Scotland's new SNP health secretary has called on NHS boards to accelerate the pace of change to give patients the services they deserve.
Launching a consultation on the government's planned health and well-being action plan, Nicola Sturgeon said she wanted to ensure better, more local and faster access to healthcare across Scotland.
And she warned managers she would not rule out punitive measures if progress is not as speedy as she would like. 'I'd prefer to use the carrot, but the stick is never out of the picture,' she said.
Better Health, Better Care: a discussion document was launched last Thursday. In it, Ms Sturgeon says she supports the direction of Scotland's health policy, as set by Professor David Kerr's 2005 report, Building a Health Service Fit for the Future. This includes shifting the balance of care from hospitals to a focus on long-term conditions and services embedded in communities.
But she said she wanted patients to be more involved in decision-making and to have a say in what targets should be set for the NHS.
'We want to make patient involvement meaningful. Patients are consulted until they have consultations coming out of their ears but I'm not sure if they feel involved.'
The consultation also discusses ways to implement the SNP's manifesto promises, including a target of 18 weeks from GP referral to treatment, abolishing prescription charges and introducing directly elected health boards. However, on the latter two the SNP minority government would struggle to get backing from the other political parties.
The consultation was welcomed by the Royal College of Nursing and the British Medical Association although BMA Scotland chair Dr Peter Terry warned that constructive engagement with the medical profession would be vital.
But former health minister and Labour health spokesman Andy Kerr said Scotland's current health strategy was the right one and a further consultation would be an 'unnecessary distraction'.
The consultation runs for 12 weeks with a view to publishing the action plan by the end of the year.
The scale of the challenge ahead was put into focus on the day the consultation was launched, when Audit Scotland published a report into long-term conditions.
The watchdog warned of poor information and a lack of joined-up working - and said it was difficult even to estimate how much money was being spent on long-term conditions.