The Government has published its mandate to the NHS Commissioning Board, setting out the new Board’s objectives and how its progress will be measured, including how it should fulfil it’s duty to promote research. In September this year we responded to a consultation on a draft version of this mandate, welcoming its focus on research and highlighting areas where it could go further. We’re pleased to see the emphasis on research is still there in the final mandate, including a commitment to paying the treatment costs for patients in research trials and a focus on the value of working in partnership to translate scientific developments in benefits for patients. But as an overarching mandate setting objectives, this doesn’t give much detail of how these objectives will be delivered in practice. We’re looking forward to seeing more detail from the Board on how they plan to do this, in particularly how they will fulfil their duty to promote research.
In the new structure of the NHS, the government has passed the day-to-day running of the NHS over to a new autonomous body, the NHS Commissioning Board. This oversees all the local Clinical Commissioning Groups (CCGs) and commissions some services directly.
The government sets the NHS Commissioning Board objectives which the Board is then in charge of delivering. These objectives take the form of a mandate given to the NHS Commissioning Board by the Department of Health. The mandate will be a multi-year document, revised each year, with objectives rolling forward until they are achieved. The Board’s progress will be measured against the objectives set in the mandate.
As everything is getting up and running, the government has been developing the NHS Commissioning Board’s very first mandate. They published a draft in July which we responded to – welcoming the focus on supporting research and increasing opportunities for patients to participate in this. We also highlighted where we thought objectives could be improved to better embed research as a core role of the NHS – particularly around education & training and improving information.
The government has now published the final mandate in light of the comments they received. It has been published alongside the NHS Outcomes Framework, which sets out in detail the health indicators that the Government wants to see improvements in.
What does it say?
The layout of the final Mandate is quite different to the draft version – it is structured around the five parts of the NHS Outcomes Framework. Research still features but is spread across the document (it had its own section in the draft).
The Board’s duties to promote research and innovation feature in section 6 of the Mandate, titled Freeing the NHS to innovate. Specifically in allowing local NHS organisations to be inventive, and to “support diffusion and adoption of good practice”.
This section includes recognition of the increasingly localised nature of the new NHS structures and the Boards role to balance local and national delivery:
The objectives in this mandate can only be realised through local empowerment. The Board’s role in the new system will require it to consider how best to balance different ways of enabling local and national delivery.
- the power of its expertise and its professional leadership, working with partners such as the Royal Colleges;
- its ability to bring NHS organisations together across larger geographical areas, not as the manager of the system, but as its convener;
- its duties to promote research and innovation – the invention, diffusion and adoption of good practice;
We’re looking forward to more detail on how this will work in practice. I’m interested in particular in the mention of the Board’s ability to bring NHS organisations together across larger geographical areas – will this be linked with/through Academic Health Science Networks?
We’re also really pleased to see a commitment to supporting NHS patients to be involved in commercial and non-commercial research in Section 7 The Broader Role of the NHS in Society. This objective was included in the draft version of the mandate and sets out to ensure that the new commissioning system promotes and supports participation by NHS organisations and NHS patients in research funded by both commercial and non-commercial organisations, most importantly to improve patient outcomes, but also to contribute to economic growth. This includes ensuring payment of treatment costs for NHS patients taking part in research (also known as Excess Treatment Costs) funded by Government and charities.
This section also emphasises the value of partnership working, setting an objective to make partnership working a success for, among other things,
improving services through the translation of scientific developments into benefits for patients;
This is brilliant to see. Translating research into real benefits for patients – new treatments and improvements in their care – can only happen with lots of different partners working together. The Board can play a valuable role in fostering these partnerships.
The Mandate also retains another objective previously in the research section of the draft – that the Board must ensure drugs and treatments recommended by the National Institute for Health and Care Excellence (NICE) are made available to patients, which is good news for patients and will also be welcomed by the UK pharmaceutical industry.
