NHS Board’s draft ‘mandate’ unveiled
pharmafile | July 5, 2012 | News story | Sales and Marketing | CCGs, NHS, NHS Commissioning Board
Health Secretary Andrew Lansley has unveiled the proposed ‘mandate’ for the NHS Commissioning Board, the set of strategic goals the government will give it every year.
The new approach is aimed at allowing the NHS Commissioning Board to run the health service with a minimum of political interference.
Andrew Lansley said: “In the past there has been too much focus on systems and processes rather than people. For the first time the mandate will focus on holding the health service to account for results that make a difference to people.
“Objectives for improving care will be shaped by what the public needs and will be one of the most important ways the Government can hold the new system to account.”
The new draft mandate, which is open for consultation, contains a total of 22 ‘objectives’ which range from high level targets to increase the life expectancy of people in England, to targets related to the introduction of CCGs, the new frontline NHS organisations.
Many in the health service feared that the NHS Commissioning Board could be overwhelmed and distracted if the government gave it too many targets. But the initial reaction from the health service managers’ organisation the NHS Confederation has been positive.
Mike Farrar, NHS Confederation chief executive said: “Encouragingly, this mandate broadly ticks the main box – it keeps things relatively simple and consistent. Unlike documents that have gone before it, the mandate does not seek to develop an ever growing ‘wish list’ of objectives.
“It rightly encourages commissioners to exercise their knowledge of the needs of their local communities to plan and deliver the best care. We are particularly encouraged to see such a strong focus on the importance of good mental as well as physical health.”
Farrar said that it was essential to strike the right balance between national direction and local control, with the NHS Commissioning Board at the national level and CCGs at the local level.
Farrar said: “The NHS Commissioning Board will have a responsibility to allow local commissioners to take the decisions that are in the best interests of their community, while providing national consistency in areas like quality, safety, access and value for money. We will have to wait to see whether this can be put in to practice, and ensure the NHS Commissioning Board avoids returning to the old style of command and control.”
Farrar also praised the plans for allowing a longer period in which commissioners and providers can achieve their objectives “so long as the Government lives up to its promise and limits any annual changes to a minimum”.
He concluded: “We welcome the emphasis on the importance of providing a positive experience for patients. The recommendations put forward by our dignity commission placed a strong emphasis on changing the way we design, pay for, deliver and monitor care services. We hope to see this vision become a greater reality as the new shape of commissioning beds in.”
The NHS Commissioning Board is already operating in shadow form, led by health service chief executive David Nicholson. He will take on the title of chairman of the Board when it officially takes control from 1 April 2013. The government says it expects to see all CCGs taking control from this date as well, although the Commissioning Board could in theory block or delay their authorisation.
The 22 Objectives
Objective 1: Secure an additional X life years for the people of England, through the reduction of avoidable mortality, by 2015; X life years by 2018 and X life years by 2023.
N.B. the draft mandate contains a number of figures marked as ‘X’ – the Department of Health says these will be finalised following the consultation.
Objective 2: Increase the number of Quality Adjusted Life Years for people in England with long-term conditions to X by 2015; X by 2018; and X by 2023.
Objective 3: Improve recovery from illness or injury through increasing the number of Quality Adjusted Life Years for NHS patients in England by X by 2015; X by 2018; and X by 2023.
Objective 4: i) Increase the proportion of NHS patients in England who would rate their experience as ‘good’ (an additional X patients by 2015); ii) increase the proportion of patients who would recommend their hospital to a family member or friend as a high-quality place to receive treatment and care; iii) increase the proportion of doctors, nurses and other staff who would recommend their place of work to a family member or friend as a high-quality place to receive treatment and care; and iv) provide evidence that poor performance is being tackled where patients and/or staff say they would not recommend their hospital to family members or friends as a high-quality place to receive treatment and care.
Objective 5: Improve patient safety, reducing Quality Adjusted Life Years lost to NHS patients in England through avoidable harm by X% by 2015; X% by 2018; and X% by 2023.
Objective 6: Ensure continued improvement of health outcomes, as measured by the indicators in the NHS Outcomes Framework, in relation to baselines set out in the technical annex.
