The scale, pace, cost and management complexity of delivering the NHS modernisation agenda is being underestimated, claims the NHS Confederation.Describing the NHS Bill outlined in the Queen’s Speech as tough and radical, chief executive Stephen Thornton said: “Expectations of how the modernisation agenda can be delivered must be checked – its radicalism has been underestimated in many quarters.

“It is a huge agenda which is supported by NHS organisations but will require a NHS cultural Revolution. There needs to more recognition of the scale, pace and cost of the agenda and constructive support for NHS management upon which its delivery is dependent.”

He said the new shift toward standards, the introduction of a Commission for Health Improvement, and also of clinical governance, plus the establishment of Primary Care Trusts, represented a huge organisational change.

Meanwhile the Deputy Prime Minister has sought to defend the progress of his transport initiatives, following their omission from the body of the announcement on the year’s legislative programme.

John Prescott said: “Only four months after it was published, our Integrated Transport White Paper is well on the way to being implemented. Most of the proposals in it do not require legislation.”

He said fiscal measures would drive the move for better buses and more environmentally friendly vehicles and that public funding announced in the Comprehensive Spending Review would improve public transport, traffic management and road maintenance. He also said that plans for the Shadow Strategic Rail Authority could move ahead with existing legislative powers to start driving change.