The NHS's challenging new year will be dominated by four themes

Prediction is a fool’s game. That said, 2015 feels like – yet another – crucial year for the NHS and it is possible to detect four themes likely to dominate.

None will surprise HSJ readers – but reviewing them together brings home quite how challenging 2015 will be.

The period regulated by the general electoral authorities actually starts this week and as a result decision making at the centre and, to some extent, in the service will slow markedly for nearly half the year. After 7 May, the wrangling that coalitions and minority governments bring is unlikely to produce clear policy for some months.

‘The need to make step-changes in efficiency will be upper most in the minds of leaders’

Some NHS leaders may be pleased those at the centre are otherwise occupied – but most will realise performance pressures and the resulting debate over healthcare funding yokes the fortunes of government and the service closely together in 2015.

Regardless of any money next year’s public spending settlement produces for the service, the need to make step-changes in efficiency will be upper most in the minds of healthcare leaders.

The highest new entry in this year’s HSJ100 is Lord Patrick Carter – chair of the Department of Health’s procurement and efficiency board. The “Carter review” could have every bit as big an impact on what is expected from the service in terms of efficiency improvement as Robert Francis did on quality regulation and patient safety.

Finally, post-election the work to make the NHS Five Year Forward View’s vision a reality will begin in earnest with a spotlight on the most challenged health economies, emphasising a change of focus away from failing individual organisations to the overall effectiveness of a regional system.

Bringing tension to a head

Underlying these four main themes are important sub plots.

In hindsight, the last five years have proved remarkably quiet on the industrial relations front given the controversies over reform and pay. The continuing austerity and the desire for provider – as opposed to commissioner – reform is likely to bring this tension to a head whatever the election result.

‘Expect Dalton review proposals to get renewed attention’

A particular hot spot will be changes in the shape of primary care – hence the smoothing balm of the autumn statement’s £1bn pot for upgrading GP surgeries.

HSJ has for a while predicted that the focus would shift from commissioning to provision in the second half of the decade and that many looking to exercise influence would switch “sides”.

The decision of South Devon and Torbay Clinical Commissioning Group chief clinical officer Sam Barrell to become chief executive at Taunton and Somerset Foundation Trust and that of Corby CCG chair Peter Wilczynski to take up the leadership of a large primary care provider is the beginning of a trend.

Expect too, the proposals contained in the Dalton review of the acute landscape to get renewed attention once there are no longer marginal constituencies to be won.