Published: 17/03/2005, Volume II5, No. 5947 Page 7

NHS chief executive Sir Nigel Crisp said the changes outlined in the delivery plan would have far-reaching consequences, but he wants to see the NHS 'get up this learning curve' much more quickly than in the past.

He said the document marks a point in the development of the NHS similar to the one reached four years ago.

'In 2001 the NHS had some new, tough targets which most of the cynics didn't think it could beat, ' he said. 'It [also] had new ways of working, such as star-ratings and new levers, like primary care trusts and strategic health authorities.

It took two years to really learn to understand how to use the new levers, but from the end of 2003 We have really motored.

'In some ways the end of 2005 feels like 2001. We have got new, tough targets: the 18-week access targets; and the one for combating childhood obesity is even tougher.

And We have got some new levers:

payment by results and so on.' But this time he wanted the NHS 'to get up this learning curve much faster'.

A Patient-led NHS explores how services will have to change in the era of choice.

Sir Nigel said: 'Some people say, for example, 'if we give people choice on elective care then we can't deliver emergency services'. But the answer to that is: 'If people do not choose your hospital, you can't deliver emergency services in the way you do today'.' The NHS chief executive said the answer to these issues was the development of care networks, and A Patient-led NHS gives specific responsibility to PCTs and SHAs to 'review and develop' them in 'emergency, urgent and specialist services'.

Sir Nigel said: 'We are as interested in promoting these networks as we are in promoting choice. We need to be really radical in thinking through those models.' Asked for an illustration, he cited Great Ormond Street's move to deliver children's services for North Middlesex Hospital, which was struggling to recruit the necessary staff. He said that this showed networks could be used to deliver 'quite detailed and intimate services - not just eye clinics'.