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Strategic Context

The Health and Social Care Act 2012, which recently passed through Parliament, reaffirms the principles of the NHS as a comprehensive health service for everyone, based on clinical need not people’s ability to pay.

In line with the new requirements in the Act, the Government are now consulting on their proposals for their first mandate to the NHS Commissioning Board and they have now published a draft mandate. The consultation period runs until 26th September 2012.

The core purpose of the mandate, and of the NHS Commissioning Board itself, is to help improve people’s health and the outcomes of healthcare. The main way the Government proposes to do this through the mandate is by setting objectives for improvement against the NHS Outcomes Framework which sits alongside similar frameworks for Adult Social Care and Public Health. The frameworks are aligned and contain shared indicators to drive collaboration and integration.

In future, the mandate will be the main way for the Government to say what it expects the NHS commissioning system to achieve with the money it is given. This is the first time that any government has been required by law to consult on its objectives for the NHS, and it brings an unprecedented degree of transparency.

The mandate is a formal accountability document primarily about the Government’s ambitions for improving NHS services in future. Future mandates will evolve as objectives are achieved and new priorities emerge.

By contrast, the NHS Constitution is an enduring document, which sets out the principles and values of the NHS and the rights and responsibilities of patients and staff. It describes what everyone can expect from the NHS now, and it is about the NHS as a whole – patients, public and staff – not just commissioners.

The draft mandate includes objectives under five headings:

  1. Improving our health and our healthcare
  2. Putting patients first
  3. The broader contribution of the NHS
  4. Effective commissioning
  5. Finance and financial management

It gives more freedom to local commissioners to decide how best to improve quality and outcomes in the light of the needs of their populations. Integrating care around people involves promoting overall recovery wellness, focussing on mental as well as physical health, and preventing illness or dependency rather than focusing solely on treatment.

It recognises that, as more people are living with multiple long-term conditions, it is important to take a holistic approach, looking at quality of life and quality of care as a whole, rather than focusing primarily on the treatment of specific clinical conditions.

This is a radical shift in approach from the past and the Government’s approach will evolve as information about outcomes improves and their methodology develops.

One of the aims of the Government’s reforms is to create more flexibility for NHS services to adapt and evolve to respond to the choices of patients and meet new health challenges.

The NHS contributes to the growth of the economy: not only by addressing the health needs of the population, thereby enabling more of us to be economically active; but also through supporting, adopting and spreading new health technologies; and through exporting innovation and expertise internationally.

The NHS Commissioning Board will need to play a role in encouraging innovation within a system that continually scans for new ideas and takes them through to widespread use.

Developing our NHS care objectives: A consultation on the draft mandate to the NHS Commissioning Board
(Department of Health, 2012) and Our NHS care objectives: A draft mandate to the NHS Commissioning Board (Department of Health, 2012).


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