Equity and excellence: Liberating the NHS ,1 the white paper published by the Department of Health in June has now been followed up with a letter from Sir David Nicholson, the English NHS' chief executive 2 that outlines transition arrangements to the new health and social care system proposed in Equity and Excellence . The white paper (61 pages long) heralds yet another reform of the NHS, arguably the 16th major one in the last 30 years. Described as challenging and far-reaching reforms that will drive NHS cultural changes, some key points include: