Commissioning England Wales

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NHS mandate

BMA summary of 'A mandate from the government to the NHS Commissioning Board: April 2013 to March 2015'

  • Read the mandate online
  • The NHS Commissioning Board (NHSCB) is legally obliged to pursue the objectives in the mandate
  • The mandate corresponds with the NHS Outcomes Framework 2013-2014 (NHSOF)  
    Read the BMA summary of the 2012-2013 NHSOF
  • NHSCB's first objective is to demonstrate progress against all of the indicators included in the NHSOF by March 2015
  • The NHSCB is to report on its progress annually and the government will publish annual assessment of its performance. This will include feedback from clinical commissioning groups (CCGs), local councils, patients and others


Five priority areas have been identified

  • Improving standards of care and treatment, especially for older people and at end of people’s lives
  • Diagnosis, treatment and care of people with dementia
  • Better support for people with multiple long-term physical and mental health conditions
  • Prevention of premature death from biggest killers
  • Furthering economic growth including supporting people with health conditions to remain in or find work


Part 1: Preventing people from dying prematurely

Objective: England to become one of best countries in Europe at preventing premature deaths by 2016 including:

  • Earlier diagnosis of illness, including working with Public Health England to support local government roll out of NHS Health Checks
  • Ensure people have access to right treatment, including NICE recommendations
  • Reduce unjustified variation in avoidable deaths between hospitals
  • NHS to measure and publish outcome data for all major services by 2015
  • Government to strengthen ‘quality accounts’, which all providers are legally obliged to publish


Part 2: Enhancing quality of life for people with LTCs

Objective: measurable progress to NHS being among best in Europe at supporting people with ongoing health problems

  • Particular progress expected in (i) involving people in their own care (ii) use of technology (iii) better integration of services and (iv) diagnosis, treatment and care of people with dementia
  • Measurable progress by March 2015

Objective: ensure NHS gets better at involving patients and carers, including:

  • All with long-term conditions (LTCs) and mental health problems to be offered a personalised care plan
  • Option to hold a personal health budget for patients who would benefit (subject to evaluation of pilot programme)

Objective: significant increase in use of technology to help people manage their health and care, including:

  • Online access to GP-held health records
  • Online booking of GP appointments and repeat prescriptions
  • e-consultations more widely available
  • Progress towards 3 million people with LTCs benefiting from telecare and telehealth by 2017

Objective: drive better integration of care across different services, supported by further national actions including:

  • Better measurement of user experience of seamless care, better use of technology to share information, open and fair procurement practice, new models of contracting and pricing to reward integrated care

Objective: measurable progress by March 2015 to ensure diagnosis, treatment and care of people with dementia is best in Europe.


Part 3: Helping people to recover from episodes of ill health or following injury

Objective: shine a light on variation and unacceptable practice in relation to quality of services including:

  • Reporting results at local council, CCG, provider and consultant-led team level
  • Development of clinical audit, PROMs and patient experience measures
  • Making it easier for patients and carers to give feedback

Objective: ensure that significant changes to services or reconfigurations meet four tests 

  • Strong public and patient engagement
  • Consistency with current and prospective need for patient choice
  • Clear clinical evidence base
  • Support for proposals from clinical commissioners

Objective: put mental health on a par with physical health and close the gap between people with mental health problems and population as a whole.


Part 4: Ensuring that people have a positive experience of care

Objective: ensure that CCGs work with local authorities to ensure safe, appropriate and high quality care for vulnerable people (particularly learning difficulties and autism).

  • Substantial reduction in reliance on inpatient care

Objective: pursue long-term aim of NHS being recognised globally as having highest standards of caring, particularly for older people and at end of people’s lives. 

Objective: measuring how people feel about the care they receive and more regular ‘friends and family’ test (currently in annual NHS staff survey) including: 

  • Introduce ‘friends and family’ test for patients across the country for acute hospital inpatients and emergency department patients from April 2013, for women using maternity services from October 2013 and all those using NHS services thereafter
  • Hospitals with good scores will be financially rewarded

Objective: improve standards of care and experience for women and families during pregnancy and in early years for their children. 

Objective: people with special educational needs or disabilities to have access to services identified in agreed care plan. 

Objective: uphold the rights and commitments, and improve levels of performance in access to care, as set out in the NHS Constitution.


Part 5: Treating and caring for people in a safe environment and protecting them from avoidable harm

Objective: continue to reduce avoidable harm and make measurable progress by 2015 to embed a culture of patient safety in the NHS including through improved reporting of incidents.

Other objectives:

  • Get best outcomes for patients by strengthening local autonomy of CCGs, health and wellbeing boards and local providers of services
  • Support the NHS to become more responsive and innovative by 2015 including:

    - Embedding patients' legal rights to make choices about their care, and extending choice in areas where no legal right exists (eg any qualified provider in community and mental health services in line with local circumstances). [Note government will be publishing a 'Choice Framework' soon to explain to patients the choices they have.]

    - Supporting creation of fair playing field between public, independent and voluntary sector providers

    - Improving and extending pricing system for providers to make it transparent

  • Ensure new commissioning system promotes and supports participation in research
  • Make partnership a success (working with local councils, schools, job centres, housing associations, universities, prisons, police)
  • Ensure good financial management and unprecedented improvements in value for money across the NHS
  • Quality and value of services commissioned by NHSCB and CCGs to be measured and published in a similar way