David Nicholson CBE, NHS Chief Executive

It gives me great pleasure to introduce this edition of Public Service Review: Health. The NHS starts this year on a really strong footing. In recent years, the Service has combined a remarkable turnaround in local finances with significant improvements for patients, including increasing access to GPs, halving MRSA rates, and meeting the 18-week referral to treatment target.

Staff and patient satisfaction surveys are showing better results than for a number of years.

And all this demonstrates that our leadership is responsive and high quality.

But these achievements are part of a wider story. The NHS is on a fantastic journey from a monopolistic top-down system to a more open, diverse and plural system.

Change is being driven by factors like demographics, medical technology, information technology and, most importantly, the expectations of our patients.

There have been three phases on this journey so far. The first was about increasing capacity and investment, and the second about introducing levers to enable reform, like choice, contestability and more freedom for providers. We are now in the third phase, which is about using that extra capacity and the reform levers to transform services to deliver high quality care for patients, underpinned by Lord Darzi's Next Stage Review and his report, High Quality Care for All.

The Review has done two things – set quality as the organising principle of the NHS, and provided a clear statement of what the definition of quality is.

For the first time, we have a way of talking among all the different interests in the system so we can focus on improving quality for the benefit of patients.

The NHS is entering a new era and we do not underestimate the degree of change we need to make all this happen. We have looked at evidence from across the globe about large-scale change and what works and what doesn't.

The evidence shows that leadership that looks out to communities and patients is more likely to deliver the sort of change we are seeking than leadership that continually looks up to the bureaucracy and to the centre.

I come from a generation of leaders who built their reputations on delivering national targets. This was an important thing to do and services for patients have improved as a result.

Now, our leadership challenge is to turn an organisation traditionally focused on delivering targets to delivering quality.

We do have a head-start. Looking at the values in the draft NHS Constitution, which have been developed with staff, patients and the public, it is clear that our business is people-centred and about caring for people.

If we are going to be successful, it is essential that our leadership profile is reflective of the wider workforce. We are keen to embrace people from all professions and sectors and particularly want to encourage more clinicians to join our leadership community.

To achieve our ambition of being able to 'act local' and wrap services around the needs of individual patients, our leadership also needs to reflect the communities we serve. We need to identify and nurture people from a range of backgrounds and communities.

In taking this forward, there are four principles that underpinned the work of the Next Stage Review that should continue to inform us – co-production, clinical leadership, system alignment and subsidiarity.

This means working in partnership to plan and improve services, creating the conditions for clinicians to lead, drive change and innovate for the benefit of patients, aligning the system around the same goals, and ensuring that power resides as close to patients and communities as possible, with each part of the system doing only what it uniquely can do.

That last principle, subsidiarity, is a useful way of thinking about how we want to take leadership forward. Start with the individual. We all have responsibility to improve our own performance and take our personal development seriously. Line managers have a responsibility to help and support us, and the organisations we work for, to create the policies, resources and frameworks to allow that to happen.

Then, it is the responsibility of the system to create the conditions to ensure that talent is nurtured and leadership valued and supported.

The National Leadership Council is being set up to drive and champion this work. It will gather intelligence and evidence, set standards, fund and commission leadership development programmes, and assure that leadership capacity and capability are improving.

We are in the final stages of designing the council, which I will chair, and will be recruiting members via open competition in the early part of this year.

We want to build a leadership culture that is different from the past. Our challenge is to create the conditions for leadership to flourish and drive the improvements we are seeking for our patients.

Getting this right is a key priority and I am hugely enthusiastic about this work. It is an exciting time to be part of the leadership community in the NHS.