Polite rather than enthusiastic applause greeted Andrew Lansley's speech to the NHS Confederation conference in Manchester as the health secretary urged the service's managers to "regain the momentum" after the 'pause' in the government's health bill.

He began by talking about the pause taken following the controversy that greeted the publication of the aforementioned Bill in the New Year. Mr Lansley said that "while we were pressing ahead, there grew an increasing perception among some people – too many people – that the Bill could pave the way for things that they didn’t want".

He acknowledged that "too big a gap had opened up between what was actually happening on the ground and what was perceived to be happening by the commentariat at Westminster". The pause was then taken in April because "we needed a way to reconnect, to reassure those with genuine concerns, and to learn from those already implementing the changes locally about how to make the plans better".

Competition creates 'level playing field'

Mr Lansley went on to say that the bill had been improved by the suggestions made by the NHS Future Forum, under Prof Steve Field, concerning issues of implementation, education and training. He noted that many people had been concerned about the impact of competition on the NHS,  but said "competition will only ever be used as a means of improving care for patients", used to "create a level playing field that allows the best providers to flourish".

The health chief admitted that some people feared the Bill would undermine the values of the NHS, but he said "I would never let that happen. We have now, I hope, reassured people of our commitment to the fundamental values of the NHS – of healthcare for all, free at the point of need".

He stated that the Future Forum "did a fantastic job" but it has ended and "it’s now time to regain the momentum, to get back on the front foot". As part of that, he announced the fifth wave of clinical commissioning group pathfinders.

Fifth wave of pathfinders

The 35 new Pathfinders bring the total to 257, covering almost 50 million people, around 97% of the population in England. Some primary care trusts have already delegated budgets and commissioning responsibilities to these pathfinders, he said "and I hope the majority will by next April". By April 2013, "commissioning groups will start to take statutory responsibility in their own right".

He spoke about the "four major challenges facing the NHS, and facing you as managers". The first is to dramatically increase productivity through treating more people closer to home and focusing on prevention as much as on cure, but he stressed that "making big savings must not be about crude cuts to services".

Variation in quality shocking

Second, he spoke about significantly improving the quality of patient care, saying that "people are generally satisfied with the NHS but if people were only aware of the variations in the quality, they’d be shocked". Mr Lansley argued that "the NHS can be so much better. You know it. I know it", adding that ."we need to measure more, to publish more, to incentivise more. In the coming years, we will give England the most transparent healthcare system in the world".

The third challenge is to have more community-based care and more specialist care in centres of excellence, Mr Lansley said, noting that  the amended bill means ministers are accountable overall, with a duty to promote a comprehensive health service, "but the political balance needs to change, with no more interference in the day-to-day running of the NHS".

The fourth challenge is to cut bureaucracy and to integrate services around the needs of patients, he said. He said so much red tape "must stop. We can’t afford it. It stifles innovation".

Mr Lansley concluded by talking about the importance of quality management, saying that "modernisation is every bit as much about organisational leadership as they are about clinical leadership" However delegates on the floor were not convinced, and the secretary of state was repeatedly asked why politicians do not come out in support of NHS chiefs. He claimed he had just defended management in his speech, saying that he was not denigrating managers by trying to remove wasteful bureaucracy.