The Mandate's impact on CCGs

Earlier this month saw the publication of the first mandate from the government to the NHS CBB setting out the ambitions for the health service for the next two years. The mandate underlines the Health Secretary's responsibility to preserve and defend the principles of:

  • an NHS that remains comprehensive and universal free at the point of delivery;
  • available to all based on clinical need; and
  • ensuring that the NHS stays relevant and trusted in a rapidly changing world.

The mandate is structured around five areas which mirror the five domains of the NHS outcomes framework where the government expects the NHS CB to make improvements:

  • preventing people from dying prematurely;
  • enhancing quality of life for people with long-term conditions;
  • helping people to recover from episodes of ill health or following injury;
  • ensuing that people have a positive experience of care; and
  • treating and caring for people in a safe environment and protecting them from avoidable harm.

At a glance the NHS mandate would appear to allow some freedoms for CCGs but some old-style targets will remain.

The mandate includes a list of indicators of quality of care but does not set out specific targets preferring 'general improvements across the board'.

The decision not to do this may allow CCGs to have more freedom in their commissioning decisions and avoid the board having to 'micro manage' CCGs.

The mandate also stresses the importance of liberating the NHS to innovate by decentralising power and promoting local autonomy of CCGs health and wellbeing boards and local providers of services.

In terms of CCG authorisation the mandate says that for any CCGs given conditions the NHS CB will set out a clear timetable to full authorisation. It also adds that CCGs will be 'in full control of where they source their commissioning support'.

Looking at the choice and integration agenda CCGs will be required to introduce further choice and competition in some cases. The mandate says that by 2015 the board will have extended patients' rights to choice which includes 'offering the choice of any qualified provider in community and mental health services' and to make NHS procurement 'more open and fair'.

The Mandate includes a strong focus on decentralisation and freeing up local organisations to innovate. The real test will be how this translates into practice especially given the tight financial climate and need to maintain financial control.

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