After some years of financial turmoil, the service is about to record a near £2bn surplus, with NHS foundation trusts – the freestanding, self-governing health service businesses – holding another £1.5bn or so of cash in the bank.

Since April 1, patients have had a choice of any accredited hospital, public or private, for routine treatment. By the end of this year the maximum wait will be 18 weeks, with the average much shorter. And hospital acquired infections – patients’ “number one priority” along with hospital cleanliness, according to Mr Nicholson – are finally on their way down.

So in its 60th anniversary year, “on the big safety, money and access issues we will have delivered something quite significant”, Mr Nicholson said in an interview with the Financial Times. But while “that is good, it is not good enough”, he said as he underlined that the NHS was still in the process of transforming “from one system to another”.

That, he stressed, “is not a trivial, piecemeal change. This is a fundamental change in the way health care is delivered”.

The NHS had moved from the huge expansion in spending and staff after 2000, to introducing new incentives for commissioning and for choice, and now needed to make services more personalised and responsive to patients.

Key to that would be giving patients far more information, while getting primary care trusts – which purchase care on patients’ behalf – “to focus their absolute attention on the benefits to their patients and communities” rather than “always looking after the provider parts of the NHS”.

Private sector hospital providers have been expressing disillusionment as the apparent scale of opportunities open to them has shrunk, although Mr Nicholson said private sector interest in providing primary care remained vibrant.

But he added: “I cannot imagine an NHS service in 10 years’ time that does not have significantly more private engagement at almost every level – whether it is in the provider arm, or supporting and developing commissioning, or whether it is the direct provision of services. It seems to me that is the nature of the system we are trying to move towards.”

The new system has brought tensions. Monitor, the regulator for the foundation trusts, complained recently that the Department of Health still seemed to be trying to subject them to command and control by telling them to appoint extra matrons and to have hospital “deep cleans” to control MRSA infections.

Mr Nicholson acknowledged that in the new system “I haven’t got the ability to tell them how to do it. That is absolutely true”. But he had every right to tell any NHS provider that they must tackle hospital infections in the wake of the big death toll at the Maidstone NHS Trust.

“I don’t want to have a spat with the regulator. I think Monitor is doing a fantastic job.” But he added: “It is not public confidence in individual organisations that suffers [in a case such as Maidstone]. It is public confidence in the whole system. I have a responsibility to defend that reputation, and I have a right to express a view.”

With the NHS having significant sums of unspent capital, and with the intention being to run the same level of surplus this year to even out expenditure over the three-year spending round, the service was now “in a good place”, he said, with ample funds to meet its immediate objectives.

But it had to prove it could complete the reforms and use the money well.

“It is a big test. That is why 2008 is so important. When we look back, whether we have exploited this position well will be the judgment of how successful the NHS is over the next 10 years.”

http://www.ft.com/cms/s/0/1661d598-0117-11dd-a0c5-000077b07658.html

Health Direct asks why if the NHS is so financially healthy and can afford cancer drugs aren’t doctors being allowed to prescribe them?

Private hospital groups have shown limited enthusiasm for labour’s plans to outsource treatments. As one executive put it, their fear is that Whitehall’s “push” for private sector provision was “less pronounced than it appeared to be a few years ago”.

Private sector providers complain that ministers have a habit of decreeing that the market should be opened – then failing to check their spin has been implemented. Somewhere down the Whitehall chain, companies complain, change is blocked – whether by disapproval of the profit motive, turf wars or an ideology-fuelled conviction that public services should remain in the public domain.