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How can the NHS move forward from the current situation where it is besieged by the Francis report and cuts? Post the Health and Social Care Act 2012 and the economic climate, providing affordable and safe healthcare is now one of the biggest challenges we face. The NHS is always changing and over time, successive governments have attempted to put down their own markers, trying to shape the structures and ethos of the NHS according to their own outlook and ideology. But what does the future hold in light of the changes that are taking place right now? The implementation of the Health and Social...

The workforce, self care and personalised medicine need to change if health services are to remain sustainable Health services need to change. The creeping epidemic of chronic conditions and an ageing population present new health needs for which our episode-focused health service is poorly suited. As the recent Francis report emphasised, citizens rightly expect high quality services that are also compassionate and patient-centred. Put these factors together with long-term financial pressures and it is hard to see how the NHS can remain sustainable without innovation. More of the same simply won't...

We must put the integrity of the whistle-blowing system beyond question, for the benefit of both patients and staff The NHS is under pressure over whistleblowing and gagging. We in the NHS leadership community need to make it crystal clear that we regard attempts to prevent staff from raising concerns about patient care as utterly wrong and self-defeating. Responsibility for quality of care rightly rests with the boards of NHS trusts and the frontline clinical teams they employ. Boards of directors therefore need to build an open culture where the concerns of staff are freely discussed. Effective...

After the Mid Staffordshire hospital scandal, we need to rededicate ourselves to care and the principles of stewardship Public debate about the NHS tends to focus on politics and health issues. But at heart, the NHS is a service - and it is vital to think of ourselves as service leaders within that service. In his report from the public inquiry into the Mid Staffordshire hospital scandal, Robert Francis said: "The NHS is a service of which the country can be justly proud ... a service staffed by thousands of dedicated and committed staff." Yet the danger we face is that, while poor service...

We round up readers' thoughts on the direction of the NHS after the Francis report, following an online live discussion Whistleblowing and a duty of candour Jon Restell: "Whistleblowing is a bad safety net – it runs counter to human nature to expect people to routinely demonstrate the courage to risk their careers and livelihoods (and more pertinently the welfare of their families) to right the wrongs of a system. Only an open safety culture will support people to speak up and talk about harm that others are doing." Jo Webber, head of policy at the NHS Confederation : "The duty...

What can be learned from the process? Here's our experts' and readers' – suggestions from an online live discussion Patients are the best free resources Paul Hodgkin, chief executive of Patient Opinion : "The person with the greatest incentive to get good care to bed seven is the person in bed seven. That person now has a public voice via Twitter, blogs or Patient Opinion . The public nature of these conversations makes this scalable, cheap and a force potentially capable or really creating a new culture of compassion." We need to 'disrupt' cultures Steve Laitner,...

St Helens and Knowsley's initiative could become a model as the government pushes to put patient records online by 2014 A teaching hospital in the north-west of England claims it was the first NHS trust in England to become paperless. A year ago, St Helens and Knowsley put the last of its 500,000 patient records on line after spending the previous three years working closely with 88 local GP practices and two other trusts. The first step the trust had to decide was what it wanted a digitalised system to achieve. The new system two requirements: to scan paper records and be able to collect live...