Fleshing out detail of national plan placated sceptical Confed audience

It did the trick. Last week we urged health secretary Alan Milburn not to waste the opportunity afforded by his speech to the NHS Confederation's annual conference to reveal more about the national plan to the very people who would so soon be charged with implementing it. Despite his obligation to unveil the full plan in Parliament first, we warned that he would preside over a huge anti-climax if he had nothing to add to the stream of leaks regularly finding their way into the media.

Mr Milburn - who admitted to HSJ before his speech that he had read our comment last week - accepted our advice. Restrained only by constitutional proprieties, he was clearly bursting to impart as much about the plan as he could get away with. And it worked: his closing address to the 1,400 senior managers, chairs and non-executives gathered in Glasgow proved the outstanding highlight of a rather dull and flat event. The only pity was that he had not spoken at the conference's beginning rather than its end: what he had to say would have sent an electric current, which was otherwise missing, through the subsequent two and a half days.

For this was a health secretary evidently chastened by the accusations of relentless centralisation, of 'control-freakery', of displaying a bullying manner alongside a lust for blaming and shaming, of having a less than wholehearted regard for the professionals who keep the NHS afloat. His tones were warm and conciliatory.

He paid tribute to the confederation, many of whose ideas would be in the plan, he confirmed. He lauded NHS staff: no one faulted their dedication or commitment, and if he pointed out the service's weaknesses it was not to attack them - they felt the frustrations of a system which failed to liberate their talents as he did.

There was even a contrite nod to the government's propensity to announce every initiative at least three times: in a reference to£20m to cut waiting times for cataract surgery he quietly underlined the fact that these resources had been 'already announced'.

As a result, most of his audience departed feeling more positive about the national plan than when they arrived. In the words of one health authority chief executive, Mr Milburn's speech and his responses to questions were 'entirely aligned to the views of the majority of the audience, who have too often in the past been frustrated by bland vacuity from politicians'.

The multifarious labours of the modernisation action teams and the controversial consultation exercise look not to have been in vain. It would be rash to claim the iron fist has been amputated, but for the moment at least it is swathed in sumptuous velvet.

Much interest centred on Mr Milburn's proposal for 'earned autonomy' (first revealed in HSJ , page 4, 25 May) and the accompanying system of 'traffic lights' which will alert him, the rest of the service, patients and public to under-performing organisations while enabling the best run to enjoy greater freedom.

He summed up the type of problem which has driven him to try to micro-manage the service with an anecdote about a patient instructed by a London hospital to bring in a pillow because it had run out, and disinfectant because the bathrooms would be dirty. 'It should not require action from me to put it right.' Hard to argue with that, and many patients could cite similar experiences.

The plan would be all about 'redesigning services from the patient's point of view'.

But the traffic light system will bring snags, attractively simple though it seems. What of the fate of an outstanding department within a red light organisation? It could disintegrate as demoralised staff leave.

How long will failing institutions have to turn around? How robustly will they be judged? And how many of them will there be? If only a handful, the system will lack credibility; if many, it will damage public confidence in the entire NHS. A red light will cause turbulent ripples in a local community which may be difficult to manage. And the Commission for Health Improvement will come increasingly to resemble OFSTED - an ominous sign.

For the detail we must await the plan - three short weeks away.