The government has published a new slimline version of the NHS Mandate, trimming from the original a stream of proposed requirements to leave a more focused set of objectives for NHS England.
Announcing the new-look version, put together following a near three-month consultation period, health secretary Jeremy Hunt said changes to the mandate have now been kept to "an essential minimum" to ensure that it remains "strategic, outcomes-focused and affordable within NHS England's budget".
Consequently, certain commitments outlined in the mandate's original form published in the summer - including charging foreigners and moving to a paperless NHS - have now been omitted.
The NHS Confederation has welcomed the 'refreshed' mandate, commending the government for "resisting the temptation to introduce a 'shopping list' of new requirements on the NHS".
The final version, it agrees, maintains a more strategic approach and a greater focus on health outcomes than the first draft published earlier this year.
Key objectives for NHS England threaded into the refreshed mandate, which is due to come into effect from April 1, 2014, include taking forward the relevant actions laid out in the government's response to Robert Francis' report on Mid Staffordshire, and rapid progress in the Vulnerable Older People's Plan.
It also sets out an objective for NHS England, working with clinical commissioning groups (CCGs), to contribute to a new system-wide ambition of avoiding an additional 30,000 premature deaths per year by 2020, through supporting earlier diagnosis of illness, reducing variation between hospitals in avoidable deaths, and ensuring people have access to the right treatment.
Also key, NHS England needs to make progress in ensuring that the diagnosis, treatment and care of people with dementia in England is among the best in Europe, the government says.
As such, it has agreed a national ambition for diagnosis rates that, by 2015, two-thirds of the estimated number of people with dementia in England should have a diagnosis, with appropriate post-diagnosis support.
Elsewhere, mental health must be put on a par with physical health, so NHS England should work with CCGs to make progress on ensuring crisis services are in place which are accessible, responsive and as high quality as other emergency services.
Strengthening local autonomy
NHS England has an objective to get the best health outcomes for patients by strengthening the local autonomy of CCGs, health and wellbeing boards and local providers of services, and the government stressed that it will hold NHS England to account for achieving this.
In a letter to the Health Secretary, NHS England chair Sir Malcolm Grant said it is "fully committed to delivering the outcomes specified in the mandate", but he also stressed that work will continue on areas not contained within it, such as a radical seven-day service review and embracing opportunities created by technology, through initiatives such as a paperless NHS.
So far there seems to be more support for the updated version than its predecessor.
Matt Tee, chief operating officer of the NHS Confederation, applauded 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," while the Alzheimer's Society said "it's great that diagnosing dementia is now hard-wired into the NHS and that there is an aim to provide appropriate post diagnosis support".
