The chief executive of the NHS Confederation has warned of the dangers of excessive centralisation and bureaucracy as a result of the health service reforms.

Describing the level of “nervousness” about the future among NHS management as “unprecedented” in his opening address to this year’s Confederation conference, Mike Farrar told delegates that those in Whitehall were still struggling to see the “wood for the trees” while NHS management could see the “forest fire had already started”.

Nevertheless, he said the conference could not be a “council of despair”.

“Whilst few people might 12 months ago have said we should start from here there is an absolute desperate attitude to get on and deal with pressures,” he said.

Mr Farrar said the Confederation supported some of the government’s aspirations including the need to get more clinicians into management, closer working between health and local government and integrated care but serious concerns remained.

He warned that although there was a need for the centre to retain a “grip” during transition there was a danger of excessive centralisation in the future and that extra bureaucracy stemming from more input at grassroots level, such as through health and wellbeing boards, could reduce “freedom to act and act quickly”.

Setting out his message to the politicians, Mr Farrar called for them to be honest about the need for reconfiguration and engage in an intelligent debate about competition, not a “political fix”.

The former NHS North West chief executive said politicians must stop the “attack on management” by moving away from “crass” targets to reduce the number of managers.

“It’s absolutely critical that people understand that high quality management is correlated to high quality care.”

He said “most of the difficult decisions” such as those around industrial relations and reconfigurations would have to be taken by NHS management in the next 18 months to two years, before the “reforms kicked in” and management needed to step up to the plate.

Speaking about the future of the Confed, Mr Farrar said it would be a “do tank” not a think tank focusing on spreading ideas and best practice as well as place where the whole health industry could come together and have a stronger voice as a result.

“I intend to lead the NHS Confederation to be a very strong and effective body, strong and effective in terms of representing our views to government, strong and effective in terms of value for money and strong and effective in terms of bringing industry together.”