Thank you so much for the letter you sent to me and my NHS colleagues to mark the start of the new year. I know we all appreciate the time you have taken to write to us, though I have to say I would have preferred it to have been personally addressed rather than appearing on an email from our communications department. I would like to take this opportunity to offer my thoughts on the points you raise.

Over the past 10 years we have invested in health services at record levels. There are now 79,000 more nurses, 30,000 more hospital doctors, 6,000 more GPs. Where we have seen opportunities to improve the management of health resources we have sought to carry out the reforms which have made this possible – from new roles for nurses and GPs through to new foundation hospitals with greater freedoms and improved stewardship of the NHS’s resources.

No doubt the above figures are true, but this does not account for the people recruited who have become disgruntled with working in the health service and therefore left, it takes no account of the people who lost their jobs in the recent reorganisation, and it takes no account of the disgruntlement felt generally as your government managed to hack off pretty much all hospital doctors (modernising medical careers), all other staff with your derisory pay deals and just about everyone with your centralised, target driven policies.

And in 2008 the NHS is as relevant as it was in 1948. For sixty years now Britain has shown the way to health care not as a privilege to be paid for but as a fundamental human right. The NHS remains our priority not just because it has been fundamental to our past, but because a renewed NHS will be even more important to our future and that of our children.

The trouble is that you need to explain to people exactly which bits of the NHS you want to be part of their fundamental human rights. Health care in 2008 is significantly different from the way it looked in 1948, after all if you have an operation or a baby for that matter you no longer expect to spent the best part of 2-3 weeks sitting in a bed. The types of investigations and treatments you expect are not only different but significantly more expensive. Only last year there were a number of high profile cases where people demanded what they considered the best drug for their condition no matter the cost or effect that their prescription would have on the rest of the health economy.

You have responded with improved care and a higher standard of service. Over the past ten years waiting times have been sharply reduced. 99.9% of people with suspected cancer are now seen by a specialist within two weeks of being referred by their GP, which is up from 63% in 1997. Over 99% of people with suspected cancer receive their first treatment within a maximum of 31 days of diagnosis. Cancer mortality rates have fallen over the last 10 years, and an estimated 60,000 lives have been saved. Similarly, death rates from cardiovascular disease in people aged under 75 years are down in the last 10 years, saving 175,000 lives.

These are your achievements and I want to thank you for them.

Well it is kind of you to say so, and no doubt these are just the tip of the iceberg. People no longer lie on trolleys in hospital corridors waiting to be taken from the emergency department to a ward, people no longer wait to be seen by a consultant and then subsequently for a hip replacement or whatever for 2 years as they previously did. The things I mention are due directly to the work put in by NHS employees rather than in the main due to better treatments, but as I say it is nice of you to thank us.

Whenever I have visited hospitals, GP surgeries, and health centres across the country people tell me of their huge admiration for our doctors, our nurses and those who work in our health service. The best of NHS care has always depended on its staff for innovation, for commitment and for professionalism and we will continue to draw on your ideas and look for ways to empower you.

With all respect people are hardly going to be allowed to meet you to say that those working in the health service are horrible, unpleasant work shy people. But it is true that the commitment of people who work in health care has been second to none. To a great extent the NHS runs on good will, because while many salaries are now of a reasonable level we are all expected to go ‘that extra mile’ to step in for those who who are not there or not good enough, to carry on working at the end of the shift because you just can’t walk out on people who need you. Change and innovation has become many of our middle names, and many of us spend our working lives trying to persuade those who would rather keep doing the same thing to embrace change.

In 2008 we know that working together there is more to do. The Government’s priorities for the coming year will be to do all we can to support you as you work to bear down on hospital infections and improve access to care. We have committed additional investment to MRSA screening and deep cleaning of our wards in order to help you. Achievement of the 18 weeks target by the end of the year will mean the shortest waiting times since the NHS was established – almost unthinkable just a few years ago.

