Comment: Barometer suggests acute care is 'close to the edge'

Not only have respondents to the survey of chief executives suggested how Mr Stevens should prioritise his in-tray, they also paint a picture of a health system that is close to the edge.

‘Any new legal system and a changed approach will always bring concerns about ease of implementation’

The underlying concern in the system is reflected in a particularly low level of confidence in the ability of commissioners to carry out their role effectively. It is therefore surprising that trust chief executives remain confident that they can maintain, and even improve, the quality of their services.

More consistent is their encouragement to Mr Stevens to take a radical look at service transformation, with 75 per cent of trusts supporting NHS England leading service change.

At the same time, the results show more than 70 per cent of trusts have a real concern that competition regulation and merger controls will make it difficult to make clinically and financially necessary changes to services.

This is in part a reflection of the complexity of merger clearance and new procurement rules, which require a changed approach to reconfiguration, purchasing of services and joint working.

Bedding in changes

As the rules bed in, these concerns are likely to abate; any new legal system and a changed approach will always bring concerns about ease of implementation.

‘Half of respondents suggest Simon Stevens should reconsider current entitlements to free NHS and care services’

Moving forward, effective delivery of service change will need an in-depth understanding of how processes should be structured, and decisions made in line with the new rules; a clear and changed approach will be essential to ensuring the new law does not act as a barrier to improving services.

It appears nothing is taboo, with half of respondents suggesting Mr Stevens should reconsider current entitlements to free NHS and care services; nearly 40 per cent suggesting he could extend charges for health services; and more than 70 per cent advocating an immediate overhaul of NHS payment systems.

We await the next barometer with interest to see whether these gloomy predictions have proved accurate, and whether Mr Stevens’ new year’s resolutions for the NHS will have the desired effect.

Peter Edwards is senior partner and Sharon Lamb is commercial partner at Capsticks LLP