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Wednesday 28 September 2016
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Lansley publishes NHS CB draft mandate

The chair of the NHS Commissioning Board (NHS CB) will be required to write Bank of England-style ‘open letters’ to the Health Secretary should it fail to meet objectives set out in the draft mandate published today (4 July).

Our NHS Care Objectives: A Draft Mandate to the NHS Commissioning Board outlines the 22 objectives across 60 areas the NHS CB will be measured on and held accountable for.  

Drawn from the indicators in the NHS Outcomes Framework, the mandate said it has purposefully not singled out any clinical conditions or patient groups to allow the NHS CB and CCGs the flexibility to decide where to focus their efforts, based on local need. 

The NHS CB will be made responsible for allocating commissioning budgets “in future” but have been warned to ensure any changes in allocations do not destabilise local health economies.

In hosting clinical senates and clinical networks, the board should promote the bodies as sources of advice, leaving CCGs free to make decisions freely.  

The document also confirms the funding for the controversial CCG incentive – the Quality Premium will come from within the overall administration costs limit set in directions for the NHS commissioning system.

The NHS CB will also be tasked with preparing CCGs and NHS providers for emergencies such as a flu pandemic or prolonged severe weather events.

Health Secretary Andrew Lansley is also due to announce today that the chair of the NHS CB could be asked to write Bank of England-style ‘open letters’ to the Secretary of State if they fail to achieve the care objectives.


“Today we will be laying the foundations of the new, more independent NHS,” said Lansley.

“An NHS will free from constant political interference, focused on achieving better results for patients not simply on processes and tasked with continuously improving the care that patients receive.



“But today will also be about thanking NHS staff for the excellent performance they have achieved over the last year in difficult economic times.  They have hugely reduced the number of people waiting long times for treatment, they’ve almost completely ended the indignity of people being treated on mixed sex wards and they have ensured that fewer people than ever are getting infections like MRSA or C Diff.

“This is a record they can be proud of, and one that we hope to improve each year through our new care objectives for the NHS.”

The draft mandate echoed Lansley’s ‘pre-mandate’ letter to the Chair of the NHS CB Professor Malcolm Grant in April, reiterating the board’s duty to promote CCG autonomy and the devolvement of power to the local organisations.

The board has also been told to operate a “transparent system, based on clear principles, in which its approach to issues such as pooling financial risks, and interventions in the event of poor performance, distress and failure, is clearly set out for CCGs”.

Around £20bn has been set aside for the NHS CB’s commissioning duties, which will include primary care, specialised services for patients with rare or very rare conditions, health services for people in custody, and military healthcare.


The published draft mandate sets the objectives for April 2013 through to March 2015, and will set the ambitions for improving outcomes over the next five and ten years.

It is due to be revised each year to ensure it remains up to date, however it is believed the government intends to allow the objectives to roll forward until they have been achieved.

Changes to the mandate with parliament can only be made if the NHS CB agrees to the changes, there is a general election, or in “exceptional circumstances”.