Mike Farrar, NHS Confederation chief executive, spoke on Friday of his optimism prior to the publication of the NHS Future Forum report, but warned that the period of uncertainty has been destabilising:
"The government must now give the NHS some clarity and enable it to focus on the major problems it faces such as financial pressure and the variability of care. It is essential that those responsible for taking key decisions are able to do so with confidence and certainty.
"It is easy to think that agreement on words in speeches does the trick, but we also need practical ways forward. We cannot go on with indefinite uncertainty, buffeted by events. The NHS needs to concentrate on its day job and chart a way through the stormy waters ahead.
"Ministers will have heard from many people with different views. But there is a serious risk that, in trying to take into account all of these views, they will come up with an unworkable system.
"For example, it's essential that a wide group of clinical staff are engaged in the redesign of services. But we also want a commissioning process that starts from a primary care perspective.
"We need the NHS to do more to prevent health problems, to help people earlier when they are in need and to reduce demand for the more expensive parts of health system.
"These issues are as important for providers of healthcare as they are for commissioners. So it is critical that all the incentives align if we are to manage the budget pressures and do the right thing for patients.
"It's tempting to think that integrated care is the opposite of choice and competition. It is not. Any high-quality system, including its regulatory and performance management regimes, needs to deploy both of these to serve the patient interest.
"So adopting an overly entrenched or ideological view will not always serve the patients' interests. What we need is a flexible system, not a straitjacket, with NHS managers and regulators held to account for their decisions.
"We need a sensitive and coherent transition that allows people to take on responsibilities when they are ready, not to some arbitrary 'big bang' date.
"Achieving this in practice may mean more responsibility being taken centrally in the short term. So we believe the NHS Commissioning Board has a responsibility to develop capability locally.
"It is essential that we maintain momentum towards the longer-term prize, the devolution of power and responsibility to healthcare professionals and local people. This is important because healthcare in Cornwall requires different approaches to Salford.
"If ministers see leadership and management as wasteful bureaucracy and overhead, they will ignore the very people that can make or break the reforms. Clinical and administrative leaders are as one on this: good healthcare systems involve high quality management.
"We welcome the fact that, through the listening exercise, politicians from all sides have sought the views of managers and health service leaders. But the key is to keep on talking and listening as we move into implementation.
"Managers are the key to reform, not its enemies."