Delays in access to health service have been one of the public’s top concerns and the focus of major political reform in the United Kingdom for many years.1 2 Waiting can have an important clinical impact; for example, delays in access to diagnosis and treatment can increase the likelihood of preventable complications, creating unnecessary risks for patients.3

Progress towards meeting national targets has been substantial but has been achieved largely through incremental change and expanding capacity. The most recent review of the NHS notes the need to accelerate change, in view of factors such as the rising expectations of the public and the development of our information society, to provide what patients want—personalised care.4

The US Institute of Medicine’s Committee On Quality And Safety In Healthcare recommended the use of frameworks based on simple rules to guide the complex changes that are needed to transform health systems.5 Simple rules have also been successfully used to guide major improvement initiatives in England (box 1).6 7