Time is running out to make urgent changes to NHS policy that will require difficult political decisions, the NHS Confederation is warning.

A report on the challenges facing the government and NHS says the quality of the debate to find solutions to the NHS funding problem has so far been “very poor”.

We could wait for central government to redesign a new set of national incentives and mechanisms, but time is running out

The NHS needs to experiment with new payment systems that will help to improve the quality and cost effectiveness of care for patients with chronic conditions, the report says.

It states: “We could wait for central government to redesign a new set of national incentives and mechanisms, but time is running out.”

On social care, “the funding system is broken and the approach of passing the cost burden on to future generations is no longer an option”.

It says a clear statement is needed on what people can expect to receive and the contribution they will need to make.

Claims that financial pressures can be met by cutting management and bureaucracy are “plain wrong” and “greatly underestimate the scale of the problem”, the report says.

Any management cuts will need to be matched with fewer initiatives and targets.

The report also raises concerns that “the regulatory system is not working and that there is no clear consensus about what the current system is for”.

It concludes: “Raising difficult political decisions on the eve of a general election may not find favour in Westminster, but the long term problems raised in this paper urgently need decisions and action - not only from politicians but from NHS leaders.”

Write your own manifesto

Have you ever felt so frustrated with the political parties’ health policies that you wished you could write your own? Now your chance has come.

On hsj.co.uk we have set up two wikis - websites that allows users to easily (and anonymously) create and edit content - to enable managers and clinicians to develop their own policy ideas. At the time of writing they are blank, awaiting the collective wisdom of HSJ readers.

Managers: set out your policy agenda here

Clinicians: this is your policy wiki to craft as you see fit