The Mandate: Strong on Choice but Weak on Voice

Wed, 4 July 2012

National Voices welcomes parts of the draft mandate to the NHS Commissioning Board but says it must be strengthened to deliver on: ‘no decision about me without me’ – the patient involvement mantra that has been adopted by the government.

The leading coalition of patient organisations says the mandate is good on some important issues such as joined-up care and mental health. National Voices is also pleased that the draft is shaping into a clear document which will help the public to understand the aims of the Commissioning Board.

However, National Voices is concerned that the mandate is weak on patient involvement ie on ensuring patients are as involved as much as they wish in their direct care and treatment, and management of their conditions.

This point was discussed extensively in consultation around the Health & Social Care Act. In the Act, the relevant duty for commissioners was amended twice in response to calls from the patient movement. However, the draft text of the mandate, and a concurrent consultation which is labelled as ‘shared decision making’ don’t reflect this. Instead they both have a much stronger emphasis on delivering a wider choice of service provider than they have on delivering people’s involvement in the decisions about our daily care, such as which treatment options to choose, or how to plan the management of our continuing conditions.

Patient organisations consistently say patients are more interested in choices around their care and treatment – as above - than choice of provider.  We underlined this in a recent letter to Andrew Lansley sent from National Voices, the Health Foundation, the Foundation for Informed Medical Decisions and the NHS Alliance.

Jeremy Taylor, chief executive of National Voices, a coalition of more than 130 health and social care charities, says:

“The draft mandate is strong on choice but weak on voice. We welcome its drive on important issues like joined-up care. Yet, as it stands, the mandate is disappointing when it comes to people’s decisions around their own care and treatment.”
National Voices wants the Commissioning Board to have goals for patient involvement in care and treatment that are as strong, unambiguous and focused on implementation as those for driving integrated care and provider choice. What this would mean on the ground is:

1. Patients get comprehensive and tailored information, and support to use it, delivered at  clearly identified points in patient pathways [as per the information strategy]

2. People with long-term conditions get education and support for successful self-management

3. People participate in decisions about the available treatment options, Decisions will be based on full information about their risks and benefits

4. Patients take part in personalised care planning with their professionals

National Voices say the above should be linked to a revised objective for patient experience outcomes in the Mandate. This should include increasing proportions of patients who report that they were as involved as they wanted to be in decisions. This would bring the Mandate into line with the Outcomes Framework (Domain 4 on Patient Experience.)

National Voices will work with members on a full response to the Mandate consultation. We will publish this in National Voices’ E-newsletter.

Notes to editors

Links to key documents

•    National Voices’ responses to consultations such as the Choice and Control response highlight patients’ demand for shared-decision making ie more say in their own care and treatment.

•    National Voices’ recent letter to Health Secretary, Andrew Lansley highlights flaws in the current Shared-Decision Making consultation which confuses choice of provider with the more important choice over care and treatment.

•    National Voices and partners including the Health Foundation campaigned successfully for the clarification of patient involvement in the Health & Social Care Act. We felt this was important because patient involvement is often misunderstood and yet it is key to improving results as well as patients’ experience of care and treatment. Read more on this. See more on the Act.


For National Voices media enquiries please contact:  Jules Acton on 020 3176 0737 / 0773

About National Voices

National Voices believes in people shaping health and social care. It is a coalition of more than 130 health and social care charities and speaks on behalf of its members and of the millions of patients, carers and social services users that they represent. It works to ensure that patient voices are heard and that they influence decisions at national level. National Voices' website.