The NHS looks set to remain the top political priority - and with good reason. Still at the heart of what the public associate with the best of British and costing society £100 billion a year, there are few more emotive issues.

All the parties are grappling with how to ensure the NHS remains fit for purpose in the future. The first challenge is how to give power to local services and re-engage clinicians in reform and decision-making while ensuring the NHS remains accountable to the public.

The NHS Confederation, which represents over 95 per cent of NHS organisations, has welcomed the Conservative's recent contribution to this debate - their white paper: NHS autonomy and accountability. It makes a number of interesting proposals.

The white paper starts with a strong commitment to a set of updated NHS values. Staff who work in the NHS will recognise and support these, in particular, the commitment to create seamless services for patients. The complexity of patients' problems will make the creation of a much more joined-up service absolutely imperative.

Much of the change needed now in the NHS will have to be delivered by clinical staff and managers developing local solutions together, rather than implementing national initiatives. The white paper acknowledges the importance of staff being engaged in the development of services and recognised for the contribution they make.

There is now a consensus across political parties and key NHS organisations about the need for increased autonomy in local NHS services. The NHS Confederation welcomes proposals from the Conservative Party to give the NHS more local autonomy. However, whilst the creation of an independent board may be part of the solution to increased autonomy in the NHS, we should not forget that some form of political involvement is unavoidable in a service that spends so much public money.

A recent NHS Confederation report 'From the ground up: how autonomy could deliver a better NHS' made the case for devolving autonomy and increasing accountability within the health service. In that report, we argue that behavioural change, not more restructuring, is the solution to many of the current problems in the NHS. An independent board would not be enough to deliver a truly patient-led service unless it goes hand in hand with real devolution of decision making closer to patients.

The white paper also calls for the complete removal of the target regime in the NHS. Whilst this would be a popular step with many, it must be remembered that, in some cases, targets have been useful in focusing attention on otherwise neglected areas. There is a balance to be struck. Some targets have also come to be regarded by the NHS as little more than a box-ticking exercise which fail to get to the heart of how we really improve services for patients.

However, people working in the NHS do expect to be held to account for the quality of service they deliver and so we welcome proposals in the white paper to measure outcomes for patients rather than just outputs. For some time, the NHS Confederation has been calling for a radically different way of measuring success in the NHS, by putting patient satisfaction at the centre of a new approach.

Finally, it is worth noting that research by Ipsos MORI has shown that a major source of the public's negative views of the NHS are the views of the staff who work in it. Hopefully, the policies contained in the white paper could go a significant way to overcoming the scepticism and cynicism that marks the attitude of many staff in the NHS. If the white paper is part of a journey to shift the debate away from structures towards the delivery of high-quality clinical care and the promotion of good public health, then staff will of course become engaged.

Nigel Edwards
Director of Policy
NHS Confederation

The NHS Confederation represents over 95 per cent of NHS organisations. NHS Employers, which is part of the NHS Confederation, is holding a fringe meeting with the Work Foundation at Conservative Party conference calledIs the health of the nation built on the morale of NHS staff? on 1 October at 5:30pm at the Streeton Hotel, 206-214 North Promenade, Blackpool.