The NHS is facing enormous challenges - demographic changes, an ageing workforce serving an increasingly diverse population, budget pressures and an increased role for the private and not-for-profit sectors. NHS bodies and local government are expected to overcome these pressures and take the lead in promoting community safety, social inclusion, health equality and well-being.
The challenge is to equip health and social care organisations to deliver on this broad and ambitious agenda. So how do they need to change as organisations and what type of managers and leaders do they need to develop?
The Audit Commission and management schools will tell you there is no one all-important factor. They will point to evidence that successful public sector organisations share common characteristics: leadership, clearly stated values, partnership working, a performance management culture, and the ability to work across traditional departmental and professional boundaries.
I do not doubt that when an organisation is succeeding, evidence of these characteristics can be found, but I do not think it is helpful to believe you need to get all these things in place before your organisation is equipped to meet the challenges that lie ahead. Instead, organisations should focus on one major challenge. In my view, if they can get equality and diversity right, all else will follow.
If equality and diversity in recruitment are right, you will have a workforce that reflects the diverse population you serve. If you recruit people who do not all come from the same background, hold the same beliefs and think in the same way, you are more likely to have the creativity and insight to respond to the challenges of providing services to a diverse population.
Of course, this will only be realised if you have managers who are skilled in leading a diverse workforce. This means developing their people management skills, as well as creating a safe working environment where staff feel able to challenge and be challenged.
If you get equality and diversity right, you will have developed your listening skills as an organisation and so you will have the right approach to engage communities and work in partnership with the voluntary, community and faith sectors. Such skills will stand the organisation in good stead for promoting community safety, social inclusion, health equality and well-being.
To know you are succeeding, you must monitor recruitment and service take-up and set targets based on local population profiles and patient surveys.
Meeting the really big challenges means radically changing the way people behave in the organisation. It means engaging staff at every level in doing things differently and it requires people to be inspired.
League tables and cost-cutting have limited motivational appeal. Claiming the customer is king is hard to maintain in the face of hospital closures, cuts in services, removing children from their parents or admitting someone to a psychiatric ward against their wishes.
And despite the traditional emphasis on charismatic leadership, frontline staff do not do what they do for the chief executive. Nor do they do it for the money, they do it for the people they serve and because they want to make a difference.
The challenge is to maintain this sense of commitment at the same time as the public sector adopts many of the methods and language of business.
What better way of doing this than focusing on fairness - in how we recruit people, how we select them for promotion, how we treat people at work, how we allocate scarce resources and how we provide services. Fairness is relevant, fairness inspires.