Submission to the Department of Health: Refreshing the mandate to NHS England

National Voices has a concern about the process being used to revise the Mandate. We suggest that reviews of the Mandate should build on the BBC Charter model. That is, strategic objectives should be developed and mutually agreed between the government and the arm’s length/independent agency prior to consultation and refinement.

National Voices welcomes some of the new ambitions expressed in the government’s consultation document, but questions whether it is appropriate at this point to drop so many new or revised objectives into the new commissioning system.

For example, we fully support the ambitions the government has proposed for vulnerable older people. However, we support the same ambitions for all people who need multiple services over time, and who would benefit from person centred coordinated care.

NHS England is at an early but positive stage in gearing up the commissioning system to tackle these challenges, and is playing its part in the national collaboration on integration which is likewise gathering momentum. Selecting and prioritising one sub-group of the population that requires coordinated care risks undermining progress towards wider system transformation and creating unintended consequences by diverting commissioners’ attention into short term responses.

While the Department of Health and NHS England, together with other national partners, are engaged in driving forward person centred coordinated care, there is no compelling reason to add further specific objectives on ‘integration’ at this stage.

We also warn that it is unhelpful for the consultation document to appear to position integration of care in the context of saving money, as this is an expectation that will be very difficult to fulfil within the lifetime of this Mandate.

We make one exception to our concern about additional objectives. As NHS England has committed itself to the ambitions and objectives in Better Health Outcomes for Children and Young People there can be no objection to these being included in a refreshed version.

National Voices has opposed the government’s proposals to change the charging arrangements for migrants. We therefore oppose including an objective to do this in the Mandate to NHS England.