I started in clinical leadership development and management in the 21st century and in those years have witnessed dramatic changes in the NHS which have culminated in the recent reforms.

Over the last 65 years the NHS has had to deal with a variety of external macro-environmental and internal pressures and although having managed to get through, it is always responding to these pressures in a reactive way.

We have got through and have reached the 65 year milestone which is to be celebrated, but reacting to change is not going to deliver us the next 65 years.