The government has published its first-ever mandate setting out its ‘ambitions’ for the NHS, what the Health Secretary Jeremy Hunt describes as its priorities for the the health service.

The objectives of the mandate include improving standards of care and not just treatment, especially for the elderly and vulnerable; better diagnosis, treatment and care for people with dementia; better care for women during pregnancy, including a named midwife to provide one-to-one care.

There will be, as the prime minister has already announced, a friends and family test from next April so patients will be able to give feedback on the care they receive in hospitals. And by 2015, patients will be able to book GP appointments online and order a repeat prescription.

Mental and physical health will be given equal priority. There will, also, be emphasis on preventing premature deaths from cancers and heart diseases. The mandate is the document given by the Government to the new NHS Commissioning Board, which will in turn pass it down to the commissioning groups who will be in charge of purchasing the care on behalf of patients.

Mr Hunt said the document sends a signal that the government is ‘optimistic’ that the NHS can improve. The NHS chief executive, Sir David Nicholson, went further and said the mandate was the most ambitious document he had seen and was ‘more radical than the structural changes that have been seen’.


The intentionally slim-line document is meant to be understandable by the public. And to this end it lacks a lot of detail including how the government will be held to account if they do not fulfill the ‘ambitions’ in the mandate.

Mr Hunt did say that in the end it will be his head on the block and that he will be voted out if the public does not feel this mandate has been met. But there was no answer on repercussions should GPs or the commissioning board not deliver.

He did say that what they did not want to do was to performance-manage from behind desks in Whitehall and to that end they had limited themselves to specify outcomes, for instance, reducing cancer deaths, and not to say what the process should be.

There is a plan that by 2015 everyone should be able to find out how well their local NHS is providing the care they need by the publication of results. But there will be no new national IT projects after the spectacular failure of the attempt to introduce a system by the Labour government.

NHS managers have welcomed the document. The NHS Confederation said that it was “really important that the government avoided stuffing the mandate to the gunnels with detailed targets for every condition under the sun.”

Labour said it was nothing more than a “wish list”. The Shadow health secretary, Andy Burnham said the government had put the NHS on a “fast track to fragmentation”.  The launch also came as the Royal College of Midwives warned that the NHS is short of 5,000 full-time midwives and the Royal College of Nursing claimed that the ‘NHS was sleepwalking into crisis’ and that 61,000 frontline posts are in danger or have been axed in England.

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