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As Larry says 'It is always important to learn from anyone and everyone. But USA spends 16% GDP on healthcare. Please note, I am not trying to take away anything which Virginia Mason has achieved. Having heard its CEO I am simply amazed by their success. To have 50,000 patient safety incidents reported in a year and reduced medico-legal cases to only 3 a year, I really commend their success. But with 16% of GPD we can really achieve a lot more.

NHS spends 8.75% of GDP and it is still considered as one of the safest and the best healthcare in the World. Of course it is probably the most efficient one when one compares the money spent. So there is so much for us to be proud of NHS.

But NHS is not perfect and there are many challenges. Francis, Berwick, Keogh and Kirkup reports summarise what is wrong with the NHS and gives solutions. However, NHS has not managed to get basics right and that is values, culture, leadership, governance, accountability, staff and patient engagement.

Unless we get values, culture and values based leadership and accountability right, nothing is going to change. All we can do is trim at the edges but there will be more Keogh Trusts, more Francis reports more tragedies for patients and staff.

In 2010, we started our journey of making Wrightington, Wigan and Leigh Trust one of the best Trusts in the country. We defined our values, culture, appointed value based leaders and put robust governance and excellent staff and patient engagement. Five years on in 2014 we were awarded the best Provider Trust of the year and 2015 staff feedback improved from bottom 20% in 2010 to top second in the Country. Yet TDA has not visited us, CQC has visited, Simon Steven has visited and Monitor senior leaders have not visited us. But everyone talks about Virginia Mason!

Of course, we are not perfect and there are still many challenges and the most important challenge is financial challenge. Even here I am convinced we can save lot of money to NHS if only we are allowed to lead and manage GP services, Primary care, community care, mental health, nursing home and social care. Sadly NHS is good at working in silos and there are many hoofs to cross and by the time everyone agrees lot of money is wasted.

NHS is a great institution and vast majority of staff want to do their best and have high values but sadly NHS has many poor leaders, too many with authority and too many working in silos and there is club culture old boys network ways of working and appointing leaders. NHS also has blaming, naming, shaming and gaming culture. There is no proper accountability for the Board level leaders for their values and behaviours. Board level leaders are appointed for their technical skills and not for their values or leadership skills. Unless we change all these patients, staff and NHS will continue to suffer.