Refreshing the Mandate to NHS England: 2014 – 2015

This briefing responds to the Government’s proposals to update the Mandate to NHS England for 2014-15.


Published: 27/09/2013

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The Mandate to NHS England is intended to set out the Government’s ambitions for the English NHS – this briefing responds to the Government’s proposals to update the Mandate for 2014-15.

The Government’s Mandate to NHS England is a key document. Its purpose is to dictate how the NHS is accountable to Parliament, and therefore the public. During summer 2013 the Government consulted on its proposed update to the first Mandate it published in November 2012.

Its consultation document, Refreshing the Mandate to NHS England: 2014–2015, proposes to update the NHS Mandate following some important recent developments, such as Robert Francis QC’s report into care failings at Mid-Staffordshire NHS Foundation Trust. Our briefing responds to the key questions outlined in the Government’s consultation.

This approach makes some sense if the mandate is to move towards being a summary of an ongoing process of joint work between the Department of Health, NHS England and other bodies

The refreshed Mandate contains a relatively large number of new objectives for NHS England, which vary widely in the time-frame on which they focus and in the amount of detail they contain.

Many of these objectives reflect policy initiatives brought forward by the Department of Health since the publication of the first Mandate, and they look ahead to upcoming proposals on improving care for vulnerable older people. Many of them serve mainly to formalise the duty of NHS England to work with the Department of Health on initiatives which are already firmly in place.

This reinforces a picture in which the Mandate forms only one element of a broader system by which the Department of Health sets and revises both priorities and processes.

The intention behind the introduction of annual Mandates was to provide NHS England with clear, high-level objectives, which it could work flexibly towards as an autonomous body. There was an emphasis on independence from political interference and giving commissioners the ability to innovate.

In our response we argue that the proposed changes indicate a further shift away from the model of an autonomous arms-length health service. The Government should reflect on the implication of this change and, furthermore, they must be alert to the possibility that the shorter term, more detailed goals contained in the proposed update, will take priority over longer term, more abstract goals.

Suggested citation

Nuffield Trust (2015) Refreshing the Mandate to NHS England: 2014 – 2015. Briefing.