More doctors and nurses, greater investment in information technology and improvements in care quality are the key issues for the future of the health service, departing NHS chief executive Sir Alan Langlands told MPs last week.
Sir Alan used a session billed as 'valedictory' before the Commons public accounts committee to make a plea for more clinical staff to speed movement of patients through the system.
He also admitted politicians had been 'tightening up' their control of the NHS: 'Ministers have taken on more powers of direction' and were using statutory instruments, national service frameworks and new national bodies such as the Commission for Health Improvement to centralise power. But it was important not to 'stifle' local innovation, he stressed.
Sir Alan said he hoped the plan to combine his job with that of the Department of Health's permanent secretary would mean 'greater integration between the NHS, public health and social care', but he stressed that the chief executive should not become 'remote' from those at hospital and health authority level.
The move 'towards a more managed system of primary care' was the most significant change during his time in office, he said. Pointing out that 90 per cent of patient contacts were with GPs or community staff, Sir Alan said patients were beginning to see the difference since the introduction of primary care groups.
He also pointed to growing efforts to make doctors answerable for their clinical performance as a key development, highlighting the 'vast change' from clinical freedom to clinical accountability.
Managers and clinicians were now working more closely together, he added. MP Alan Williams demanded to know 'what on earth was wrong' with managers who in a series of high-profile cases failed to stop incompetent doctors treating patients. Sir Alan said many cases had gone undetected because there had been 'a tradition of walking on eggshells' in dealing with clinicians who could affect a manager's career.
But the situation had changed. He pointed to the 'big advance' in the appointment of 400 medical and nursing directors across the country: 'They have credibility in their clinical fields' which had 'helped other managers engage in clinical issues'.
Since the last election clinicians had started 'fighting' for management funding, he said. While 'managers kept their heads down' doctors had demanded resources so the service was well managed.
Sir Alan couldn't resist a quick dig at the committee. He described his 24 appearances before its members as 'largely positive - but watch the game-playing'.