Final Report > Recommendations > The nature of the Recommendations

The nature of the Recommendations

• Our Recommendations are grouped together under various headings reflecting the themes highlighted in our Report. We identify those Recommendations which we consider sufficiently important to merit early implementation. Other Recommendations we recognise will take some time to implement, either because further debate is required, or because they require other changes to be in place.
• The Recommendations are interlocked and interrelated. They are parts of a jigsaw: each needs the other to complete the picture. We believe that action needs to move forward in relation to all the themes simultaneously. We do not place a priority on one theme over another.
• We have deliberately chosen not to cost the Recommendations we make. This is not least because, with many of our Recommendations, change can be achieved by doing things differently within existing resources. We estimate that around half of our Recommendations could be implemented with no or relatively modest expenditure. A significant number relate to changes already underway. Furthermore, many of the fundamental changes needed in the way in which the NHS currently works concern attitudes and culture. The resources needed for these changes are not necessarily financial. That said, the NHS continues to confront the consequences of long-term underinvestment. We make it clear that, to achieve that which patients are entitled to expect of the NHS, will require sustained additional funding. To fail to provide it would be to fail the NHS and thus to fail the public.
• Whether, how and over what time frame these Recommendations are implemented will be a matter for government and for others. We are conscious of the fact that the NHS has only recently begun to digest and respond to `The NHS Plan'. The Department of Health (DoH) is setting a series of targets to be achieved to implement the Plan. A further report, such as this one, with many Recommendations might seem like the last straw. But this would be to misunderstand this Inquiry and the nature of our Recommendations. First, we make no apology that there are a large number. It would be a surprise if it were otherwise, given the nature of our task. Secondly, our Recommendations are not in the form of performance targets: tasks which must be achieved in a certain way by a certain date. Thirdly, they are not addressed specifically or exclusively to trusts or to professional bodies or Royal Colleges or even to the NHS. They include all and go beyond them. And fourthly, while there are some which call for urgent action, many of the Recommendations are about a process of change over time. They build on each other and can be organised accordingly.