As in the draft, these are the only areas where research specifically features by name. We flagged up several other functions and objectives of the Commissioning Board that are important for research in our response to the draft mandate. On these:
- Education and training - The Board has a statutory duty to regard the need to promote education and training, and to support an effective system for its planning and delivery. In section 4.7, the Mandate says “the Board should support Health Education England in ensuring that the health workforce has the right values, skills and training to enable excellent care.” It’s really important this includes supporting them to engage with research – staff need training to conduct research and understand and implement its outcomes. We’re looking forward to more information about how this will work in practice as the NHS Commissioning Board and Health Education England get up and running.
- Putting mental health on a par with physical health - This was a core theme of the draft and remains in the final Mandate. This is an area where research will play a vital role. As part of this, David Cameron announced greater funding for dementia research and a commitment to increase opportunities for people to take part in research back in March.
- Information services – Section 2.6 of the Mandate sets a commitment for the Board to “achieve a significant increase in the use of technology to help people manage their health and care.” in particular by promoting the implementation of electronic records in all health and care settings and working with relevant organisations to set national information standards to support integration and secure linking of electronic records wherever they are held. As we’ve said many times before, data saves lives! Researchers need access to health records to study the causes of disease and also to identify patients to invite to take part in clinical trials. Services like the CPRD will help this but will rely on the NHS having solid information infrastructure. So this is good to see. (the Department of Health is currently asking for views on an update to the NHS Constitution which will help clarify how patient data is handled)
- Redesigning services to ensure high quality care - The Board has a responsibility where clinicans are proposing significant changes to local services to ensure these meet four tests: (i) strong public and patient engagement; ii) consistency with current and prospective need for patient choice; iii) a clear clinical evidence base; and iv) support for proposals from clinical commissioners. It’s really good to see this commitment to be led by a clear evidence base as services are redesigned. The process of redesigning services provides an excellent opportunity for the board to champion steps to embed and support research as services are redesigned.
- The Board’s own commissioning - The Board itself will be responsible for around £20 billion of direct commissioning, particularly for specialised services for patients with rare conditions – this will include research and research infrastructure, such as diagnostic labs. The Mandate flags up the importance of this for rare conditions in section 9.2 alongside an objective that all commissioning – directly by the board or by others – will be subject to the same assessment and standards.
- Patient choice – The draft mandate included a Choice Framework, outlining all the choices which patients should be able to expect to have about their healthcare. Following consultation they plan to publish this Choice Framework shortly and also work further with Monitor on how choice can best be used to improve outcomes for patients.
We’re looking forward to seeing this – in the draft choice framework, we were really pleased to see “choosing to participate in research” – meaning there is an ambition for all patients to have a choice about whether and how they participate in research. We really need to get this right as we know that patients want to be offered opportunities to participate in research and not all of them are being offered these opportunities at the moment. Only 33% of patients taking part in the Cancer Patient Experience Survey 2011/12 said that taking part in research had been discussed with them but of those who were asked, 95% were glad they had had the opportunity.
We’re pleased the core objective of supporting research, patient participation and payment of excess treatment costs is stated loud and clear in the final document. But this is quite a “top level” document and doesn’t go into the details of how these will be delivered – details that need to be ironed out as the system gets up and running.
We’ll continue to push for these details, working with the Department of Health and the NHS Commissioning Board to ensure we get this right and these objectives really deliver better research. It’s important that the emerging NHS institutions truly embed research throughout the new system to improve care and treatment and deliver efficiency. As we said in our response to the draft mandate, research should be embedded across the NHS.
To help us better understand what this will look like in practice and feed into the developing system, we are holding a meeting on 10 December to begin shaping a vision for research in the NHS. We’re inviting people from across the NHS to discuss how research is conducted now and the steps already being taken to embed research in the NHS, exploring how barriers to research within the NHS can be overcome and how the public can become more involved. This will help us develop a vision for research in the NHS which we can use to constructively engage with the NHS as the new structures get up and running. If you’re interested in joining us email Martin at firstname.lastname@example.org.