MiP brought together NHS leaders from Wales, Scotland and England to discuss the opportunities and threats from the devolution of NHS services.

NHS Wales chief executive Andrew Goodall said the 2009 reconfiguration of services in Wales had brought greater accountability and a very strong ethos of partnership working.

The small size of Wales – with just 10 chief executives – “gives us an opportunity to have action and momentum,” he said. But there was also a lot of public scrutiny which could translate into a very visible focus on managers’ actions, he added.

Malcolm Summers head of staff governance at NHS Scotland, said reforms in Scotland would involve the majority of care being provided locally, with centres of excellence for complex care. “There is a focus on safe staffing and putting that on a statutory basis,” he said.

Summers saw working with trade unions in partnership as the way forward for NHS Scotland, with each health board having an employee director on the board. “It’s about recognising that we are all under pressure but there is a lot that we can do collectively,” he said.

NHS Confederation chair and former health secretary Stephen Dorrell argued that devolution in England was not primarily driven by the need to reorganise NHS services. The NHS needed to “come down off the hill”, he said, and see itself as part of the patchwork of public services serving communities.

NHS leaders must now move beyond rhetoric about integrating services and “challenge ourselves on how we can make it real,” he said. “Why is it that we still think there is something different between primary and community health services? If we can’t join those up, then we really are lost.”