NEWS FOCUS: Micro-management of the NHS will continue at the government's peril, reports Ann McGauran

Letting go is healthy, can be fun and will help you achieve your political objectives. That is the top tip to the new government from the NHS Confederation.

The plea comes as the Confederation's chief executive, Stephen Thornton (left), sets out the organisation's thinking for the next four years or so. An end to micro-management might help, he says.

There has been much talk by health secretary Alan Milburn of decentralisation, Mr Thornton says. 'But will local debate be allowed, given that implies differences of opinion, argument and local headlines?'

He believes the 'jury's out' on whether the structures we are going to have when new legislation is implemented could be used in a decentralised or centralised manner.

The confederation gets the chance to present its vision in a series of meetings with ministers over the next few weeks.

'The aim, Mr Thornton says, is to try to get to the point where what the NHS delivers meets public expectations of what it should deliver. ' But at present the confederation's conclusion is that the 'gap is widening despite modernisation'. Lots more money is going in, but it can't be about 'more of the same'.

The big questions now include whether outpatient services as they are currently organised are needed, or whether much of that work can be taken on GP specialists and stand-alone diagnostic and surgical centres. When it comes to the elective centres, should there be a role for the private sector? The confederation is 'up for those sorts of discussions', Mr Thornton says.

But there is a significant proviso when it comes to opening the debate about the role of the private sector: 'Let's have a level playing field.

The thing that holds back public sector management is the political context in which it operates.

Often if you look at private organisations, they have a relatively simple brief about targets and are left to get on with it. That is what we are asking for. '

The confederation is also adamant that there needs to be less emphasis on 'simple, straightline' performance targets. Instead there should be a more sophisticated approach with the acknowledgement that for two to three years there will be 'precious little improvement before you hit the upward curve'.

The organisation will soon present its own model performance management system, together with a critique of the traffic lights approach, including the 'crudity' of it. The incentives, Mr Thornton argues, are for trusts to be 'at the upper end of orange': neither exposing yourself as brilliant nor attracting attention by being too awful.

He calls for 'top-quality leadership' and a recognition of the need for investment in management and he calls for managers to be allowed to 'think radically and laterally' about staffing.

Nurse anaesthetists and nonmedically qualified staff could take on some procedures without supervision - 'perhaps not overnight, but we do want to get very serious about the possibilities'.

And crucially, Mr Thornton argues, in order to deliver - and following the tough experience of this year's service and financial frameworks - there needs to be a 'further generous Treasury settlement'.