conference focus :

Decades of under-investment mean that it will take at least a generation to turn the NHS around, NHS Modernisation Agency director David Fillingham admitted.

'It is a marathon not a sprint, ' he said of the agency's task. 'After 30 years of under-investment, this is at least a 20-year job and it will take me through to retirement.

We are at step one.'

Although some successes have been achieved quickly through the work of the collaboratives and the National Patient Access Team, most of the change needed to really improve the service and health would take much longer, he added.

Transforming the whole ofhealthcare rests on the three Rs, he said - not the three associated with Ofsted, but renewal, redesign and respect for people.

Mr Fillingham, who took up his post three weeks ago, said the Department of Health was 'learning' about the role that performance management has to play.

He suggested that a smaller number of central targets with local flexibility in how they are achieved, like the system employed by oil company BP, is the model it is working towards.

'It is about clear outcomes in a small number of things, with local discretion and judgement and energy and enthusiasm about delivering them, ' he said.

But there would always be a tension in a large organisation like the NHS between centralisation and decentralisation, he acknowledged.

And, he stressed, it would not be the agency that transforms the NHS, but the people working in it, whom the agency would support in becoming an entire 'modernisation movement'.

As part of this programme he reiterated the agency's plan to encourage managers to spend some time - 'maybe two or three years' - working with them before taking that experience back into the service.