Is the NHS mandate really that radical?

The government has been quick to declare the publication of the NHS mandate as important.

In fact, Health Secretary Jeremy Hunt and Sir David Nicholson, head of the NHS board, went into overdrive when they unveiled the document at a press conference in London on Wednesday.

They referred to it as being "historic", a "landmark moment" and even "more radical" than the overhaul of the structures of the health service itself.

Their argument was that the mandate at 28 pages represented an end to ministers managing the NHS from behind their desks in Whitehall.

By setting out a clear and concise commitment over what the NHS was going to try to achieve from 2013 to 2015, the public and those working in the service had for the first time a written contract about what should happen.

In particular, Mr Hunt argued it resisted the temptation of telling the service how this should be achieved - unlike the target culture that characterised Labour's years in power.

Instead, he said it focussed on what success would look like - better dementia care, less premature deaths from things like heart disease and cancer - leaving it to the NHS to decide how best to go about it.

'Tightly controlled'

However, what was not included in the 28 pages was the detailed guidance the NHS has already been given.

There are 65 "performance indicators" it has to routinely measure, while 150 "quality standards" govern what is expected across a range of areas from stroke care to treatment for depression.

And while Mr Hunt had a dig at the old target culture, the mandate does not mark the end of hospitals having to strive to meet either the 18-week waiting time or four-hour A&E standards originally set by the previous government.

In short, the NHS is still likely to remain a tightly controlled organisation even after publication of the mandate.

Others have also raised concerns that despite the promises being made at the moment, politicians may not be able to resist meddling in the NHS in the future.

It is a point made by Ruth Thorlby, a senior fellow at the Nuffield Trust think-tank.

She says the risk - particularly in the lead up to an election - is that pressure from the top leads the NHS board to "tighten" its grip on the local NHS.

After all, it is an inescapable fact that with a budget of over £100bn, the NHS remains the second largest area of public spending after welfare.