But you allow the population, generally through the media, to think that MRSA and other ’super bugs’ are due mainly to the inability of health workers to wash their hands. You have bought into the idea that deep cleaning wards will solve everything when these are not the only causes of MRSA in our hospitals. I would imagine the cleanliness of wards and the rise of MRSA are caused by slightly different things. It might not be your government that promoted the tendering of hospital cleaning to external companies for the cheapest price but you cannot pretend that there is no link between that and a lack of cleanliness generally. The 18 week targets do give us the best opportunity to change patient pathways and to improve care and treatment at all stages of the pathway so long as it isn’t just about time scale but quality is promoted too.

But 2008 should be more than this as well. I intend for this also to be the year in which we demonstrate beyond a doubt that the NHS is as vital for our next 60 years as it was for our last – more relevant to our future and the challenges that we face than ever before. That is why one of my first acts as Prime Minister was to ask the eminent surgeon, Professor Ara Darzi, to conduct a fundamental review of the NHS, listening to patients, to staff and to the public and understanding their expectations from a 21st century healthcare service.

Yes and we can barely wait for more significant changes to the way services are delivered and the way our organisations are run. We cannot wait for more re badging, re branding and more control and targets. Remember some of us have only just recovered our nerve from last time, and some of my colleagues remain gibbering shells of their former selves. So beware of the Darzi reviews and the effect any new policy might have on the staff you care about so much.

So over the course of the next year the Department of Health, under Alan Johnson’s leadership, will be setting out how the NHS needs to continue to reform to meet the new challenges of 21st century healthcare and 21st century lives. Reform and change which we will work with you to achieve to create a better NHS.

I don’t deny the need for this, but Alan Johnson is not really showing much in the way of leadership so far, however I am prepared for a sudden burst to come our way!

We will describe how we will achieve our shared ambition of an NHS which is more personal and responsive to individual needs. Personalised not just because patients can get the treatment that they need when and where they want, but because from an early stage we are all given the information and advice to take greater responsibility for our own health.

This is great stuff, but I wonder quite how you balance the agenda where you offer choice with the one where you expect people to take more responsibility. What about if they choose to live unhealthy lives and then expect us to pick up the pieces?

We will talk to you about the changes we need to make together to create an NHS which is as good at prevention and keeping us healthy as it is at the care and the cures we know are there when we need them. An NHS which is able to offer the help and support that we all need to make healthy choices for ourselves and our families.Well yes, because contrary to popular belief this is meant to be the national health service rather than an illness service which is how most seem to treat it.

We will set out how we can give all those patients who want it, or would benefit from it, far greater control and choice over their own health and their own healthcare. We need an NHS that gives all of those with long-term or chronic conditions the choice of greater support, information and advice, allowing them to play a far more active role in managing their own condition in partnership with their clinicians. And even when healthy, we know all of us will benefit from earlier information about potential health risks and advice on how we can keep ourselves fit and well.

You are going to need to help us as health professionals learn how to do that though. We have been brought up to take control and patients generally have fitted into the model where doctor / nurse knows best and they are expected to conform. A new mind set is needed to allow people to take the control back and to enter into more of a partnership relationship with their doctors or nurses. In some cases someone will need to be available to advocate on behalf of patients, particularly those with the kind of conditions that make this difficult to do for themselves. We also have to learn to be open and honest about what can and cannot be done and have debates about the finite resources we have and how we best spend them.

And we will also examine how all these changes can be enshrined in a new constitution of the NHS setting out for the first time the rights and responsibilities associated with an entitlement to NHS care.

I am all for this, but how it is sold and how the media pick it up will be important other wise it will be all about rights rather than anything to do with responsibilities.

I believe these are steps vital to securing the health of the NHS for the next sixty years. They will require a broadening and a deepening of reform to ensure that the NHS as a whole attaches the same priority to a personal and preventative service as many of you already reflect in your own day-to-day decisions. And I believe they will transform the experience of the NHS for millions of people in this country.

Working together I know we can make these changes a reality. I thank you for your continued hard-work, determination and innovation and I look forward to working with you all to make 2008 not just a milestone for the NHS’s past but for its future as well.

I look forward to working with you too Gordon and hope that part of the celebrations for the 60th year of the NHS doesn’t tie me into a pay deal worth about 2% over 3 years because that just won’t be good enough. Meanwhile, thanks for the letter and a happy new year to you too.