With the current media climate of negative headlines about the NHS, it is very easy to make the so-called 'crisis' in the NHS a self-fulfilling prophecy. However, it is important that we take a balanced view.

We are half way through a ten year NHS reform programme producing system change on a much larger scale than any other organisation has ever attempted. The NHS is currently running faster than ever before to deliver ever-demanding targets and service re-design.

What's more, the NHS is delivering this phenomenal change programme without the level of funding that individual companies involved in similar transformation projects would have invested.

Therefore, it is no surprise that there is turbulence in the system and some financial instability. Some of the instability is about historical deficits, but unfortunately the scale of these is clouding the debate and preventing a proper discussion about how we deliver real change in the NHS.

In reality, if we look at the service as a whole, the picture is mixed. However, it is heartening that every single NHS organisation is engaged in some kind of system redesign that challenges traditional ways of delivering clinical care. Some are further ahead than others, but in many places managers are producing massive changes by using new ideas - such as lean thinking - and working in different ways.

However, there are significant challenges. The biggest of all is that we have been so obsessed with the 'tools' that enable us to make the changes - for example payment by results, practice based commissioning and patient choice - that we are at risk of forgetting what we're trying to achieve in the first place, that is high quality, responsive care for individuals.

And the technocratic language about the 'tools' disengages clinicians who find themselves struggling to deliver services in an increasingly demanding climate, without any idea how the reforms can actually help deliver services for patients.

We need to tackle these issues head-on to ensure that we are delivering services that we all want ourselves and our families to be proud of using. We need a better understanding of how to use the 'tools' to the best effect to help us to deliver the change. We also need clarity about how patients will benefit from service redesign. We also need to reengage with clinicians.

There are challenges ahead for all parts of the system and we must regain a spirit of collective action - the NHS is strongest when it works together. We need to get away from collusive and bullying atmospheres that have damaged the system in recent years.

We need leadership from the top, but delivery on the ground in every organisation in the country. Each NHS organisation needs strong leadership, with systems focusing on engaging those who deliver care.

That's why our conference in June this year will be focusing on how, in increasingly financially challenging times, NHS leaders can re-engage clinicians, deliver change and achieve real value for patients. In a time of change and uncertainty it is crucial that some time is given to step back, take stock and look at the bigger picture.

NHS Confederation annual conference and exhibition 2006 - Achieving value for patients and the public 14-16 June, International Convention Centre, Birmingham

British Journal of Health Care Management - May, 2006