By Adam Brimelow
BBC News health correspondent
The man who led the landmark inquiry into the Bristol heart scandal says the health service is still failing to do enough to protect patient safety.
Sir Ian says patient safety should be the top priority
Sir Ian Kennedy will mark five years since his report into the deaths of children undergoing surgery at Bristol Royal Infirmary on Wednesday.
In a speech, he will renew his call for the government to put patients at the centre of everything the NHS does.
Sir Ian is now chairman of the health watchdog, the Healthcare Commission.
However, he said he was making his comments in a personal capacity, out of a sense of responsibility for the legacy of the inquiry.
It found that between 1991 and 1995 the mortality rate for open heart surgery on children under one in Bristol was probably double the rate for England, and even higher for children under 30 days.
It concluded that many of the flaws and failures within the hospital were part of the systemic shortcomings in the wider NHS.
Sir Ian said since the inquiry the NHS had made "stuttering progress" towards a truly patient-centred service.
He said: "That calls for cultural change among professionals, among managers of trusts.
"It also calls for the introduction of different ways of delivering the services which patients deserve and need."
He argued that historically the NHS has been organised around buildings or the interests of professionals.
The government's reforms had gone some way in addressing this, he said, but he argued that they are not sufficiently radical.
He called for more responsibility for decision-making to transferred to a local level, with increased democratic engagement - as is starting to happen with Foundation Trusts.
Value for money
He said: "We need to redefine value for money with a greater emphasis on the word value, to reflect what local taxpayers value their money being spent on."
In this way he said, the postcode lottery can be a good thing, reflecting local priorities.
Sir Ian said despite a high incidence of avoidable deaths and harm in the health service in England - as in other developed countries - the problem has not been kept at the top of the agenda.
Referring to a National Audit Office report putting the estimated range of deaths between 800 and 30,000, he said: "In 2006 we should have a better handle on the scale of the problem."
He also believes there is still a tendency to apportion blame, which prevents people from being open.
Sir Ian said there had been progress on safety since Bristol, but he argued that at times it has been pushed out by other considerations, such as managing finances properly or pushing enough people through the system.
He said: "Safety has to remain at the top of the agenda.
"Safe care is the most important thing, and I don't think all the time it has been at the top of the agenda."
A spokeswoman for the Department of Health said: "It is important to remember that the vast majority of NHS patients receive safe and effective care.
"Our own NHS patient safety programme - one of the first in the world to give priority to tackling patient safety at a national level - has led to this
country being seen as being at the forefront of the growing international drive to improve the safety of health care.
"Significant progress has been made, for example, all trusts have established reporting systems and we are learning from our mistakes.
"We accept that more needs to be done to secure full public confidence that the NHS is truly embracing patient safety."