NHS acting chief’s interview

On being asked how NHS could avoid system paralysis: Sir Ian: "There is an urgent timetable, you are right. The action we need to take is challenging - probably among the most challenging in the history of the NHS - because we have to maintain the excellent results that we published in our annual report ... and we need to meet the challenge of the deficits."

"I think the picture you paint is really demanding - and on top of that we need to take forward and accelerate the healthcare reform programme. Much of that we will publish in the summer on issues such as the way forward on regulation, commissioning and provider reform. That is a really challenging agenda in anybody's book.."

On being questioned if he really believed in the merger of strategic health authority/primary care trust and if so what was the benefit?

"I very much support the direction of travel: the creation of larger PCTs; establishing a plurality of providers; involvement of the independent sector; and the creation of foundation trusts with different incentives and a stronger voice. All these are entirely the right ingredients." "I'm keen to do that. It is right for the patients and for the NHS. But at the end of the day it is the quality of people who make a difference in any system ...

Organisational models are important because they enable certain things, but it is people in the end who will make a difference. It is important that we get as many top quality people as possible in these posts." "Larger strategic health authorities will bring benefits in terms of linking with regional government to take forward health improvement and some of the strategic challenges in the NHS."

His Opinion on the reconfigurations requiring closure of entire district general hospitals:

"I don't know the whole of the country. People will need to look for local solutions. But there will be major change in all district general hospitals. That is inescapable because of the direction of travel on the white paper."

"I can think of very few instances where we are talking about closing whole hospitals. You never say never, but I can think of very few where that would be the case."

"The first task of the new strategic health authority chief executives will be to finalise local development plans in which they will identify service reconfigurations. We (at the DoH) should be in a position later this year to take decisions and make them public."

When asked if the NHS can return to financial health: "Do I believe that every system can make the change? Unequivocally, yes. It will take some time in many areas. The context of every area is different."

"In some areas, you will need significant restructuring and service reconfiguration to get to that point. You are dealing with a lot of historical decisions that are either helping or hindering you. But the job of leadership is managing the context you are in. There is no reason why the problem we have got now cannot be addressed. "People should now have the feeling when they come with these difficult issues that support is there. From the prime minister downwards, we are all saying it is there. We now need to demonstrate it is as well."

"I don't believe there is anywhere that can't be put right, but in many places there are great challenges."