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Editorial Tuesday 13 Novemeber 2012: The Mandate is out. Don't get over-excited. It could be worse.

The DH has published the Secretary of State For Health's mandate to the NHS for the next two years.

It's not actually too bad, but it's no reason to get excited.


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Much will be made of the fact it doesn't specify any new targets (beyond saying that there will be some). That is mildly shrewd. There are many other ways to do targets: today's new NHS Outcomes Framework and Commissioning Outcomes Framework being the most obvious.

Instead, it's all "measurable progress ... significant progress ... clear plans ... objective". As it says at Point 14 of the introduction, "the Mandate is not exhaustive".

It's also worth remembering that as Note 4 on page 27 says, "The Secretary of State also has power to use the Mandate to set any “requirements” that he thinks are necessary for the purpose of achieving the objectives; these must be backed up by regulations. This mandate does not include any requirements".

Blah blah blah the NHS
SOS Jeremy 'Bellflinger' Hunt's introduction is mildly funny, promising us that he is "immensely proud of what the NHS has achieved, not only for the extraordinary things it does for us as individuals, but also for what it says about us as a nation".

Ahem. Don't mention The Bellflinger trying to get the NHS section of the Olympic opening ceremony cut, will you?

Other than that it's the usual 'the NHS must keep up blah blah blah NHS is not perfect blah blah blah' stuff.

The text does provide some reassurance for CCG leaders, holding the point that the mandate is "the main basis of Ministerial instruction to the NHS, which must be operationally independent and clinically-led". Another shot in the arm comes with "The Board is legally required to pursue the objectives in this document. However it will only succeed through releasing the energy, ideas and enthusiasm of frontline staff and organisations. The importance of this principle is reflected in the legal duties on the Secretary of State and the NHS Commissioning Board as to promoting the autonomy of local clinical commissioners and others".

Liberation is the new whatever, it seems.

These are Things That Are Not Surprising, sure. But new Secretaries Of State have a habit of bringing a few surprises with them. The Bellflinger, of course, has primary legislation in his way if he had wanted to change them.

The closest Hunt has got to his own stamp is his Fab Five priorities: "(i) improving standards of care and not just treatment, especially for older people and at the end of people’s lives; (ii) the diagnosis, treatment and care of people with dementia; (iii) supporting people with multiple long-term physical and mental health conditions, particularly by embracing opportunities created by technology, and delivering a service that values mental and physical health equally; (iv) preventing premature deaths from the biggest killers; (v) furthering economic growth, including supporting people with health conditions to remain in or find work". Maybe Paralympic sponsors Atos could help with Number 5?

But there follows an interesting line, which I have not seen before: "The Board is also expected to play a full role in supporting public service reform". It could mean anything.

There is also rather a wicked section in the finance chapter: "The Government expects the principle of ensuring equal access for equal need to be at the heart of the Board’s approach to allocating budgets. This process will also need to be transparent, and to ensure that changes in allocations do not result in the destabilising of local health economies". Clear as mud, but winking towards the old Lansley aim of favouring the old over the deprived in reworking the NHS funding formula.