Mix together Patricia Hewitt’s vision of care closer to home1 and Ara Darzi’s strategy for improving quality and patient safety2; add in a large dose of financial reality to reflect the much tougher outlook for NHS spending; sprinkle over the seasoning of partnerships and integrated care; and cook on a hot stove until ready to serve. This is the recipe used to produce Andy Burnham’s Christmas dish, the latest five year plan for the English NHS.3

Although the plan contains little that is new, it is nevertheless important in setting out the government’s stance in the lead up to the 2010 general election. Echoing Ara Darzi’s strategy, the plan argues that NHS staff themselves need to lead the implementation of reform as less reliance is placed on national targets. It is described as “the largest and most complex programme of change the NHS has ever attempted,”3 not least because it aims to continue improving performance while releasing up to £20bn (€22bn; £33bn) in efficiency savings.

In an attempt to secure the support and commitment of staff, a deal is proposed under which pay restraint is linked to a guarantee of employment to frontline staff. Under this guarantee, the jobs of these staff would be secured in return for flexibility and mobility locally or regionally. The importance of partnership …