Politicians need to tell the public the truth about the real scope and effects of the changes that the NHS needs to make to become more efficient and effective while living within its means, the head of the NHS, David Nicholson, has said.

Nicholson, who is also chief executive of the nascent NHS Commissioning Board, which will have a key role in the new look NHS, was speaking to delegates at the annual NHS Confederation conference in Manchester on 21 June.

He referred to a speech delivered in 1962 by the then health secretary, Enoch Powell, which became known as the “water tower speech”—an allusion to the forbidding architecture of the Victorian mental asylums—and from which Stephen Dorrell, chairman of the parliamentary health select committee, had quoted extensively in his …