NHS Commissioning Board Mandate – Implications for Local Activists

Do you remember Strategic Health Authorities? Most people were completely unaware of their existence and they had no accountability to local people. Yet they were the key mechanism used to shape the priorities of Primary Care Trusts – when the Strategic Health Authority blew its whistle all PCT managers stood to attention. The NHS Commissioning Board is their new incarnation – “it will oversee the way that over £80bn of taxpayers money is spent to secure NHS services in England”. So in the world of localism how does the draft Mandate for the NHS Commissioning Board help us tackle inequalities and increase citizen control?

The Department of Health consultation on the mandate closes on the 26th of September 2012

There is a great deal in this document – which feels more grounded and relevant for local activists than the NHS constitution. The NHS Commissioning Board will pull the strings of Clinical Commissioning Groups and commissions GPs so the mandate will be crucial in terms of setting the tone locally.

Local citizens and organisations will need to be clear about the ambition within the mandate in order to encourage and challenge Clinical Commissioning Groups and to motivate Health and Wellbeing Boards to challenge or ignore the NHS CB on areas where it is weak or passively implementing poor government policy.

Overview

I am going to look at the following sections:

• Section 2 Improving our Health and our Health Care – which focusses on 3 main areas – Inequalities, Mental Health and Health Improvement.
• Section 3 Putting Patients First
• Section 4 Broader Role of NHS

Section 1 – Improving our Health and our Health Care

Inequalities

Strengths – Clear and Strong Statements

• tackling inequalities “a central priority for the Board”
• “Its about inequalities in access and outcomes”
• “Board must focus on those attributable to social deprivation as well.”
• “The Government expects the Board as far as possible to make progress towards reducing inequalities across all NHS Outcomes Framework Indicators”
• “the NHS cannot achieve world class health outcomes for all without a particular focus on those who are disadvantaged, vulnerable or socially excluded”

Weaknesses – Only commits to setting inequalities outcomes for Domain 1 (preventing people from dying prematurely) of the NHS Outcome framework initially. Leaving those for enhancing quality of life for people with long term conditions; helping people to recover from episodes of ill health or following recovery; ensuring people have a positive experience of care; and treating and caring for people in a safe environment for a later unspecified date.

After 2 years The Governments Inclusion Health Programme is getting referenced in policy documents but has not produced any work of significance & has no public profile – the only public document is an archived one produced by the last government.

Implications for local champions – Clear statement provides plenty of opportunity to create a coherent argument at a local level. However, CCGs will need to be encouraged to take a broader approach where no explicit outcome measures exist – this will be challenging.

With no mention in the mandate of the social determinants of health or co-production of services with citizens local champions will need to develop assertive local models to push CCGs to establish strong links with agencies tackling the Social Determinants of Health & co-production with citizens.

Mental Health

Strengths – Strong Statement to put Mental Health on a par with physical health.

Key document is Mental Health Implementation Framework which is a powerful cross government plan produced with a range of statutory and voluntary sector partners.

Weaknesses – It is unclear what national leadership the NHSCB will be expected to provide with regard to making connections with other key national agencies and in championing this agenda across other government departments.

Implications for local champions – CCGS will need to be pushed to have approaches that include focus on social determinants such as access to welfare rights – when the NHSCB will be promoting a narrower agenda.

NHSCB representatives will need to be held to account by local champions through Health and WellBeing Boards with regard to actions they are taking at a national level to promote this agenda across government.

Section 2 – Improving Health

Strengths – “NHS has a vital role in improving the publics health through helping us stay healthy”

Weaknesses – Feels incoherent and lacking in strategic impact – mixture of traditional service roles – Screening, Immunisation and Health Visitors and weak internally focussed plans such as improving the health of the NHS workforce and sound bite ideas such ‘Every Contact Counts’

Implications for Local Champions – CCGs will need to be encouraged to take a broader and more coherent approach than the NHSCB. They will need to be encouraged to engage critically with poorly thought through ideas such as ‘Every Contact Counts’.

Section 3 – Putting Patients First

Strengths 

• “Patients as joint participants in their own care and recovery”
• Recognition of role of carers

Weaknesses – No description of how the NHSCB will ensure strong public engagement in its own work or accountability to local areas.

• Focus on the individual as driver for change – personal budgets and choice.
• Emphasis on Information Strategy – which is very IT based
• Proposed drivers – ‘choice and personalisation’ not proven as main drivers for improving quality.
• Hard to see how the NHSCB will support local efforts to develop new delivery models like health champions

Implications for local action – persuading CCGs that there are valid roles for active citizens who are involved in improving roles of their own health, their families and communities. Ensuring that the collective action and long term relationships with communities is understood and developed.

Section 4 – Broader Role of NHS

Strengths – Recognition that NHS needs to work more in partnership with other sectors and agencies – for example improving childrens chances of achieving as good eduction responsibility of health services as well as local government and schools

Need to prevent hard to reach groups “falling through gaps”

Weaknesses 

• There is a strange shopping list of priority areas that feel like they have been put together on the back of an envelope – Children and Young People, Crime, the Armed Forces and promoting growth, innovation and research.
• The NHSCB comes across as part of Government. We get no feeling that this will behave any more independently than Strategic Health Authorities – a passive government delivery structure with no mind of its own – unlike local government.
• No recognition of the role of the voluntary and community sector
• No clear responsibility for supporting and funding capability and innovation within primary care and CCGs.

Implications for local action – Need to build alliances with local government and CCG to develop more coherent strategies for addressing need that are a counterweight to the narrow list imposed on the NHS CB.

What do you think?