A remarkable feature of the NHS is the resilience of public confidence in it. Despite constant headlines that it is "in crisis", satisfaction levels actually rose last year from 60 to 63 per cent according to the British Social Attitudes Survey. They are currently at their third highest level in the 33 years since the survey began in 1983.
This is worth noting because it runs counter to so much of what we read about the NHS. Reports over the last year have focused on lengthening waiting lists, overstretched A&E departments and over-pressed GPs. Yet only one in ten patients waits longer than 18 weeks for routine hospital treatment, one in 20 spends longer than four hours in A&E and less than one in eight reports difficulty making a GP appointment.
For most people most of the time, the health service still performs well - thanks largely to the extraordinary efforts of those who work in it.
But though satisfaction levels are currently high, there are growing fears about the NHS's future. A record 55 per cent of the public say they expect the NHS to deteriorate over the coming years. Social, demographic and economic pressures are mounting. Yet there is no long term plan to confront them.
A Lords committee this month attacked the "culture of short termism" that prevails in the NHS and the unwillingness of the Department of Health to look beyond the next few years and warned it was threatening its survival. The failure to plan for social care needs, driven by the ageing population, has led to elderly patients being marooned in hospital, consuming NHS resources that don't meet their needs, undermining its stability.
Their principal suggested remedy is the establishment of an independent Office for Health and Care Sustainability which would assess health and care needs over the next 15 to 20 years and report to parliament on demographic changes, workforce and funding issues. Possible models would be the Office for Budget Responsibility, the National Infrastructure Commission and the Low Pay Commission.
We need better planning. But how do we bring about change? What would a reformed NHS look like? We need reform that is self-sustaining, that creates an organisation with the resilience to respond to the challenges it faces - social, demographic, technical.
Our delivery mechanisms for care are based on the last century - the divisions between primary, secondary and social care are out-dated. Devolution is important because local change happens at local level. I am excited by the work in Manchester where health and social care budgets have been merged across the city. I tried to do the same in London as chair of the London Health Commission in 2015 but there are difficulties. There are too many hospitals in parts of London but we have not acted in changing them and creating modern primary and community services.
As health minister in Gordon Brown's government, I introduced a new kind of clinic, staffed by a range of clinicians, where patients would receive treatment previously only available in hospital, freeing up beds and bringing care to the community. That is where you get better quality, more cost effective care with a better patient experience. Some of these "polyclinics" were built and thrive today. But we lacked support from the centre and a business model to drive uptake.
We need a system that builds confidence. We centralised stroke services in fewer hospitals, with better expertise and care, and now we are saving 1,000 lives a year in London. We did the same for major trauma and heart attacks. Quality should be the organising principle of the NHS, as I argued a decade ago. I do not believe that regulation is the way to improve quality. Regulation should be there to ensure a minimum core standard is maintained, so we can all sleep at night.
Above all, the NHS needs to exploit the information revolution. New technologies are changing the way care is delivered and how it is provided but the NHS has been slow to adopt them, as the Lords committee says. Young doctors are absolutely engaged with the digital era and its potential to improve care. One of the big safety gaps in hospital is when one team hands over care to another. Digital innovations will sort this out. Then we can start to tackle the productivity challenges and better utility of the workforce that we face.
We need a narrative that empowers individuals, re-ignites enthusiasm and commitment and is focused on the pursuit of excellence. We need to be given a financial envelope, permission to make some of the big changes and cover in case they fail. That is the only narrative I know that unites everyone and can help to sustain the NHS - the politician, the manager, the doctor and nurse at the front line, and the community worker.
Lord Darzi is a surgeon and director of the Institute of Global Health Innovation at Imperial College London. He was a Labour health minister from 2007-9Suggest a correction