'What managers need is clarity on what is expected of them and what they can expect from the centre'

NHS acting chief executive Sir Ian Carruthers rose to the occasion with an NHS Confederation conference speech last Thursday. It captured the emotions many are feeling in the service and sculpted from them a powerful message for the coming year. Most delegates, at every level, who heard it believed it hit just the right note.

Sir Ian is not a natural big-room speaker, but it was clear that he had worked hard to find the right tone. Rarely referring to his notes, he talked to the conference about the pride delegates should feel in their achievements and the challenges ahead. He called on managers who will be moving or losing their jobs to 'leave a legacy we can all be proud of'. And he also talked about the responsibility to engage with the true extent of problems as quickly as possible and get on with solving them.

It was not a speech of ideas. NHS managers already have an array of new ideas to digest and work on. They are of a number and complexity that would make most of their counterparts in the private sector baulk.

What managers need is clarity on what is expected of them and what they can expect from the centre. And deliver they must. To paraphrase NHS Confederation policy director Nigel Edwards later in the conference, if success is about plan-implement-evaluate, one out of three ain't bad - it's terrible.

Sir Ian's compelling mixture of soft and hard messages was in contrast to the well-intentioned but stiff performances of his predecessor, Sir Nigel Crisp, in previous years.

Sir Ian's was a classic leadership speech, and at a conference rife with speculation about who would eventually get the top job it set a powerful tone for the rest of the year.