The chance we've been waiting for

I make no excuse for the fact that our first priority when we took office last May was to ensure the health service gave patients a decent service over the tough winter months. Thanks to the efforts of hundreds of thousands of nurses, doctors, managers, home helps and therapists - and a£300m cash injection from the new government - record numbers of patients have been treated, and we have avoided a winter crisis for the first time in years. Now the time has come to build on the achievements of the past few months and tackle waiting lists.

Of course, some people claim waiting lists don't matter. I'm afraid they are badly out of touch with patients' priorities. Let's not forget the longest average waiting times are not for procedures of dubious effectiveness but for paineasing, disability-reducing, highly cost-effective operations such as cataracts and joint replacements. Cutting waiting lists will cut average waiting times for these so-called non-urgent cases.

As important, long waiting lists undermine public confidence in the NHS. They embody the sense of bureaucracy, slowness and inconvenience at the heart of declining satisfaction with the health service. Opinion polls consistently show that waiting lists are far and away patients' greatest concern about the NHS. By comparison with other countries' healthcare systems they are our Achilles' heel. Like it or not, lengthening waiting lists are a powerful metaphor for the state of the health service. This remains stubbornly true despite the last government's sustained efforts to divert attention to other aspects of waiting.

Indeed, it's no accident that advertisements for private health insurance focus on NHS waiting lists. Waiting lists are the recruiting sergeant for private medicine. And research shows that once people have insurance they are less willing to see increased funding for the NHS.

So high waiting lists force people into the private sector and undermine public support for the NHS. By contrast, cutting waiting lists will be the single most important way of rebuilding public confidence in the sustainability of the NHS into the next century. It will be tangible proof that the 10-year programme of modernisation spelled out in the white and green papers is delivering the goods for patients.

That's why the Budget increase will be targeted at cutting waiting lists. Every health authority and trust will be set waiting list reduction targets linked to their share of the extra cash. It will mean the biggest ever cut in waiting lists in the history of the NHS. Further cuts in the list will follow. In the meantime, no patient should have to wait 18 months for treatment that the NHS has said they need.

Unlike previous administrations, we recognise that waiting lists are not simply a static 'backlog' of cases capable of being brought down and kept down by one-off purges. Rising waiting lists show an imbalance between supply and demand.

But since the supply side interacts with demand, simply increasing supply by itself is not good enough in the medium term. So unlike previous waiting-time initiatives, ours will be taking a whole-systems approach.

On the demand side, we will develop complementary approaches to ensure that waiting list cuts are sustained. Our new approach seeks to integrate care across sectors, so that patients are not automatically shunted into hospital. By developing unified primary care group budgets we will align clinical and financial responsibility.

By scrapping the purchaser efficiency index we will end the current perverse incentives to increase hospital activity for its own sake. And most important, by establishing the National Institute for Clinical Excellence, we will develop authoritative clinical guidelines to ensure waiting list cases are clinically effective and appropriate.

Linked to this, we will expand the supply of elective activity. It will allow non-urgent waiting times to fall as total waiting lists fall, without displacing more urgent cases. But we will take three other supply-side measures. First, we will change the incentives for trusts and individual clinical teams both by setting targets and linking resources to waiting list reductions rather than finished consultant episode increases, and by introducing longer-term service agreements.

Second, we will seek to extend many of the innovative schemes developed over the winter to cut bed-blocking and allow the uninterrupted flow of elective inpatients. Third, under the supervision of NHS chief executive Alan Langlands, individual trusts and health authorities will be subject to rigorous performance management to raise standards to the level of the best.

And we're determined to do even more. In this, the health service's 50th year, we have got to modernise the whole waiting system. We've got to revolutionise the NHS's mindset so that treatment is fast, convenient and flexible. That's why earlier this week we launched the first national pilots of NHS Direct, our new 24-hour nurse-led telephone advice line. Patients will be able to get top-quality clinical advice, round the clock, when they need it, at home or at work. It's why we'll be funding computerised booked day-case appointment systems. And it's why we're launching NHSnet to connect every GP and hospital to the NHS's own information superhighway, so that patients get quicker test results, online outpatient, and telemedicine links to specialists.

With your commitment and energy, all this is possible. It marks the start of a 10-year programme of modernisation. Only by both investing and modernising can we rebuild public confidence. The future of the NHS depends on it Alan Milburn MP is minister of state for health.