I may have got a bit carried away so I'm not sure if this will get to you but...
Do you agree with our aims for the mandate to NHS England?
Broadly my answer is No.
There is far too much emphasis on statistics/metrics/benchmarking etc.
Strategic seems to be synonymous with vague/waffly/non-specific/management speak. Despite saying that one of the aims is to "support transparency between the NHS and the public" the actual wording of the priorities and objectives does very little to make things clear for members of the public.
The only aim I do agree with is that of setting longer term budgets and plans.
Is there anything else we should be considering in producing the mandate to NHE England?
Yes
There must be a commitment to sufficient funding through the fairest and most efficient system (which the evidence shows, is public funding through progressive taxation).
The aim of transparency for the public should be expanded to ensure that the public are given specific meaningful and easily understood information about the aims, objectives and priorities.
There must be a commitment to REDUCE the burden of measuring/statistics in order to INCREASE the funding available for actual patient care.
There must be a commitment to base priorities and objectives on evidence - scientifically valid evidence - rather than profit, political agendas, or scare mongering.
What views do you have on our overarching objective of improving outcomes and reducing health inequalities, including by using new measures of comparative quality for local CCG populations to complement the national outcomes fin the NHS Outcomes Framework?
I'm afraid that sounds like gobbledygook to me.
"Improving outcomes" sounds like a marvellous objective, as does "reducing health inequalities" but all the following words appear to relate to collecting statistics and benchmarking and no practical measures to actually achieve the objectives.
Amongst the overarching objectives should most certainly be a commitment to continue to provide free healthcare at the point of delivery. Any thoughts of introducing charges should be eliminated - particularly as this would most certainly negate the objective of "reducing health inequalities"!
What views do you have on our priorities for the health and care system?
The priorities themselves sound fine but the methods by which you propose to ensure they are met seem very odd, possibly counterproductive, and definitely not based on any scientific evidence.
1: Preventing ill health and supporting people to live healthier lives.
Laudable but there are no details of how you plan to achieve this.
2: Creating the safest, highest quality health and care service by securing high quality health and care services and 7-day hospital care to improve clinical outcomes.
The first part is a laudable aim, but is there any evidence at all that changing the current staffing pattern would actually improve outcomes?
Correlation does not equal causation. The fact that there are more deaths amongst patients admitted at the weekend (or staying in hospital over the weekend), and that there are fewer staff on duty at the weekend, does NOT mean that fewer staff is the reason for increased deaths.
There are plenty of logical reasons that can explain why patients admitted at the weekend (or staying over the weekend) are far more likely to die regardless of staffing. Hospitals will obviously schedule routine surgery during the week (when there are more staff), and will schedule procedures requiring overnight or multiple days in hospital such that there are as few people as possible needing to stay at the weekend (when there are fewer staff). Therefore patients admitted at the weekend (or staying over the weekend) will quite clearly be those who come in as emergencies and/or for serious conditions requiring several night stays.
Trying to rearrange staffing patterns to have the same levels at the weekends as weekdays will therefore not logically improve outcomes, but will just spread the good & poor outcomes over the whole week.
The issue that is not addressed anywhere in the document is how to fund a change such that staffing levels will be the same all week. If the level is to be raised at the weekends to the current weekday level the cost will be significant. I have been involved in calculating full time equivalences and shift patterns in the past and would estimate that AT LEAST a doubling of headcount would probably be necessary to achieve the existing levels all week 24/7. Given this seems unachievable the reality would be a reduction of staffing levels during the week. Is there any evidence to show that this would NOT endanger the existing outcomes for possibly complicated but non-urgent procedures currently carried out when there are maximum staff available?
3: Maintaining and improving performance against core standards while achieving financial balance, by ensuring the NHS meets the needs of patients and operates within its budget.
This is so vague as to be meaningless, and is only achievable if the budget is sufficient. The priority should be to provide sufficient funding to meet the needs of patients, not the other way round.
4: Transforming out-of-hospital care, ensuring services outside hospital settings are more integrated and accessible. As part of a new patient guarantee, this means by 2020, we will ensure every patient has routine access to a GP in the evenings and at weekends, as well as effective 24/7 access to urgent care. We will also strive to reduce the health gap between people with mental health problems and the population as a whole.
"More integrated and accessible" for out of hospital services sounds great. Having cared for my father in his last years with dementia, a broken leg and heart issues all at once - a system where the warfarin clinic, the hospital, the community nurses and his GP actually communicated and had a plan would have been fantastic. He was lucky he had me to act as a conduit where many do not, but access to a GP at the weekend would not have helped in any way, and the urgent care he needed out of hours was already available (and fantastic).
I understand that several surveys have shown the public is not desperate for GPs at weekends and late, so I do really not understand why this is a priority.
Similarly to my concerns about weekend staffing at hospitals - the cost to cover a GP surgery evenings and weekends would be enormous. For a one GP surgery it would require at least one other full time GP and possibly several locums plus associated reception staff. This would actually work against your aim of having people able to have "a specific named GP who will be responsible for coordinating their care", as well as removing any hope of them working within their budget.
5: Driving improvements in efficiency and productivity by reducing waste and inefficiency to ensure every penny delivers the maximum possible benefit to patient care.
As long as "reducing waste and inefficiency" is specifically targeted with clear plans of how to do this and not by random privatisation, outsourcing or budget cutting I wholeheartedly agree. I would suggest that much of the "metrics" and stats gathering is actually very inefficient and could be culled to reduce waste.
6: Supporting research, innovation and growth, and influencing global health priorities
This I wholeheartedly support (as long as the priorities are based on clear clinical evidence). However there is no statement about how you plan to achieve this - research needs funding.
What views do you have on how we set objectives for NHS England to reflect their contribution to achieving our priorities?
Too many things are either too vague, or then state a method by which you propose to achieve the desired aim/objective that seems unlikely to do so. I would suggest a commitment to use only clear, scientific evidence based data to formulate methods of achieving your aims and objectives.
In terms of setting aims and objectives maybe ask the public! I think there is far too much time and money already spent on measuring often meaningless things against meaningless targets that very few people would actually care about. I suspect that the vast majority would just like to get into see a GP quicker than is often possible at present (and that doesn't mean at weekends or evenings just within their current available hours).
As the gateway to most further treatment GP surgeries are probably best placed to focus resources as efficiently as possible - but only with assistance and training and increased funding.