All health authorities will have to appoint their own modernisation boards and nominate a team of 'champions' to lead on the changes outlined in the NHS plan, according to new guidance from the NHS Executive.

Every NHS organisation will also have to complete a modernisation audit by the end of the summer, outlining progress on delivering the government's targets in a host of areas from reducing waiting times to achieving 2 per cent efficiency savings.

The implementation programme for the NHS plan, published at the same time as the Health and Social Care Bill containing the necessary legislative changes to take the plan forward, sets out a detailed framework for every health service organisation to deliver what is expected of it.

NHS managers have welcomed the document, described by one chief executive as 'absolutely integral' to the way forward.

Local action plans, incorporating service and financial frameworks, must be drawn up which will feed into performance agreements between regional offices, trusts and HAs on how the core requirements of the NHS plan are being achieved.

The guidance says that 'when this whole exercise is completed (and it is intended this should be done by end March 2001) we will have a national aggregate, which will inform the department of what is to be delivered against the targets and how much it is planned to cost'.

The traffic-light system will then be used to assess whether the local implementation of the plan is up to scratch and whether there will be a reward from the national performance fund.

'In the course of the next year, organisations identified as 'green' will benefit from decentralisation of decision-making and greater freedoms and flexibilities, ' the guidance confirms.

But while some may look forward to greater freedoms, there is concern about the health bill's promises of additional discretionary powers for the health secretary. The NHS Confederation and the British Medical Association are seeking clarification on the extent and application of the new powers.

Confederation chief executive Stephen Thornton said: 'We will be seeking guarantees that they will only be used in exceptional circumstances and only then following clear, explicit and transparent processes.'

The 'guiding coalition of leaders and stakeholders' who will be identified to push forward changes can expect a busy start to the new year. Among the first targets is an expectation that by April all parts of the NHS should be implementing the standards contained in Your Guide to the NHS, which replaces the Patient's Charter. From March all acute trusts are expected to offer booked admission in at least two specialties. And as part of the implementation of 'best value', every organisation will be required to review at least one major service annually beginning in 2001.

The pace will not let up beyond 2001: next year sees maximum waiting times introduced for all inpatient and outpatient services, including an upper limit of four hours between admission to hospital through accident and emergency and bed allocation.

Also by April 2002, patient advocacy and liaison services must be up and running, as well as the new patient forums which will inherit some of the work now done by community health councils.

Hugh Ross, chief executive of United Bristol Healthcare trust and a member of the modernisation board, acknowledged that the workload would stretch organisations, but said there remained immense enthusiasm for the direction of change.

'There is a huge amount to be done and one or two things that have come along quicker than we might have expected but overall people are very supportive, ' he said.

His trust already has its own taskforce which advises on and supports modernisation locally, 'liberating and encouraging ideas'.

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