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Shine a light on variations in care, government tells NHS England

Mandate for next year focuses on excellence and patient safety

Caroline White

Thursday, 14 November 2013

NHS England should “shine a light” on variations in care and unacceptable practice, and free up the NHS to innovate and help it to play a broader part in society, says the government in its ‘refreshed’ annual mandate for the body with overall responsibility for managing most of the health service’s budget.

Among the eight ambitions the government has set out for NHS England in 2014-15 in return for the £98 billion it will be given next year are the expectations that it will help people live well for longer, by getting them an early diagnosis and ensuring that all hospitals “are as good as the best.”

And it should show up variations in care in the NHS by publishing more data and involving local people in decision-making; putting mental health on a par with physical health; and developing access and waiting time standards for all mental health services, stipulates the mandate.

It should also ensure that patients, particularly the elderly and those at the end of their lives, experience better care, not just treatment, it says. This means providing good quality care seven days a week and taking on board the lessons learnt from Mid-Staffs and Winterbourne View.

And it should ensure that patients receive safe care by driving up the reporting of patient safety incidents and driving down the number of avoidable harms.

The final version of the refreshed mandate maintains a more strategic approach and a greater focus on health outcomes than the draft published in the summer, says the NHS Confederation, which commends the government for resisting the temptation to introduce a "shopping list" of new requirements for the NHS.

The Confederation had voiced "concern and disappointment" at the number and extent of proposed revisions in the previous draft, that would have added a significant amount of detail within just a year of the first mandate, it said.

Matt Tee, the Confederation’s chief operating officer said the government had obviously been through its draft proposals “with a thick black pen,” because several “specific, unnecessary operational additions” had been left out of the final version.

"The NHS has some of its strongest leaders in patients, and the clinicians and managers who deliver their care, so we welcome the refreshed mandate's focus on strengthening local autonomy, so that NHS organisations are free to innovate and develop new ways of working that drive improvements in patient care,” he said.

"We are also particularly pleased to note that today's publication shows the government has taken on board the critical importance of integrated out-of-hospital care to implementing the vulnerable older people's plan. We have said all along that this cannot deliver improvements through primary care alone, and it is good to see this has been heard and acted upon,” he added.

Noting the requirement for NHS England to show up variations in care and to foster a revolution in transparency, he said that the Confederation looked forward to the government's full response to the Francis enquiry, which is expected shortly, and details of how it intends to translate this into action.

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