One of the principal aims of England’s Health and Social Care Act 2012 is to distance politicians from the day to day management of the NHS. This aim is being pursued by the creation of the NHS Commissioning Board, which will take responsibility for allocating resources to clinical commissioning groups and commissioning some services directly. Government critics have described the board as “the greatest quango in the sky” because of its major role in the new system, overseeing how £80bn (€100bn; $126bn) of public money is spent and employing 3500 staff drawn mainly from the Department of Health and the NHS.1 The board will work under a mandate from the secretary of state for health, setting out his objectives and priorities for the NHS. The government published the draft mandate in July 2012 and is now consulting on it and seeking views on how it can be strengthened.2

The government intends that the mandate should establish clear and transparent expectations of the NHS and form the basis on which the commissioning board is held to account. It will be a document that sets ambitions for improving outcomes over a period of years. …