Objective 7: Provide an assessment of progress in narrowing inequalities for all domains of the NHS Outcomes Framework, and work towards a greater understanding of effective interventions to narrow health inequalities.
Objective 8: Ensure continuous improvement in reducing inequalities in life expectancy at birth (as measured by the Slope Index of Inequality) through greater improvement in more disadvantaged communities.
Objective 9: Develop a collaborative programme of action to achieve the ambition that mental health should be on a par with physical health.
Objective 10: Uphold, and where possible, improve performance on the rights and pledges for patients in the NHS Constitution and on the service performance standards set out in Annex B.
Objective 11: Develop a collaborative programme of action (to commence by April 2014) to further the ambition that healthcare professionals throughout the NHS should take all appropriate opportunities to support people to improve their health.
Objective 12: Enable shared decision-making, and extend choice and control for NHS patients. This includes:
– ensuring that commissioners support people to be involved in decisions about their care and treatment;
– extending the availability of personal health budgets to anyone who might benefit; and
– subject to the outcome of pilots during 2012/13, ensuring that patients are able to choose from a range of alternative providers if they either have waited, or are likely to wait, for more than 18 weeks after referral to start consultant-led treatment for a non-urgent condition.
Objective 13: Ensure that the new commissioning system promotes and supports the integration of care (including through joint commissioning) around individuals, particularly people with dementia or other complex long-term needs.
Objective 14: Improve the quality and availability of information about NHS services, with the goal of having comprehensive, transparent, and integrated information and IT, to drive improved care and better healthcare outcomes.
Objective 15: Improve the support that carers receive from the NHS, in particular by:
– Early identification of a greater proportion of carers, and signposting to information and sources of advice and support; and
– Working collaboratively with local authorities and carers’ organisations to enable the provision of a range of support, including respite care.
Objective 16: Contribute to the work of other public services where there is a role for the NHS to play in delivering improved outcomes. This includes, in particular:
– ensuring that children and young people with special educational needs have access to the services identified in their agreed care plan;
– continuing to improve safeguarding practice in the NHS; – contributing to multi-agency family support services for vulnerable and troubled families;
– upholding the government’s obligations under the Armed Forces Covenant;
– contributing to reducing violence, in particular by improving the way the NHS shares information about violent assaults;
– developing better integrated healthcare services for offenders.
Objective 17: Ensure that the new commissioning system promotes and supports participation by NHS organisations and NHS patients in research funded by both commercial and non-commercial organisations, to improve patient outcomes and to contribute to economic growth through the life science industries:
– Ensure payment of treatment costs for NHS patients who are taking part in research funded by Government and Research Charity partner organisations; and
– Promote access to clinically appropriate drugs and technologies recommended by NICE, in line with the NHS Constitution.
Objective 18: Transfer power to local organisations and enable the new commissioning system to flourish, so that:
– CCGs are established across England by 1 April 2013;
– as many CCGs as are willing and able are fully authorised by April 2013;
– CCGs are in full control over where they source their commissioning support;
– clinical networks and senates are highly-valued sources of advice and insight to commissioners;
– there is a transparent, principle-based system for the Board’s interactions with CCGs, including the effective management of poor performance and financial risk; and
– there is effective partnership working between CCGs and Health and Wellbeing Boards.
Objective 19: Ensure that financial incentives for commissioners and providers support better outcomes and value for money; extend and improve NHS pricing systems so that money follows patients in a fair and transparent way that enables commissioners to secure improved outcomes.
Objective 20: Support changes in services that lead to improved outcomes for patients. Priority should be given to changes to services which improve outcomes whilst also maintaining access, and changes must meet the Secretary of State’s four tests that there is support for proposals from clinical commissioners; strong public and patient engagement; a clear clinical evidence base; and consistency with current and prospective need for patient choice.
Objective 21: As part of the work to improve healthcare outcomes, put in place arrangements to demonstrate transparently that the services commissioned by the Board are of high quality and represent value for money.
Objective 22: Ensure the delivery of efficiency (QIPP) savings in a sustainable manner, to maintain or improve quality in the current Spending Review period and beyond.
Read the draft mandate documents in full here
Andrew McConaghie
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