NHS Commissioning Board (NHS CB), maintains the broad goals of the draft version but is lighter on specific commitments.
Positive responses from the NHS CB and the BMA suggest that criticisms of the draft version as being over-prescriptive have been addressed.
Significant changes include the loss of definite overarching commitments to reduce premature death and increase quality of life for the chronically ill.
More generally, where quantitative outcome targets were set with the numbers pending consultation, there is now only a requirement to improve.
The Mandate states that improvements should be measurable by March 2015, the end of the Board’s first term of office.
As before, it notes the duty of the Board and the DH to promote “the autonomy of local clinical commissioners”, and identifies this is the means by which outcomes will be improved.
Key priorities for improvement include: standards of treatment for older patients; diagnosis, treatment and care of people with dementia; support for people with multiple physical and mental long-term conditions; and preventing premature deaths from major diseases.
The section on premature deaths notes the importance of “tackling risk factors such as high blood pressure and cholesterol”, as well as ensuring that patients have access to NICE-approved drugs.
The section on long-term conditions places emphasis on integration of care and on patient choice. Personalised care plans and personal health budgets are promised, as well as online access for patients to their care records and the means to book appointments and repeat prescriptions.
Dementia is highlighted as a priority, with progress towards “timely diagnosis and the best available treatment” set as an objective. A further aim is “to put mental health on a par with physical health” and address poor access to healthcare among the mentally ill.
A section on innovation repeats the previous commitment to introducing the controversial “quality premium” for GPs, as well as establishing a “fair playing field” for competing providers from all sectors.
The Mandate stresses the need for “redesigning services, open procurement and contracting for outcomes” – which reaffirms the Government’s commitment to the NHS innovation agenda as well as the role of the private sector.
Sir David Nicholson, Chief Executive of the NHS CB, commented: “The Mandate avoids the danger of excessively prescribing the actions of health professionals. Our role will be to work closely with local clinical leaders and provide the support they need. Our role is not to tell them what to do.”
Dr Mark Porter, Chair of BMA Council, praised the “welcome reduction in targets, objectives and micromanaging” from the draft Mandate, but noted: “If the NHSCB’s strategic vision is to be delivered, ministers must ensure there is genuine clinical involvement and adequate resourcing.”
Commenting on the Government’s innovation agenda, ABPI Chief Executive Stephen Whitehead said: “The NHS Mandate must work hand-in-hand with Innovation, Health and Wealth to help break down barriers to innovation in the NHS and to ensure that new medicines reach patients.”