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UK Politics

The NHS must not be 'micromanaged' from Westminster, says top official

Proposals could see ministers 'telling the NHS how it wants things achieved'

The NHS must not be “micromanaged” from Westminster, health leaders have warned, in response to proposed changes to the NHS mandate which could see a dramatic reversal of key Coalition health reforms.

Under the Health and Social Care Act, ministers were intended to take an “arms-length” approach to the health service, leaving the day-to-day running to NHS England managers.  

But proposed revisions to NHS England’s mandate, the document which sets out the Government’s expectations of the health service, would lead to ministers “telling the NHS how it wants things achieved”, a senior NHS official told The Independent.

“We are concerned and disappointed by the revised mandate proposals,” said Matt Tee, the NHS Confederation’s chief operating officer. “We think that the real value of the mandate was that it would be high-level, strategic and based on desired outcomes – that it would leave the ‘how’ to the NHS locally, for which we were going to be held to account.

“This feels like a move back to micromanagement in which the centre is attempting to tell the NHS in innumerable levels of detail how it wants things to be achieved. It feels like this isn’t the deal we thought we’d done a year ago.”

If the health secretary Jeremy Hunt were to bring in any major revision of the NHS mandate, it would mark a dramatic departure from reforms led by the former health secretary, Andrew Lansley. Plans to keep the day-to-day running of the NHS at arms-length from ministers were intended to remove the influence of short-term political goals and allow managers to bring in long-term reforms without interference from the government of the day.

Among the proposals outlined in a consultation on the NHS mandate are measures that appear to open the door for closer Government involvement in improving A&E services, reporting on standards of GP practices and extending the flagship “Friends and Family Tests”.

“Experience shows us that we get the best results for patients when politicians put faith in the NHS locally to deliver the right outcomes,” Mr Tee added.

One senior NHS source said that health service managers were “furious” about the new proposals.

“What has happened here is that we have a Secretary of State who is doing his very best to pretend the Health and Social Care Act was never passed,” the source said.

A Department of Health spokesperson said: "We make no apology for having high expectations for patient services. The Mandate consultation has now closed. We are carefully considering all the responses and we will respond in due course.”