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Hunt's mandate moment

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A few weeks ago, Jeremy Hunt made his most important statement so far, as Health Secretary, by unveiling the first ever mandate for the NHS, setting out the goals to improve the nation’s health up to 2015.

The mandate is, in effect, a contract between the Government and the NHS with an objective to extend all our lives and improve quality of life. So now that we’ve had a chance to digest the mandate and the reaction to it, did it hit the mark?

Most people felt that the Department of Health had listened during the three-month consultation period; that it had come back with a reworked mandate which set out clear strategic priorities; and that the final product wasn’t bogged down with too many specifics and top-down targets.

The Academy of Medical Royal Colleges noted that the final mandate was more concise and focussed than the draft. Macmillan Cancer Support was pleased to see the focus on the key objective of reducing premature deaths from the biggest killers such as cancer and heart disease. The Association of Directors of Adult Social Services (ADASS) praised the commitment to improving the diagnosis, treatment and care of people with dementia.

The Royal College of Midwives was delighted that the mandate acknowledged ‘the importance of improving care for new mothers’. The Royal College of Nursing welcomed it for ‘setting out what the aspirations of the NHS are and how the Commissioning Board will serve patients’. Help the Hospices and the National Council for Palliative Care, who had campaigned for end of life care to be included, stated they were pleased that it appeared in the final mandate.

The Patients Association and health and social care coalition National Voices, liked the emphasis on patients, noting the new objective ‘to ensure the NHS becomes dramatically better at involving patients and their carers.’ It was noticeable that the five key chapter headings, like the rest of the document, were strongly patient focussed with simple, clear, plain, language: for example, preventing people from dying prematurely and enhancing quality of life for people with long-term conditions.

Taking these comments together makes one realise that the mandate ran the risk of being a slushy smorgasbord with something for everyone. And, indeed, a few argued that the risk had been realised. But most, including the Foundation Trust Network, welcomed the clear vision and greater prioritisation that the mandate offered.

We also liked the alignment between the strategic objectives in the mandate, the five domains that the Commissioning Board has prioritised, the organisational structure the Board has adopted and the outcomes framework that measures achievement. Business school course 101 says that aligning purpose, strategy, structure, outcomes and performance measures is key to organisational success. There’s now a much greater and clearer alignment between all these than we’ve seen before in the NHS.

Although the mandate is for the Commissioning Board, NHS Trusts are keen to work out how we can contribute to delivering the mandate too. Interestingly the key priority areas are those where our partnership with the voluntary sector is strongest - for example managing long term conditions and dementia and reducing death from the killer diseases. So we were delighted to announce a new joint project with the Association of Chief Executives of Voluntary Organisations (ACEVO) to look at how we can develop that partnership to deliver the improvements the mandate seeks.

The mandate also appeared to signal new relationships and ways of doing things. The Department passed an early test of its ability to step up to its new role of designing and overseeing the health and social care system rather than trying to run it. In the process, it provided a clear example of how giving yourself the space to get the strategy and the priorities right can pay dividends.  Despite the strong rumours to the contrary, the Commissioning Board stood behind the mandate with Messrs Hunt and Nicholson sitting shoulder to shoulder at a joint press conference.

It was also noticeable that the Department and the Secretary of State personally invested significant time and effort in talking to stakeholders about what was planned, listened carefully to what was said and amended the draft accordingly.  We can’t speak for others but we felt listened to, without having to shout too loudly. So it wasn’t just the content that felt different – the process did too.

Before we get too carried away, though, the proof of the pudding will be in the eating – a comment echoed by many others. Take paragraph 6.2, for example: “The Board’s objective is to get the best health outcomes for patients by strengthening the local autonomy of clinical commissioning groups, health and wellbeing boards, and local providers of services”. The track record isn’t particularly good here, to put it mildly – Ministers have micro managed and the prevailing NHS culture has been top down command and control. Delivering this objective will require a major change in approach from both the Department and the Commissioning Board. So this is just one of a number of areas where we should suspend final judgement until we see the laudable words of the mandate consistently translated into action on the ground.

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