Learn the lingo series: "NHS Mandate"

Written by Ali Chakera on 30 September 2012. Modified on 06 August 2013. Hits: 7517

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‘The Mandate’ is a document setting out the Government’s overall objectives for the NHS. It highlights those areas of health and care in which the Government expects to see improvements. The first Mandate was published in November 2012 and details a broad set of objectives which the NHS need to deliver on between 2013 and 2015 in order to help improve the quality of care.

The Mandate sets out five areas in which the Government expects the NHS to make particular progress, which correspond to the priorities set out by the Health Secretary, Jeremy Hunt, when he took office:

  • Preventing premature deaths from the biggest killers.
  • Supporting people with multiple long-term physical and mental health conditions, particularly by embracing opportunities created by technology and delivering a service that gives equal value to mental and physical health.
  • Improving standards of care more broadly, not just through treatment, especially for older people and at the end of people’s lives.
  • Furthering economic growth, including supporting people with health conditions to remain in, or find, work.
  • The diagnosis, treatment and care of people with dementia.


The actual objectives outlined are aligned with the five domains of the NHS Outcomes Framework, but also include factors which impact on care outside of this, such as financial management, improving innovation, joint working and economic growth. Key objectives include:

  • To ensure people have access to the right treatment when they need it, including drugs and treatments recommended by NICE.
  • To make measurable progress towards England becoming one of the most successful countries in Europe at preventing premature deaths by 2016.
  • To make measurable progress towards making the NHS among the best in Europe at supporting people with on-going health problems to live healthily and independently.
  • To continue to reduce avoidable harm and make measurable progress in embedding a culture of patient safety in the NHS including an improvement in the reporting of incidents.
  • To inspire and help people to learn from the best by shining a light on variation and unacceptable practice.
  • To make rapid progress in measuring and understanding how people really feel about the care they receive and taking action to address poor performance.
  • To ensure good financial management and unprecedented improvements in value for money across the NHS, including ensuring the delivery of its contribution, and that of Clinical Commissioning Groups (CCGs), to the QIPP programme.

As part of the reforms to the Health Service in England, the Government has passed responsibility for the day-to-day running of the NHS to a new independent body, the NHS Commissioning Board (NHSCB).

The Mandate is now the main basis of Ministerial instruction to the NHS, which must be independent and clinically-led. It clearly sets out the strategic direction for the NHSCB and ensures it is democratically accountable. It cannot be changed in the course of the year without the agreement of the NHSCB, other than in exceptional circumstances, including a general election. The Mandate is therefore intended to set a long term agenda and provide the NHS with much greater stability to plan ahead and innovate. In addition to this, the Government believes the Mandate will also enable them to:

  • Set out their priorities clearly and concisely so they are transparent and can be easily understood.
  • Give the NHSCB the operational freedom to decide how best to deliver on their outlined objectives.
  • Hold the NHSCB to account for the money it spends and the outcomes it achieves.
  • Drive forward an outcomes based approach with greater emphasis on putting patients at the heart of the NHS.
  • Embed the principle of local autonomy and innovation, as well as empower patients, service users and carers.

The NHSCB is legally bound to pursue the objectives set out in the Mandate and it must report annually on its progress. The Government will publish a yearly assessment of the Board’s performance, which will include feedback from CCGs, local councils, patients and other stakeholders. It is not yet clear exactly what action the Government will take if the NHSCB is judged to be failing to deliver on the objectives.

The Mandate states that in order to fulfil its objectives, the NHSCB should give local commissioners, providers and health and wellbeing boards the autonomy to deliver better health outcomes in their areas. To support the achievement of the objectives on a local level, the NHSCB will use mechanisms and incentive schemes such as the CCG Outcomes Indicator Set (formerly the Commissioning Outcomes Framework), QIPP, Commissioning for Quality and Innovation (CQUIN), and the Quality Outcomes Framework (QOF) to drive and measure improvements in performance. The NHSCB’s overall progress in delivering better health outcomes will be measured using the key performance indicators set out in the NHS Outcomes Framework.

The first Mandate will run from April 2013 to the end of March 2015, though the Government intends for subsequent Mandates to be updated annually. The objectives included in future Mandates will be debated in Parliament in order to ensure democratic legitimacy for the work of the NHSCB.

Editor's note: This article has been generated from information provided by Sanofi Diabetes. Please also note that the article is not regularly monitored and may become less accurate over time as things evolve.

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