The NHS has an ambitious and far reaching agenda for improving the health of the population.

Achieving this will not be easy and there are significant drivers which will affect how the future is shaped. Your Joint Venture with us will take shape in the middle of this developing landscape.

Patient Choice is the most significant driver in changing the whole structure of NHS commissioning and delivery. The patient choose and book scheme will empower patient-based commissioning with full effect from 2008. Taken with GP-based commissioning, it has the potential to open the market to unfettered plurality. Purchasing of healthcare is on the way to being determined almost exclusively by patient choice and provided by a mixed economy of independent and NHS organisations.

Specialisation and brand awareness are likely to follow increased knowledge and consumerism. Correctly interpreting those elements of choice which influence patient decisions in areas such as access, environment, quality (even if only perceived) and the latest equipment and procedures will give providers a competitive advantage. Organisations in the UK are on a steep learning curve: they have never had to compete for patients before.

The NHS has traditionally operated lengthy waiting lists which have become politically unacceptable. We are now talking about building in spare capacity - making waiting rooms redundant and changing the health market beyond recognition. If it succeeds, the building capacity agenda has the potential to reduce the demand for private healthcare.