NHS 'will forgo public support' if service fails in bid to improve

The NHS plan's first annual report has lauded the progress made in improving patient care, recruiting staff and investing in hospitals, but has warned that unless the service can do better it will lose the support of the public.

The report points out that 'it is clear that the NHS is valued. . but unless the NHS can change to meet the expectations of the British public, that support will wane'.

In key areas such as waiting times for treatment, development of IT and improvements in primary care, the report makes clear that there is still a huge amount to be done if the plan is not to fail.

It says: 'Overall, the challenge of reducing waiting times cannot be overestimated. It will be the outcome on which the public judges the success of the NHS plan.'

While the report's 70-odd pages focus overwhelmingly on the positive, the underlying message is that achieving key targets such as cancer waiting times and recruiting sufficient staff will be a 'challenge'.

In a report with many caveats, testimonies from individual boards acknowledge how much better the situation has become since the plan's inception but also how far there is to go.

While congratulating staff on their achievements, the report adds that 'it is perhaps inevitable that so far modernisation is patchy and there is clearly still a long way to go'. It continues: 'Put simply, without the capacity to carry out more treatment the NHS plan will not be achieved.'

Board member and chair of the British Medical Association council chair Dr Ian Bogle said the report 'had an air of realism about it - it is not a document that pretends things are happening that are not'. He described some of the board's meeting as 'electric' and said that he and colleagues had not felt 'muzzled in any way'.

'We have a vastly improved relationship with government - no doubt... It is a refreshing change to be able to sit down with ministers and have a dialogue after so long in previous governments banging on about lack of resources and being told there is not a problem.

And all of us on the board do think there is something worth salvaging. That really is the common factor - the great belief in the health service.'

The report points out that the quarterly meetings to discuss progress in implementation of the plan have 'initiated frank and open discussion' which Dr Bogle said 'may have been a bit traumatic for the secretary of state at the beginning... but situations come and bite you eventually if you pretend they're not there'.

It pledges that the board 'will continue to influence the secretary of state and the programme of modernisation, identifying the areas that need greater investment and greater support across the NHS. . ' But while the document highlights some of the harsh realities, its summary of the achievements of the past year cannot avoid the rhetoric of modernisation with its themes of 'renewal, redesign and respect'. In the words of Professor Don Berwick, 'the tight linkage of leadership development with the improvement agenda of the NHS holds even more promise of a coordinated effort throughout the service, in which 'all teach, all learn' is not just a slogan but a day-to-day reality.'

The report summarises the list of achievements in the key areas - clinical priorities, staffing and capacity - summarising investments and initiatives over the past year from the role of the collaboratives to the roll-out of direct booking, the 10,000 extra nurses and the less than impressive 130 extra GPs.

NHS Modernisation Agency director David Fillingham said: 'Achieving real reform will not result from actions in Whitehall or Westminster: it will be owned and driven by frontline staff in conjunction with the people they serve.'