Hospitals to be paid for patient recommendations By 2015, a further part of this objective is to increase the proportion of people across all areas of care who rate their experience as excellent or very good. The details of how the payments will work have not been decided yet. The friends and family test was included in a chapter on patient experience of care. It referred to the Mid-Staffordshire NHS Foundation trust scandal calling such failings 'abhorrent and intolerable' and includes an objective to make rapid progress in measuring and understanding how people really feel about the care they receive. Launching the document Mr Hunt said it made the NHS 'operationally independent'. But he added: "If the board does not succeed, in the end it will be my head on the block because I am the one who has negotiated this mandate with the board. Ministers appointed people to the board and we believe it is the structure that has the best possible chance to leading to dramatic improvements in the NHS. In the end we are responsible as ministers for the structures that we have set up. David Nicholson, chief executive of the NHS Commissioning Board which will run the new style system, said it was the most radical document he had ever seen in the NHS. He said: "This obsession with improving outcomes for patients has not been part of how we have thought about the NHS in the past." The wide ranging document sets key high level objectives including better care for women during pregnancy, improved diagnosis and treatment of dementia as well as driving up general standards of care, reducing mortality rates from the big killer diseases and widening access to information technology. Within each area there is a list of more detailed areas of improvement that can be measured between now and 2015 or 2016 but it does not go as far as specific targets that must be achieved. The mandate directs the Commissioning Board to make "measurable progress" towards making England one of the most successful countries in Europe at preventing people from dying prematurely. Deaths from cancer, respiratory disease, liver disease and heart disease in the under 75s will be monitored along with deaths of children under the age of one and stillbirths. Much of the mandate reiterated current aims and aspirations of the NHS including publishing mortality rates, one to one care for women in labour and online medical records. The mandate also said that wider publication of mortality rates by area, hospital and eventually by hospital team along with patient feedback should reduce variation in care and drive up standards. The mandate sets out that everyone should have online access to their own medical record by 2015 and be able to book GP appointments and order repeat prescriptions online. E-consultations through email or Skype should become much more widely available, the report said and the three million people with long-term conditions should benefit from technology installed in their own home to help them monitor their health and convey the results to professionals. Progress was also expected on patient safety including reducing mistakes causing harm, blood clots and infections in hospital and medication errors. People with mental health problems often waited too long for treatment, the report said, and local NHS organisations should 'address unacceptable delays' while putting mental health problems on a par with physical ones. Better care was also needed for children with disabilities or special educational need, the report said. The mandate was well received among health service experts, patient groups and think tanks however some commentators on Twitter said it was akin to a 'letter to Father Christmas' and was a 'ministerial wish-list'. Dr Mark Porter, chairman of the British Medical Association's council, said the lack of micromanaging targets in the mandate was welcome but warned that significant investment was needed to make some of the technological aspects work. He had particular concerns about the security of online medical records. Ruth Thorlby, Senior Fellow at the think tank the Nuffield Trust, warned that ministers may not be able to resist interfering in the NHS if they come under political pressure in the run up to the next General Election. She said: "The NHS Mandate is indeed pioneering, a bold attempt to solve a uniquely British accountability problem with the NHS. But a fully liberated NHS, where ministers cannot directly account for behaviour of commissioners as well as the performance of hospitals, might feel very disconcerting. Patient groups including Macmillan Cancer Support and the Alzheimer's Society welcomed the focus on long-term conditions and patients empowerment. Mike Farrar, chief executive of the NHS Confederation, said: "This mandate represents a major sea change for the NHS. We argued that it should not be too detailed or prescriptive. It was really important that the Government avoided stuffing the mandate to the gunnels with detailed targets for every condition under the sun. While that might have looked superficially attractive, it would have meant more top-down prescription and less innovation and responsiveness to local needs. The real challenge for the Government now is to stay true to its word and use the mandate to give the NHS stability, rather than use it as a tool to reset priorities on a regular basis.