Government misses NHS instructions deadline for first time

The Health Act 2012 requires the government’s mandate for the NHS to be laid before Parliament “before the start of each financial year”. It must specify “the objectives [NHS England] should seek to achieve in the exercise of its functions during that financial year”, as well as its funding for the year.

The Department of Health and Social Care has not given a reason for the unprecedented delay, but Brexit has dominated Parliament’s and government’s agenda in recent months. Conservative members, including the health and social care secretary, are also focused on an anticipated party leadership race.

In some years the mandate publication has been delayed by disagreement between parts of government and NHS England, although never beyond the start of the financial year.

The DHSC has said that for 2019-20 it plans for the first time to publish a single document combining the NHS England mandate and the remit letter it sets for NHS Improvement. This will be called the “accountability framework”, it said.

The government has previously been frustrated it is not able to hold NHS England and its leaders directly accountable for NHS trusts’ and foundation trusts’ finance and performance, as it is not formally responsible for providers. But, over the past year, NHSE and NHSI have appointed a single executive director team, started holding some board meetings in common, and they said last month that NHSE chief Simon Stevens will also be the “leader” of NHS Improvement, although not its formal chief executive.

This year’s mandate is expected to closely reflect the NHS long-term plan, published in January. However, it will focus on 2019-20 rather than a longer period, because this year is being presented as a transition year. A national implementation framework is due to be published in the spring, with health systems then expected to produce their own long-term strategies before autumn.

Healthwatch England, which must be consulted on each year’s mandate, submitted its views to the government last month (see attached documents below). It called on the “department to back the work of the clinical standards review [NHS England’s review of NHS targets] and outline a clear expectation that new performance measures will need to be fully tested with service users”.

The public champion organisation also asked for the mandate to emphasise involving people in NHS decision-making, learning from feedback and complaints, public confidence in new technologies, and listening to what people want from the NHS workforce.

A DHSC spokesman said: “For the first time, this year the government has combined the mandate to NHS England and the NHS Improvement remit letter into a single publication called the accountability framework.

“This reflects their shared role in leading the NHS to take forward the long-term plan in its crucial first year of implementation, and it will be published at the earliest opportunity.”

HSJ asked about the consequences of missing the deadline but the DHSC did not comment, and these remain unclear.