Something off the trolley?

Someone had done a remarkable job producing this in a matter of weeks.

Most impressively, it is not a long list of radical ideas intended to impress the public, but it shows input from people working in the field.

Admittedly, I strongly disagree with some ideas - such as the heavy emphasis on regulation, or recruitment of overseas staff. Others were gimmicky: for example, the menu designed by leading chefs.

Overall, though, the document impressed me as powerful, coherent and imaginative, determined to stay true to the principles of the NHS. It addresses weaknesses such as waiting lists, dirty wards and the lack of consumer involvement.

It proposes ideas to improve recruitment and tackles ambiguities about medics. At last, some conviction politics.

Call me naive, but I was surprised by the sceptical reception it was given in the so-called quality press. The Times opened with a big headline telling us that 'GPs attack NHS gamble'.

The Independent questioned whether it was radical, and the Sunday Times - which seems to disagree implicitly with the principle of universal coverage, the core value of the NHS - pushed for a greater role for private insurance. The much maligned Guardian, in contrast, was remarkably fair.

Irritating across the board were the selected critical quotations from largely supportive organisations, and even more the advice from so-called experts.

Talking to colleagues across the NHS gave me a very different story.

Grassroots staff, including people usually at best sceptical, were enthusiastic and keen to give it a go.

The plan has struck a chord, and despite doubts about the value of the communications exercise, it has responded to the people's priorities. I also noticed a realism largely missing in the press.

Government has to be held responsible for business planning in the NHS, but we live in the real world and it cannot perform miracles.

In other words, one has to separate the role of government from the challenge to staff. Provided the strategy is shared and the resources are made available, it is in the end up to us rather than health secretary Alan Milburn. Hence my earlier concern about too much regulation.

But no-one disagrees that the challenges are massive, and transcending all others is staffing - both numbers and skills.

The point is not whether some of the proposed new nurses and doctors have been announced before, but instead where we are to find them and how we retain them. In particular, nursing is crucial, since its status has declined and the market for potential recruits is highly competitive.

In contrast, many bright school-leavers will still want to enter medical school, so the challenge is not how to create pathways for nurses to become doctors, but how we can make nurses out of unqualified support workers without affecting the quality of care.

Stimulating retention is even more important in the short-term while we are waiting for students to qualify.

Deprived areas could benefit greatly from ideas such as supported housing and childcare. I like less a 'market forces supplement', since it will increase competition, and create situations where shortages will be shifted across to neighbouring trusts.

It is also only a small step away from locally negotiated salaries and spiralling wage bills.

A concern that will need addressing is the integration of new objectives with existing ones and system overload.

Mental health is a prime example.

Work is just starting on implementing its national service framework. The extra investment promised in the NHS plan is very welcome, and many new service elements, including primary care workers, early intervention and crisis resolution, are the right priorities.

De facto , a new standard has been added to the framework: 'Set up a comprehensive and integrated system of community services', supported by more new money than was made available for the other seven standards combined. This will test management capacity at a time when the strain is already showing.

More and highly complex planning is expected from the same few people.

I welcome the leadership centre, but would funding of additional management really be a sign of failure? No need to answer. I can imagine the headlines. . .

Rightly, the ultimate challenge mentioned by most commentators is implementation, but then it always is.

It brings us back to staffing . No newspaper I have read has mentioned the waiting lists other western countries are experiencing because of staff shortages, and I doubt whether any of the ideas proposed in the press would make any difference. Few young people would suddenly flock to work in the health service because we introduced private or social insurance.

So will the NHS plan work? It depends, of course, on how high expectations are. It will make a significant difference to issues that matter most to patients, such as access, cleanliness and quality of care.

But there will still be some form of waiting lists and the odd scandal, presented gravely on front pages. The NHS's effectiveness as a whole will be projected on the basis of the person on a trolley in accident and emergency.

They may be enough to imprint on the public consciousness that the NHS has failed, forcing politicians to jump and move on to those pastures beyond that look ever so green.