The NHS of 2023 will be totally patient-focused and have no long waiting times and much waste, the conference was told.

Looking 25 years into the future, Professor Don Berwick, director of the Institute of Healthcare Improvement, Boston, predicted that the NHS would be governed by a set of principles known as the 'Langlands Eight'.

Perhaps the most important was that patients and their loved ones could care for themselves.

Professor Berwick predicted that by 2023 doctors and other healthcare professionals would no longer feel threatened by patients.

Patients would be given control over their own care and treatment, most of which would happen in their own homes.

They would, for example, measure their own blood sugar and insulin levels, and receive information electronically.

By 2023, the Langlands principles would also mean that:

best practice had become the norm;

the NHS had learned that 'naming and shaming' did not work;

there was local control of care;

young managers, doctors and nurses trained together; and

clinicians and managers recognised that it was their duty to achieve cost-effectiveness.

Professor Berwick also suggested that the mentality dividing care and service would be broken down. The NHS would understand that matters such as privacy were important to care and that waiting cost more than it saved.

In 1998, even though bringing down waiting lists was a priority, long waits were accepted. 'This is a long way from world-class thinking. You made a mistake in thinking delays are inevitable in such a system,' he said.