The NHS Confederation's annual conference is fast approaching. So it is a good time to take a step back and look at the current state of play in the NHS. I have been wondering how things would appear to someone landing from another planet. I fear a 'man from Mars' may well feel rather confused if he landed and picked up a newspaper.

The man from Mars would quite rightly ask how come a service with such high levels of patient satisfaction gets such a bad press? How it is that a service that has paid staff extremely well in recent years now has significant levels of dissatisfaction and threats of industrial action? And how come a service that is normally delivered on a local level by people in the community or in a hospital, creates enough paperwork for an individual trust to fill a novel a day?

In explaining to our alien friends, it is worth taking a snap shot of current NHS performance. Patient satisfaction is very high. The recent Healthcare Commission survey of hospital in-patients revealed that 92 per cent rated their overall care as excellent, very good or good. With over eight million patients staying overnight in an NHS hospital each year this is a really big achievement for the service and a credit to NHS staff. Any other industry on Earth, Mars or Venus would wave its arms or tentacles in pleasure yet it is hardly worth a mention in the national press.

The NHS has delivered significantly lower waiting times. As an example, in 2000 the number of outpatients waiting more than three months for a procedure was 393,000. Today that figure is just 126 people. The number of people waiting more than six months for treatment fell from 269,000 in 2000 to just 144 today. Yet the public don't recognise or celebrate this improvement in their health services.

Despite these significant improvements, opinion polling shows that the public consistently rate NHS services much more negatively than the people who use our services. The NHS Confederation's recent report Lost in translation analysed this phenomenon and concluded that without doubt the persistently hostile reporting and the use of anecdote has resulted in the public becoming increasingly distrustful when confronted with evidence of improvement in the NHS. It would seem that disenchantment with the government translates into scepticism about the service. Health service leaders as well as the government, have failed to communicate effectively the reasons for health reforms to the public and, most critically of all to NHS staff.

NHS staff are not good advocates and only the police force have a lower level of staff satisfaction than we do. We can't just blame 'them up there' for this and every manager, every Board and every leader has a role in turning this poor perception around. The 1.3million staff should be our greatest allies not our worst critics. Very interestingly however the greatest advocates for the NHS are GP receptionists whilst the worst are the GPs themselves. This is not about money it is about culture.

At this point the rather assertive 'woman from Venus' would point out that in order to get the best from people, they need to feel valued, in control and able to influence their own destinies. For the NHS, this means that we need to design a system where the boards of local organisations set their own priorities with citizens within the overall strategic objectives of the service. Problem solving, innovation and responsiveness all improve when people feel in control. Devolution of power must be responsible; it is about collaboration and cooperation and a passion for improvement rather than barriers and boundaries and declarations of independence. Performance must be judged against clear outcomes for patients as well as a focus on the way that we treat patients to show that they are respected and valued. I remember the hand which held mine as much as the needle which took away the pain.

Every Board must ensure that the services they provide or commission are those they would be proud to use for their families and themselves. If there is a question mark then we are not doing well enough. The desire to hit targets must be superceded by the passion to improve. This will only happen if we work with our staff and patients to design services that really do wraparound and focus on the user and thus make real differences to health status or quality of life. Customer service and sensitivity is as important as measurable targets. We must aim to have patients who speak highly of our services as well as staff that are proud to work with us. In this new health service I hope I will never again have to listen to professionals saying that they don't have time to treat patients with dignity because in this new world patients will really matter.

With this new approach will come trust, so the amount of wasted paper work would be reduced as policy makers stop trying to teach their grandmothers to suck eggs. There would be fewer useless forms to fill in that do not add one iota to the task of increasing patient safety or improving patients' experience. NHS boards must be strengthened to take this responsibility for their own actions and performance and rely less on external scrutiny to identify problems and drive improvement. This is appropriate autonomy with the proper counterweight of true accountability. It will be clear where the buck stops!

Excessive bureaucracy, the biggest burden on the working lives of our members, must be cut-back. It's ironic that we take so much criticism as managers for being pen-pushing bureaucrats, when it's bureaucracy that we hate the most. For years, NHS Confederation members have been arguing that the burden of bureaucracy is increasing. The Confederation produced a report this year called The bureaucratic burden in the NHS. In it, we calculated that over 56 different inspection and regulatory organisations are scrutinising the NHS at any one time.

This is excessive. But the burden of bureaucracy goes much wider and deeper than regulation. The feedback we get from members is that the burden of bureaucracy does not merely lie in the number of visits or inspections although they too can be burdensome - the overwhelming and primary cause of bureaucracy is the duplication of activity by assessors. We must see a review of all the inspections and data collections and instructions from the Department of Health undertaken in the NHS with a view to streamlining these and reducing the impact they currently have on the NHS.

As we approach the new dawn of a new Prime Minister - Gordon Brown, the NHS Confederation believes that there are some key principles that must be applied regardless of structures or politics. First, we must have devolution of power within a truly collaborative system. Second, we must strengthen boards. And third, we must see greater autonomy across the NHS. Finally, we strongly believe that the only way to create Gordon Brown's responsive, patient-focused NHS is through empowering the service to do the right thing.

Then I will be able to give good answers to the questions from Mars and Venus!

(The NHS Confederation's annual conference and exhibition is taking place at ExCel, 20-22 June 2007)

Dr Gill Morgan
DBE Chief Executive
NHS Confederation

Published in HSJ on 14 June 2007