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Introduction

The NHS has made huge steps in providing faster, more convenient access to care through  increases in capacity and changes in ways of working. There is much more to do but a good foundation has been established.

Since 2000, we have built up capacity, deliver ed some early reforms and made the step change in performance necessary to improve services, reduce waiting times and make big improvements in mortality rates.

At the same time we have introduced clinical governance, standards and new arrangements for securing patient safety. In other words we are making sure we can improve the quality as well as the quantity of the services we offer.

But the ambition for the next few years is to deliver a change which is even more profound - to change the whole system so that ther e is more choice, more personalised care, real empowerment of people to improve their health - a fundamental change in our relationships with patients and the public. In other words, to move from a service that does things to and for its patients to one which is patient led, where the service works with patients to support them with their health needs.

Capability as well as capacity

The NHS has a proud tradition and at its best has always been very patient centred and delivered excellent care. Now, we are beginning to have the capability as well as the capacity to become truly patient led and deliver high quality services everywhere and at all times.

 New practices and systems have been identified and rolled out across the NHS: See and Treat in A&E; the Patient Targeting List (PTL) system in waiting list management; advanced access in primary care; assertive outreach teams in mental health; emergency practitioners in ambulances, primary care and A&E; joint assessment and response teams with social services; closer working links with the independent and voluntary sectors; and much more.

Much of this is led by the 100,000 and more people who have participated in the Modernisation Agency and National Primary Care Development Team programmes who have learned the new techniques for improving quality and services. The NHS now has hard evidence based on thousands of hours of experience in hundreds of organisations of how to improve quality and value for money. And staff throughout the NHS know how to apply this knowledge in improving the services they provide.

Perhaps most striking is the growth in local innovation in the way services are delivered. This is now visible in every part of the NHS - clear , practical evidence of local innovation and creativity. The NHS Live programme is supporting 300 such projects, helping develop a 'bottom up' approach to improvement to complement other national programmes.

The NHS Improvement Plan

The NHS Improvement Plan, published in June 2004, set out the way in which the NHS needs to change in order to become truly patient led. These changes are profound. They affect the whole system and the way individuals and organisations behave.

Ministers and I have spent a great deal of time in the last few months listening to patients and staff talking about the NHS, about its successes and shortcomings and about their hopes for the future.

There is clearly a great deal of support for the direction of travel but some uncertainty about aspects of it and many suggestions about how to carry it forward most effectively.

This document is designed to address these issues, offering a description of the major changes underway and - while it cannot deal with every point - describing how some of the biggest changes will be carried forward. It has been written primarily for the leaders of the NHS, the clinicians and managers, the Boards and everyone who is helping lead the transformation of the NHS. But it is vital that these leaders communicate its key messages - about the vision, the values and the major changes - in their own words for their patients and staff. 

Learning and leadership

These are complex changes in a complex system. Moving from a centrally directed system to a Patient led system inevitably increases uncertainty. We therefore need to develop even better systems for 'feeding back', learning lessons and adapting our approach while maintaining the overall direction.

This feedback and learning needs to be service wide. It needs to involve patients, staff and partner organisations. It needs to be done locally while brought together nationally. We have therefore established the National Leadership Network for Health and Social Care to play a key role in taking forward the work, collecting feedback and shaping the way we implement change.

Although this document is about the NHS, the overall direction of travel is closely allied with social care, where we will be publishing a Green Paper shortly. It is intimately linked to the Choosing Health White Paper and requires very good joint working with local authorities, other parts of government, the voluntary sector and private agencies.

I know that this vision and these changes are very ambitious, rightly so. I know too that it is very difficult to deliver improvement for tomorrow at the same time as managing today's services with all their pressures and demands. But as extra resources are available we have the opportunity to make a profound difference to people's lives.

The past five years have been about building capacity and capability. The next will be about improving quality, making sure that we give the very best value for money and use the new capacity and capability to build a truly patient led service. 

Sir Nigel Crisp
NHS Chief Executive
17 March 2005

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