Although the latest barometer indicates that chief executives remain reasonably confident that they will maintain and even improve the quality of services for patients over the next 12 months, there are clearly some significant challenges to be overcome.

When asked about the top three issues they are likely to face in the next year, many chief executives listed accident and emergency, finance and service reconfiguration.

Chief executives were asked specifically what had contributed most to the A&E crisis. Nearly all responded by citing the greater acuity of patients presenting to A&E. What’s not clear is the reason for this. Is it a consequence of social care funding cuts that have restricted access to earlier support and interventions, meaning that patients deteriorate further before entering the health and social care system?

Notably, three-quarters of respondents also referred to gaps in out of hours care as a contributory factor, leaving A&E as the default option for patients unfortunate enough to become ill overnight or at the weekend.

Confident organisations

Not surprisingly, the difficulty in achieving major service changes was raised by several chief executives, with uncertainty over whether planned changes could be achieved before the next election flagged as a concern by some.

However, respondents did not appear to share the secretary of state’s recently voiced concern that competition rules may be a significant impediment to service changes, with most confident that their organisations were complying with the new regime.

Finally, it appears that Sir David Nicholson’s misgivings about the benefits of the purchaser-provider split are shared by many other NHS leaders. Perhaps his successor, whether it is one of those named by respondents to the survey or not, will preside over the establishment of an alternative system.

Peter Edwards is senior partner at Capsticks Solicitors LLP.

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Hospital chiefs give thumbs down to purchaser-provider split