Is the NHS mandate really that radical?


The government has been quick to declare the publication of the NHS mandate as important.

In fact, Health Secretary Jeremy Hunt and Sir David Nicholson, head of the NHS board, went into overdrive when they unveiled the document at a press conference in London on Wednesday.

They referred to it as being "historic", a "landmark moment" and even "more radical" than the overhaul of the structures of the health service itself.

Their argument was that the mandate at 28 pages represented an end to ministers managing the NHS from behind their desks in Whitehall.

By setting out a clear and concise commitment over what the NHS was going to try to achieve from 2013 to 2015, the public and those working in the service had for the first time a written contract about what should happen.

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After all, it is an inescapable fact that with a budget of over £100bn, the NHS remains the second largest area of public spending after welfare”

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In particular, Mr Hunt argued it resisted the temptation of telling the service how this should be achieved - unlike the target culture that characterised Labour's years in power.

Instead, he said it focussed on what success would look like - better dementia care, less premature deaths from things like heart disease and cancer - leaving it to the NHS to decide how best to go about it.

'Tightly controlled'

However, what was not included in the 28 pages was the detailed guidance the NHS has already been given.

There are 65 "performance indicators" it has to routinely measure, while 150 "quality standards" govern what is expected across a range of areas from stroke care to treatment for depression.

And while Mr Hunt had a dig at the old target culture, the mandate does not mark the end of hospitals having to strive to meet either the 18-week waiting time or four-hour A&E standards originally set by the previous government.

In short, the NHS is still likely to remain a tightly controlled organisation even after publication of the mandate.

Others have also raised concerns that despite the promises being made at the moment, politicians may not be able to resist meddling in the NHS in the future.

It is a point made by Ruth Thorlby, a senior fellow at the Nuffield Trust think-tank.

She says the risk - particularly in the lead up to an election - is that pressure from the top leads the NHS board to "tighten" its grip on the local NHS.

After all, it is an inescapable fact that with a budget of over £100bn, the NHS remains the second largest area of public spending after welfare.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 28.

    Re 3 - The NHS has only existed for a few generations. In fact when it was formed it was believed its existence would only be for perhaps a decade, enough time to improve the health of the nation. Clearly it failed, or the treatments it offers have failed, or the money stream is too precious to switch off and too many hands in the till. Do not be sentimental over a less than perfect entity.

  • rate this

    Comment number 27.

    What's wrong with doing things for profit?
    You aim to out compete the guys down the street by offering better services or products, cheaper than they can. If you can't, your customers can voluntarily choose a provider who can, creating pressure to lower costs & innovate.

    Sounds simple & great right?
    So why don't we allow this in healthcare, where we need it the most?!

    We need more freedom :P

  • rate this

    Comment number 26.

    There's still the unacceptable waiting times. The quote the Handbook to the NHS Constitution "a maximum 62-day wait from referral for suspected cancer to first treatment for all cancers". Given that it takes time for the symptoms to appear, then you see your GP, then a specialist, then wait 62 days, many cancers are essentially a death sentence even under the new rules. D- you could do better.

  • rate this

    Comment number 25.

    I wouldn't believe a single word that slimeball Jeremy Hunt says.

    This is a man who (allegedly) broke the ministerial code, but kept his job.

    He was too close to Murdoch, and he is privatising the NHS.

    Dear Jeremy - please resign, you awful man.

  • rate this

    Comment number 24.

    As long as the NHS is a Govt sponsored enterprise, with an unlimited line of credit to Whitehall, it will cost as much as child does with an unlimited line of credit to Daddy's credit card.

    I'm not even saying abolish the NHS, just removed it's huge Govt credit card. If it's a legit, solvent, operation I'm sure she'll thrive right? Just allow a little healthy competition :P

  • rate this

    Comment number 23.

    I went to the bank the other day.
    I said, 'Can you mend my broken arm?'
    They said, 'No, what do you think we are, a hospital?
    I said, 'Yes, if you're not , why have you got all their money?'

  • rate this

    Comment number 22.

    The NHS is bleeding out already from the fatal cuts and mismanagement of funds.
    Way to many chiefs and not enough Indians.
    Got an advert where I work with a patient saying "I rely on you not to let me fall."
    I then imagine the lone nurse escorting another patient to the toilet thinking "We are really short staffed, please sit down, I don't want to have to pick you up off the floor."

  • rate this

    Comment number 21.

    It certainly is a historical landmark moment. Instead of giving just most of our money to manager's, contractors, consultants and pharmaceutical drugs baron's, why don't we just let them have the lot. Well, until such time as some brave soul shouts "STOP, ENOUGH IS ENOUGH"

  • rate this

    Comment number 20.

    My local paper is constantly running Page 1 storys about our NHS Hospital.
    For the first time in my life i am fearful of being admitted to that Hospital.

  • rate this

    Comment number 19.

    There were simpler, cheaper ways to allow local accountability. I do not trust the Conservatives - too many of their 'improvements' benefit lawyers and accountants, while costing you and me lots of money and providing a worse service.

  • rate this

    Comment number 18.

    will this be like the mandate in palestine an utter failure that led to untold suffering by ordinary people ?

  • rate this

    Comment number 17.

    Saw the same motherhood and apple pie documents produced in business, in all cases they proved worthless as at the level they are described proves impossible to manage against. 28 pages times millions of copies a waste of paper, only an inexperienced beauracrat would think them worthwhile. As very soon the majority of health services will be run by Virgin and similar companies totally unnecessary.

  • rate this

    Comment number 16.

    This heading should read the English NHS - sloppy article from Nick Triggle.

  • rate this

    Comment number 15.

    Do you need to have a mandate before you get treatment on the NHS now?
    I will have to get in touch with my feminine side.

  • rate this

    Comment number 14.

    Perhaps they could use the same template for an Alchemists mandate.

    A statement that they want Gold, some performance indicators and quality standards setting out what is expected but otherwise leaving it up to the alchemists to decide on how to achieve the final result.

    Lers be honest, this isn't a mandate as much as a wish list.

  • rate this

    Comment number 13.

    THe NHS needs to be centrally controlled as left to its own devices it will become non-accountable. The only reason we know it is not performing optimally is because of targets. Also a) cuts or b) budget increases wll be treated as (a) a chance to cut actual services whilst preserving NHS jobs b) waste the money on consultants and ill thought capital projects. A bit like your local council.

  • rate this

    Comment number 12.

    Information on the private providers bids is 'commercially confidential'. Will the private providers be like the rail franchises - dropping out when they aren't making money? How many more pen pushers and lawyers will be feeding off THIS unwanted change. Some change was necessary, but not what the Conservatives are pushing.

  • rate this

    Comment number 11.

    What I always wonder about these great new initiatives: do they imply that the last wonderful idea was wrong?

  • rate this

    Comment number 10.

    We all know and can see that the NHS has got much worse. Certain forms of Cancer for example are not now treated, critical time sensitive treatment is delayed raising the risk of death, and I dread being in a car crash, in case at teh age of 46 I find myself put on the Liverpool Care Pathway because it isn't economic to treat me. On anti-depressants 7yrsLabours targets look begnine in comparison.

  • rate this

    Comment number 9.

    If the NHS is so locally controlled how has the Slasher of the Exchecker managed to raid it of £1bn? So much for ring fenced NHS budgets - how many "locals" asked for major cuts to the NHS? The so called "pen pushers" that Tories mendaciously claim to have removed have also removed good housekeeping ethics and leaving it open to vexatious claims. It is a Charter for laxity! NHS is up for sale!


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