At the NHS Confederation conference, a group of mainly NHS managers was asked whether anyone thought working with the private sector was a bad idea. That no-one put their hand up is an indication of how far the NHS has come on partnership working.

We have all heard of world-class commissioning, and the acronyms for relationships with the private sector - PFI, PPP, ISTC and LIFT - fall thick and fast. But experiences with these initiatives are variable.

Some trusts have been frustrated at the imposition of a "one size fits all" approach from the centre. Independent sector treatment centres have been controversial in some quarters, but they have delivered a lot of activity and tremendously reduced waiting lists for procedures such as cataract operations.

In the new world of foundation trusts and the Darzi review, there seems to be a genuine desire to let locally developed schemes for partnerships with the private sector flourish. What matters in the new outcomes-based world is what works, not being hung up on structures.

Developing arrangements

FTs, primary care trusts and others are now having to learn to develop their own partnership arrangements, forever conscious of attention from the media, Monitor and their strategic health authorities.

In this environment, managers need to be bold and think widely. If it works, it works. Some new ideas may fail. Managers need to help create a culture where new partnerships are encouraged and enabled.

They need to develop the independence of thought to meet the unique needs of their local population. While local authorities have a history of developing systems to respond to community need, the NHS - arguably even in FTs - has a history of doing what it is told from the centre.

But, gradually, examples of genuine innovation are appearing.

GP control

I have been working with Stockport PCT, which encouraged the creation of a structure where GPs control a company - Stockport Health Enterprises Community Interest Company. The local improvement finance trust model was deliberately not followed.

The company is a genuine social enterprise, with local stakeholder management and reinvestment of profits into the local health economy, but it operates commercially, with a business plan. Two major new clinics are under construction, to be occupied by local GPs.

The company also provides a range of services to GPs and the PCT - with service contracts - and is looking to partner bidders for new developments across the region. Arguably, the local management makes it more accountable and responsive to the local health economy than any Whitehall top-down initiative. There are other similar models springing up around the country.

Resisting change

However, the NHS has traditionally resisted change and questioned the development of new models and partnership working, particularly outside the "home patch".

How then to encourage innovation? It is often said that entrepreneurial skills cannot be taught (thank you, Sir Alan), so what will the new co-operation and competition panel do? The advertisements are out, so clearly it will provide jobs and enable lengthy meetings to be held, seminars to be provided and detailed rules and procedures created - all in true NHS style.

Encouraging patient choice is widely perceived to be a good thing, but there seems to be an underlying concern that competition will result in trusts competing in a way that might be normal on the high street (creating efficiencies), but not in the NHS. Is this really so bad?

More freedom

Can we afford the 12.5 per cent of gross domestic product spent on health services to be excluded from such practices? Of course, unfair competition needs to be stepped on, but don't trusts need to be given the confidence to develop their range of service models, including with external partners (where appropriate), with minimal interference, provided this meets the needs of the community?

Why do PCTs and local authorities, which often serve contiguous areas, work together by exception rather than rule in most parts of the country?

The Darzi review provides a unique opportunity for the NHS to respond to patient needs in the 21st century. These needs will be increasingly diverse and, accordingly, we all need to look at new ways of meeting them, even if it means failure sometimes.