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 168.

    Well said 65. Yes it is possible to eradicate Tory-inspired private sector profiteering on the back of people's ill-health. Miliband has an electoral open goal and,unlike his Blairite brother,I think he will capitalise on this in 2015.

  • rate this

    Comment number 167.

    I guess we disagree on how the Free Market, if left alone, regulates itself.
    Kinda paradoxical in a Northern Rockish manner

  • rate this

    Comment number 166.

    Spot on - the number of overpaid contractors employed via umbrella companies is colossal.

  • rate this

    Comment number 165.

    PFI was radical, it bankrupted the NHS.
    Schools next?

  • rate this

    Comment number 164.

    Not for conservatives.


  • rate this

    Comment number 163.

    When Murdoch appointed Papa Hunt, he was sending a clear message.

  • rate this

    Comment number 162.

    The document is a complete nonsense and waste of money. Maybe our smiling, charming Secretary of State for Health thought it a good idea and he needed to do something to earn his crust, but practically it says nothing, means nothing and is just another item that allows Mr Hunt to keep the Lansley privatisation project on the tracks.

  • rate this

    Comment number 161.

    If a private organisation is allowed to make 1% profit then that should cost 1to the taxpayer and the supplier of equipment or service would be happy with the increased turnover. This document should limit the amount of profit allowed as we have seen what happened when hospitals were built under the private sector £160 to change a lightbulb, limit the chance of this sort of thing happening again.

  • rate this

    Comment number 160.

    I would not trust anything this government is in charge of its all spin fog and manipulation oh and Privatisation to suit the rich paid for by us.

  • rate this

    Comment number 159.

    I'd love to see the NHS mandated incentives to reduce spending, instead of:
    "leaving it to the NHS to decide how best to go about it."

  • rate this

    Comment number 158.

    Small wonder that there's such enthusiasm for the "mandate" (oh, the irony!) amongst our unelected masters, given that over 200 MPs and Lords stand to gain financially from privatisation. The BBC's silence on this matter has been disgraceful - but then I note that Lord Patten is a senior adviser to the company that bought Tunstall Healthcare.

  • rate this

    Comment number 157.

    156 laughingdevil

    And this is a market distortion - work avoidance, loss of skill, price manipulation that is completely absent from the fantasies of Bastiat, Hayek et al. Underpricing of bad products or services drives out good - witness the junk corporations of America, with their now grossly ovepriced junk products - competition? - what competition!

  • rate this

    Comment number 156.

    #155, indeed.Those who talk about how great the private setor is need to work for 1 month on a private IT contract. They'd soon change their tune!
    The main problem is that initally the private companies price competativly, but within a few years IT knowledge in the public sector is lost, and voila! Prices they go up! And Up! And UP! And cost the taxpayer MUCH more.

  • rate this

    Comment number 155.

    154 laughingdevil

    I fully agree - the real reason for 'outsourcing' is incompetent, unskilled management passing the buck, because they can't be asked to do the job they are paid for. Good IT comes from talking to the end user, taking note of what he needs, and then writing code.And then thoroughly testing with the customer until he is satisified. Not having a Blackadder style 'cunning plan'!

  • rate this

    Comment number 154.

    Not just the NHS, but everything. And as someone who's last job was private IT working on "outsourced" project, which Gov even now insist is cheaper than in house I know different! Considering that 4 levels of private subcontracters add 10-20% profit margin at every layer I think it's safe to say that it could be done cheaper in house unless the private sector can reduce costs by 100% plus.

  • rate this

    Comment number 153.

    149 Laughing Devil

    Unfortunately, it is the entrenched belief in the mythical Management Tooth Fairy, and 'market forces' that lie behind the current government strategy for the NHS. Something that has never worked, can't be made to work - you could have asked the nurse I saw handcranking figures into an Excel spread sheet at 3am what she thought - but it would be unprintable!.

  • rate this

    Comment number 152.

    NHS staff and the population are tired of relentless change for the sake of it at tax-payers expense.

    It seems to becoming increasingly pointless to fight anything anymore that this government are bull-dozing through without a mandate. It's very depressing that the NHS and it's patients and staff are the main victims of waste/confusion caused by Jeremy Hunt and his unaccountable cohort.

  • rate this

    Comment number 151.

    148 Bastiat

    There is no evidence in recorded history, of the Markets successfully regulating themselves. The idea of the 'free' market, like Marx's meanderings, is a nice idea, but has never been practised, and can't work without strict regulation. If you give people a licence to steal - they will steal and that is the lesson of history. No legal regulation - no growth - that's our problem!

  • rate this

    Comment number 150.

    "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."

    Does this mean the NHS will pay as much as it needs to treat, charging the max every time? What cost cutting measures are in place? I've not heard of any here??

  • rate this

    Comment number 149.

    And the free market debate has killed the debate on the future of the NHS, and bored the socks off the rest of us too boot!


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