Another anniversary - the NHS mandate

Gary Robjent

The first NHS Mandate was published 10 years ago, as the NHS celebrated its 65th anniversary. The then Secretary of State for Health (not yet recognising the significance of the close relationship with social care in the title) was Jeremy Hunt – later Chair of the Health and Social Care Committee and now Chancellor of the Exchequer. The Mandate was intended to introduce greater transparency of the government’s objectives and what it legally required* the NHS Commissioning Board (now several iterations later, NHS England) to deliver.

That first Mandate, was structured around five key areas where the government expected the NHS Commissioning Board to make improvements:

• Preventing people from dying prematurely.

• Enhancing quality of life for people with long-term conditions.

• Helping people to recover from episodes of ill health or following injury.

• Ensuring that people have a positive experience of care.

• Treating and caring for people in a safe environment, and protecting them from avoidable harm.

Jump forward 10 years (warming up first to avoid an ACL tear) and the 2023 Mandate is a very different beast. Applicable from 15th June 2023 until a new mandate is published – that will probably be after the General Election – NHS England continues to have a legal duty to seek to achieve the objectives of the government.

In 2023, the foreword from the Secretary of State begins with, ‘The government has promised to cut NHS waiting lists, meaning that people can get the care they need more quickly. That promise is at the very heart of this year’s mandate.’ This sets the tone for a much shorter Mandate than in previous years, with only three priorities. These are:

• Priority 1: cut NHS waiting lists and recover performance

NHS England will lead the NHS in recovering services for patients, in particular, delivering more planned hospital activity to tackle the elective backlog. This will be supported by a focus on increasing outpatient productivity and transforming outpatient pathways. Also, by March 2025, 95% of patients needing a diagnostic test should receive it within six weeks with the continued roll out of community diagnostic centres.

Building on the existing patient’s rights to choice, patients should be able to access all providers of NHS healthcare, from a minimum of five providers, where providers meet NHS costs and standards. Patients should be given more information, so they can easily compare providers based on waiting times, distance and quality. From October 2023, for patients already on the waiting list, the longest waiting patients can request to move to a different provider to receive earlier treatment where it is clinically appropriate and should they choose to move.

It is also intended that there will be 5,000 more beds as part of the permanent bed base for next winter.

• Priority 2: support the workforce through training, retention and modernising the way staff work

Working with the Department of Health and Social Care, Integrated Care Boards and other partners, NHS England should lead implementation of the NHS Long Term Workforce Plan (published 30th June), to ensure the NHS has the workforce to meet the changing needs of patients over the next 15 years.

• Priority 3: deliver recovery through the use of data and technology

Within this it is worth noting that by March 2024, all trusts should adopt barcode scanning of high-risk medical devices and submission to the national, mandatory Medical Device Outcome Registry (either directly or via a supporting electronic health record (EHR) or inventory management system that can support registry data submission). The registry will be used to improve patient safety and outcomes in procedures that use high-risk medical devices.

Healthwatch England, a statutory consultee to the NHS Mandate, has raised a growing concern about the rising average waiting time for elective treatment, especially with growing average waits having ‘a much bigger impact on women, ethnic minorities, people with disabilities and those living on lower incomes’.

It also highlighted recent work on referrals showing that thousands of people are on a ‘hidden waiting list’, often waiting weeks or months before their referral is accepted and they join the ‘official’ waiting list for elective care.

Alongside the above objectives, the government expects NHS England to continue the wider work to deliver the key NHS Long Term Plan ambitions, while releasing efficiency savings of at least 2.2% in 2023 to 2024 and that productivity should continue to improve back towards pre-COVID-19 levels, noting that, ‘Ongoing productivity improvement is also an integral part of long-term workforce planning.’

All this must be achieved while NHS Improvement, Health Education England and NHS Digital are integrated into a single NHS England organisation with headcount expected to be reduced in size by 30-40% by April 2024.

Gary Robjent is Head of Policy and Public Affairs for the BOA.