'The experience of the Blitz was used as evidence that, on the whole, people wanted to stay put - sixty years later, and the NHS is at it again.'

With a year of the Second World War still to go, the government published a report outlining its ambitions for the future of the nation's medical schools and education.

A central consideration was whether there needed to be additional investment in London's teaching hospitals and whether facilities should be transferred across the city or even amalgamated. A 21st century media would have had a field day at the prospect of some great institutions' buildings disappearing.

The teaching hospitals' argument in favour of limited change was centred on tradition (many hospitals had been where they were for generations), the need for them to be accessible for non-resident staff and adjacent to railway stations, and the reluctance of patients to travel. The experience of the Blitz was used as evidence that, on the whole, people wanted to stay put.

Sixty years later, and the NHS is at it again.

Lord Darzi has responded to NHS London's commission to produce a framework for action in order to make excellence uniform, tackle inequalities and raise the quality and safety of patient care in the capital.

His view is that this plan will bear fruit because clinicians have been involved; it is based on what Londoners say they wante all politicians can give support - as it is about quality; and it is both visionary and practical.

The framework is not just confined to London, as its author has now joined the government and is charged with doing the same for England.

One example of a powerful case for the clinical need for change relates to stroke care services. Technological advances have made interventional treatment, not just rehabilitation, an option, if performed soon after a stroke's onset.

Speed, skills and kit are of the essence in saving lives. But this would mean having only seven hyper-acute sites, and ambulances actually driving patients past their nearest hospital.

Defenders of inequality and inefficiency are already voicing their opposition, with politicians lining up to defend their local bricks and mortar.

The premise of this 10-year plan is clinical, so there is a chance that those who wish to preserve the status quo could lose the argument. But success rests heavily on human resources professionals, managers and trade unions.

It is they who are taking the argument out to staff to inspire and engage, and to affirm that patients should drive change, and that employees will be guided and supported.

A workforce strategy is crucial. Initial themes identified: investment in training for ambulance staff, rationalisation of non-medical education and training providers, promoting cultural awareness and understanding of inequalities, development new roles, a workforce shift from acute to the community, and producing incentives to promote and reward productivity gain.

Historians will consider 2007-17 a successful period of change if those responsible for HR management play their full part in this dramatic opportunity to improve the quality and comprehensiveness of patient services.