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Government Sets Out 2023 Mandate to NHS England

Tackling the COVID-19 backlog of elective care and improving cancer outcomes were among top priorities listed in the  2023 mandate to NHS England

Supporting the workforce through training, retention, and modernising the way staff work was also listed as a key priority, along with helping recover performance through the use of data and technology.

The mandate, published by the Department of Health and Social Care, is intended to apply from 15 June 2023 until a new mandate is issued.

'Significant Challenges'

There were "significant challenges" for the year ahead, which also included reducing accident and emergency and ambulance waiting times, and improving patient access to primary care, it acknowledged.

In a foreword, England's Health and Social Care Secretary, Steve Barclay, said a major theme for this year was "supporting innovation and the adoption of the right digital health technologies, and through ensuring the workforce is well supported".

The new mandate was a shorter document than in previous years in response to the health system asking for fewer targets. Instead, Mr Barclay wrote, it "emphasises the Government’s commitment to deliver on the key concerns of the public and recognises the importance of allowing integrated care systems the freedom to deliver effectively".

Waiting Lists and Emergency Care Improvements

On waiting lists and recovery, the mandate envisages that by March 2025, 95% of patients needing a diagnostic test should receive it within 6 weeks, with the target aided by the continued roll out of community diagnostic centres.

Work should continue on improving 1- and 5-year survival for all cancers in line with the ambition set out in the NHS Long Term Plan that 55,000 more people diagnosed in 2028 would survive for 5 years or more. At the same time, there should be progress towards the ambition of diagnosing 75% of cancers at stages 1 and 2 by 2028.

The mandate also called for A&E and ambulance performance improvements that would include 76% of patients being admitted, transferred, or discharged within 4 hours by March 2024; and improved ambulance response times for category 2 incidents to 30 minutes on average over 2023 to 2024.

Additionally, there should be an emphasis on increasing capacity, with 5000 more beds as part of the "permanent bed base" for next winter, and 800 new ambulances on the road, including specialist mental health ambulances.

In primary care, improvements to GP access should see patients who need an appointment getting one within 2 weeks, and those with urgent needs being seen on the same day or next.

On technology, the mandate called for 90% of NHS trusts and foundation trusts to have electronic health records by December 2023, and 95% by March 2025.

NHS Strikes Are 'the Elephant in the Room'

Responding to the publication , Mathew Taylor, chief executive of the NHS Confederation, said the "core objectives are sensible", but that until publication of the NHS Long Term Workforce Plan, "the NHS will have one arm tied behind its back while trying to deliver against this mandate".

The Confederation said a notable "missed opportunity" was the lack of priority on promoting good health and prevention, and the absence of targeting "parity of esteem between mental and physical health", which had been a feature of the previous mandate.

The blueprint for NHS recovery comes against a background of industrial unrest in the NHS, which has had a significant impact on elective care. NHS national medical director, Professor Sir Stephen Powis, said on Monday  that strikes were wreaking a "huge impact" on NHS services. With more than 106,000 postponed appointments being added to over half a million postponed over the last 6 months because of strikes, there was a "massive cumulative impact" on efforts to address the treatment backlog, he warned.

Sir Julian Hartley, chief executive of NHS Providers, said it was notable that when Mr Barclay delivered his speech at NHS ConfedExpo – on the day the mandate was published – efforts to resolve ongoing industrial action was "the elephant in the room". Sir Julian said: "It's vital the government and unions restart negotiations urgently so we can end this disruption and focus on treating patients."