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The shape of the new NHS – two key documents published yesterday

by Simon Kirkland | Analysis

14 November 2012

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What will the new NHS Mandate mean for patients?

Since coming to power in May 2010, the UK’s coalition government has begun to roll out some far-reaching reforms of the way the NHS works across England.

Without getting too caught up in their finer details, a key feature of the new-look English NHS is the new NHS Commissioning Board, which will oversee how a whole range of local bodies work together to commission  care for their communities.

And the Government will periodically set the Board’s exact objectives and aims via what’s known as the Mandate, which we discussed here a few months ago.

Yesterday we were at the Department of Health for the launch of the first Mandate, which will set the Board’s priorities for two years, starting from April 2013.

A second document was also published yesterday – an updated NHS Outcomes Framework for the next year (starting in April 2013), which complements the Mandate by providing an overview of how well the NHS is performing.

We’ve been poring over these two hugely important documents, to find out how they’re likely to affect things for cancer patients.  Here’s our first take on things.

The Mandate – good news for patients

Having had 24 hours to digest its contents, we’re broadly pleased with the measures relevant to cancer in the final Mandate.

One really important item, which appeared in an earlier draft and which we were keen to see in the final thing, was an objective to ensure that the NHS promotes and supports research.

Research is fundamental to improving things for cancer patients. Cancer survival rates have doubled in the last 40 years, largely as a result of the progress made through research and clinical trials. On top of this, a recent survey showed that the vast majority of those who discussed research or trials with their doctor are glad to have been asked.

We’re also delighted that the Board has been specifically asked to cover treatment costs for NHS patients taking part in research funded by Government, and by charity partners like Cancer Research UK.

The Government also set a new ambition – that England will become one of the most successful countries in Europe at preventing premature deaths. As we’ve argued before on this blog, we think the Board should prioritise the early diagnosis of cancer, to ensure that the Government achieves its target of saving an additional 5,000 lives a year from cancer by 2014/15.

We are also pleased that the Board has been asked to uphold patients’ rights, such as cancer and diagnostic test waiting times. These are important in providing good quality care and reducing patients’ anxiety – and we continue to monitor them very closely.

The Mandate also includes a number of other points of interest. The Board will be legally obliged to:

  • ensure that patients have access to the right treatment when they need it;
  • reduce unjustified variation in avoidable deaths between hospitals;
  • involve people in their own care;
  • improve the use of technology;
  • measure and understand how people really feel about the care they receive, and take action to address poor performance;
  • uphold cancer waiting times;
  •  embed a culture of patient safety and encourage healthy behaviour from the public such as not smoking.

The next step for the Board is to produce a business plan detailing how it will achieve these objectives. This needs to be ready for when the NHS reforms take full effect in April.

A positive Outcome?

The updated NHS Outcomes Framework is also good news for cancer patients. This sets out how the NHS will measure progress and success, and these measurements, or ‘indicators’ as they’re referred to, are absolutely vital.

As far as cancer’s concerned, there are new indicators that should allow the Board to keep a better eye on things.

The new document now has indicators covering one- and five-year survival for all cancers combined, but also separate one- and five-year survival for breast, lung and bowel– the most common types of cancer.

Taken together, these will help the Board to analyse progress in improving survival across all types of cancer, and see if survival for less common types is improving at the same pace as the rest.

But on top of this, we’re encouraged to hear that the Government wants these indicators to be used at a local level, to measure the performance of the new Clinical Commissioning Groups. So we hope that one- and five-year survival across all cancers can be included in the new Outcomes Framework that will measure the CCGs, as soon as possible.

One last bit of good news – the Government is also working on a new indicator to measure children’s cancer survival for the first time.  Cancer causes more children’s deaths aged 1-14 than any other cause, and is responsible for 21 per cent of deaths in this age group, compared to 18 per cent of deaths caused by accidents and external causes.

We’re working hard to find cures, and spent over £8 million on children’s cancer research last year, but the new indicator will be an important incentive to make sure improvements continue to flow from the laboratories and trials into the wider NHS.

So, all in all, these two announcements yesterday are a welcome step forward, and reflect much of what we’ve been telling Government they need to focus on.

The key now will be in the implementation, and we’ll be keeping a close eye on how things progress – watch this space.


Simon Kirkland is Cancer Research UK’s senior policy and public affairs officer