Sir David Nicholson, outgoing chief executive of the NHS England, has called for a new strategy for the future of the NHS that will help it side-step electoral tyranny, instil a positive culture, and better weather media storms.

Addressing delegates at the NHS Confederation conference in Liverpool last week, Nicholson stressed there is an enormous amount to do, starting with the promotion of a positive culture and making a plan for the future to ensure that the NHS is no longer the victim of political debate or "the media storms that come and go".

"We cannot allow the tyranny of the electoral cycle stopping us from making the real and fundamental changes that we need to make to the NHS, we cannot allow that to happen this time. We will be letting down our patients and our communities if we did," he said.

Beware of political manifestos that claim "with a little bit of growth, with a bit of management costs savings, with a bit of improvement in procurement and a bit of integration, you can solve the long term problems of the NHS" because "you can't", Nicholson stressed, and called for "absolute clarity and honesty" from political leaders about the true impact of living with the financial climate for the foreseeable future".  

Politicians, he said, have enormous difficulties being able to think beyond the relatively short term, and so the job must fall to the NHS itself.  "That's why NHS England will be developing, with the NHS and other organisations, a shared vision about what the NHS of the future could look like," he announced, "not one which is based on the reduction of the offer but one which is based on change the way in which we deliver the offer for our patients and our communities".

Strategy is essential, because if there is no alignment in the direction of the service, there will be "managed decline for the NHS over the next few years", he warned.

Primary care needs "modernising"

Picking on primary care, Nicholson noted that while "a massive fan" of the current system, it clearly "doesn't deliver for everybody" and needs modernising. "It would be extraordinary if a model identified in 1948 was still suitable today, so we need a radical look at the way in which primary care works," he said.   

But Nicholson also voiced outrage about harsh coverage of general practice in recent weeks, and claimed "the potential power and contribution that general practice makes to the health and well-being of the nation and healthcare and the running of the NHS is absolutely enormous".

Elsewhere, he also spoke of the need to look at incentives in the system and maximising opportunities within transparency and patient power.  

The future of the NHS depends on people taking control of their own conditions and more responsibility for their care, and shifting the conversation towards what patients and the health service can do for each other, he said.

Last month Nicholson announced that he will retire from his position at the top of the NHS in March next year, following a barrage of criticism of his involvement in the Mid Staffs scandal.