Andrew Lansley tells NHS Confederation conference that managers should start acting over reforms

As a guest speaker at the NHS Confederation's annual conference in Manchester last Thursday, Lansley spoke about the continued need for reform and how the decision to pause the Health and Social Care Bill had provided fresh impetus for change. He said: "The pause gave us the opportunity to build a greater sense of ownership, which is essential for proper implementation. And it enables me to assure you that the coalition government is fully committed to the NHS and its modernisation."

But he said that, on the advice of the Future Forum, which was set up to run the 'listening exercise', they had decided the pause should end and the Government was now committed to rewriting the bill and putting the changes into practice.

He told delegates: "I said to you last year that 'patients must be at the heart of everything we do, not just as beneficiaries of care, but as participants in its design'. That still stands. Last year I said that we need 'a rigorous focus on outcomes with the ambition of securing results and healthcare services in this country that are among the best in the world'. That is still true. Last year I said we must set professionals free to 'use their clinical judgement to do their jobs to the best of their ability and on the basis of the evidence'. That vision also remains. And last year I underlined the central importance of emphasising public health and modernising social care as part of a comprehensive set of long-term reforms. That, too, we are pursuing. But my main message to you is that, after the pause, it is now time to move forward and get on with improving services for patients."

"I said to you last year that 'patients must be at the heart of everything we do, not just as beneficiaries of care, but as participants in its design'. That still stands.

And he spoke directly to GPs, asking them to get behind the new commissioning approach and begin planning improved care pathways. He said: "Listening to GPs, I know that while our plans were in flux, some became less keen to commit to long-term changes. And some of them - some of you, I know - will have felt unsure about how to proceed. Well it's now time to regain the momentum, to get back on the front foot, to focus again on the challenges we all face."

He used his speech to announce the Government's fifth wave of pathfinder GP clinical commissioning groups - the new name for GP consortia. With 35 organisations included in the latest round, it brings the total number in England to 257, covering almost 50 million people, or 97% of the population.

Lansley said: "Some PCTs have already delegated budgets and commissioning responsibilities to pathfinders and I hope the majority will by next April. By October next year, the NHS Commissioning Board will begin to establish full clinical commissioning groups, delegating budgets to them directly. And, by April 2013, commissioning groups will start to take statutory responsibility in their own right. It will be the mission of the NHS Commissioning Board to help local commissioning groups to get up and running as quickly as is sensible to do so."

And he told NHS managers they had a four-pronged mission: to increase productivity, to improve patient care, to reshape how care is delivered, and to integrate care around the needs of patients.

My main message to you is that, after the pause, it is now time to move forward and get on with improving services for patients

He said: "Every provider, especially hospitals, needs to take a deep and profound look at the services they provide and at how they provide them. The best hospitals no longer think of themselves as a physical place, as bricks and mortar, but as providers of excellent healthcare. Not so much a hospital trust or a mental health trust, but a healthcare trust. This flexibility makes adapting creatively to change far easier. But change, even when clinically justified, is not easy. People form a strong emotional bond to the places that may have saved their life or that of a loved one. So it is incumbent upon us to make the argument for pressing forward. Change must be, and must be seen to be, clinically and never politically led. Of course, the NHS will always be political to an extent. The Government sets the overall budget and we've amended the bill, reaffirming that ministers are accountable overall, with a duty to promote a comprehensive health service. But for the future there will be much less interference in the day-to-day running of health services."

Without high-quality management, we cannot hope to meet the challenges we face

And he said it was managers that would have to take the lead, adding: "I know from long experience that many of you are among the most vocal opponents of excessive bureaucracy. It must stop. We can't afford it. It stifles innovation and it gets in the way of providing the best patient-centred care. Management is vital. Without high-quality management, we cannot hope to meet the challenges we face. Without good managers, we can't achieve the efficiency gains so vital to the NHS. Without good managers, we cannot reshape NHS services and without good managers we cannot create a streamlined, integrated NHS. Modernisation is every bit as much about organisational leadership as it is about clinical leadership. I know this is a tough time; I understand the difficulty of the position some of you find yourselves in, but not changing is not an option. Patients need you to keep at it; to do what is necessary to make the transition to the new system a smooth one. So it is time now to look these challenges in the eye. To do what is necessary to meet them; to regain the momentum. So I ask you to return to your organisations with one simple message: The pause is over. It is now time to act."