By Sarah Harvey, Alasdair Liddell and Laurie McMahonHealth reform has long been dogged by the law of unintended consequences. Not only is the service complex, making it difficult to identify appropriate levers of change, but also each part of the system is connected to other parts.

This publication, which is not a research report, aims to assess the strengths and weaknesses in the current levers, explore how they are likely to interact and considers how the system can be made more robust and sustainable. It draws on the collective expertise and experience of more than 100 active participants in health care across England including clinicians, managers, policy-makers, regulators and analysts.

The report provides valuable insight into how the changes can be made to work effectively and poses questions and challenges for all those who want a health service that is genuinely responsive and effective.

Published by the King’s Fund and available for download at: http://www.kingsfund.org.uk/publications/kings_fund_publications/windmill_2007.html