The NHS Mandate is out for public consultation. Did you know? Neither did we until it was almost too late to respond. At the end of October, the Department of Health quietly put the mandate aims and objectives out to consultation for 4 weeks, with a deadline of 23 November.
What is the NHS Mandate?
In the government’s words:
“The mandate to NHS England sets the Government’s objectives for NHS England, as well as its budget. In doing so, the mandate sets direction for the NHS, and helps ensure the NHS is accountable to Parliament and the public… This consultation document sets out, at a high level, how the Government proposes to set the mandate to NHS England for this Parliament.”
In our words:
Because NHS England is an ‘arm’s length’ organisation, not under the direct control of the Secretary of State for Health (since the Health & Social Care Act 2012) it has to be mandated to carry out the wishes of the government. It’s what Jeremy Hunt refers to when he excuses himself from proper responsibility or political accountability for the NHS.
Why should I care about it now?
BECAUSE IT'S NOW that you can raise concerns and put your views directly to the Department of Health on what kind of health service you wish to see in the coming year. Although we are under no illusions about the direction of travel of the NHS under this government, we believe that we should take every opportunity to shout our message loud and clear. And if the government issues a document for democratic consultation let's make sure we respond clearly: we demand a comprehensive, universal, equitable and accessible service run under Bevan's principles. A service based on the effective District General Hospital and GP practice model, publicly funded and available to all on the basis of clinical need, not ability to pay. A place where commerce should be held at bay, not invited in to run it.
I'm in - what can I do?
You can see The NHS Mandate here
You can respond to the Mandate by emailing email@example.com
These are the questions the mandate asks you to respond to:
Question 1: Do you agree with our aims for the mandate to NHS England?
Question 2: Is there anything else we should be considering in producing the mandate to NHS England?
Question 3: What views do you have on our overarching objective
of improving outcomes and reducing health inequalities, including by using new measures of comparative quality for local CCG populations to complement the national outcomes measures in the NHS Outcomes Framework?
Question 4: What views do you have on our priorities for the health and care system?
Question 5: What views do you have on how we set objectives for NHS England to reflect their contribution to achieving our priorities?
What’s the best way to reply?
DON'T WAIT - THE DEADLINE IS THE 23rd NOVEMBER!
Caroline Molloy’s response goes in depth and beyond the five questions contained in the mandate. That’s because there is much in it that is worrying.
If you would like to stick to the five questions, here are our suggestions:
Question 1: Do you agree with our aims for the mandate to NHS England?
I don’t agree with the commissioner/provider model, the marketisation of the NHS.
I think that it was wrong to remove the duty to provide a comprehensive, universal, health system from the Secretary of State for Health. I object in principle to the existence of NHS England as an ‘arm’s length’ body, and to competitive tendering.
I absolutely do not endorse NHS England’s Five Year Forward View which appears to use the USA model of health provision as its blueprint.
2. Is there anything else we should be considering in producing the mandate to NHS England?
The NHS used to base its strategy on the evidence of epidemiological data but now seems to base it purely on cost and ‘feedback from friends and family’: you need to get back to evidence-based strategies. The NHS is not selling commercial services, but caring for the health of the nation.
‘Yearly deliverables and metrics’: what is that supposed to mean, other than more admin and boxes to check? I want to see more investment in training clinicians, less in running a market with all its attendant overheads.
Where does it say that your core aim is to provide a comprehensive, universal, accessible, high quality service, according to clinical need not ability to pay?
Transparency between the NHS and the public is mentioned, but not evidenced in the way the mandate itself was distributed and publicised.
Use plain English with clear and understandable terms and objectives at all stages of consultation.
3. What views do you have on our overarching objective of improving outcomes and reducing health inequalities, including by using new measures of comparative quality for local CCG populations to complement the national outcomes measures in the NHS Outcomes Framework?
A good healthcare system should have objectives to improve outcomes and reduce health inequalities but the mandate is more concerned with scorecards than practical proposals.
Reduced budgets in education, public health, social care and the NHS itself will not lead to service enhancements. In real life the NHS is struggling with basic provision in many areas. A mandate which is disconnected from reality is pointless.
I do not wish to spend my time checking league tables of health services and hospitals, checking to see if my local area is better or worse than another.
How onerous are the requirements of medical professionals to fill in questionnaires or report? What difference does it make?
4. What views do you have on our priorities for the health and care system?
I think that the reduction in the budgets for social care (overall 25% cuts to local authorities, with disparities between them such as will lead to greater inequalities of health) and public health (£200 million budget cut) indicate that your priority is saving money, not prioritising care. It seems likely to me that combining the health and social care budgets is likely to bring in back-door charges for NHS services which were previously free to access.
In times of budget restrictions taking more money out of the front line hospitals budget for the Better Care Fund, which appears to be about planning and management consultants, not about actual care, is incomprehensible.
To focus on mental health provision when mental health services are being run down, underfunded at an even worse level than physical health, and their facilities closed, adds insult to injury. It should indeed be a real priority. As it stands that means increased funding. Reducing the use of management consultants should free up funds.
Your obsession with a vision of a ‘seven day service working for everyone’ ignores reality: we already have a 7 day service in as much as access to GP provision and emergency care in hospitals is available at all times.
It should be a priority in every mandate to ensure we have sufficient, fully trained professional clinicians.
I don’t agree with moving to a ‘person-centred’ NHS in the way you use the term: it requires more administration and will be more likely to lead to fragmentation of services, except that it will of course make it easier to work out health insurance premiums.
5. What views do you have on how we set objectives for NHS England to reflect their contribution to achieving our priorities?
The statement that a strong NHS depends on a strong economy is nonsense. It is the other way round. Every penny invested in health repays society with better quality of life for all.
Don’t set objectives for NHS England. Return the NHS to public ownership and get on with achieving those objectives yourselves.
Stop the progress of the Cities and Local Government Bill before we lose our NATIONAL Health Service to even more fragmented and variable local service.