It is possible to sit back and mourn the disappearance of the old ways of working in the NHS.
The loss of system control, the inherent waste of confusion and chaos, lost functionality that accompanies every structural reorganisation in any industry are real, but despite this downside the current impact of the "not yet enacted" Health and Social Care Bill means that there are opportunities around every bend. The bill effectively opens the market place for competition in a number of areas, verging on a deregulation of healthcare.
Some players sense this, others fear it, for they know it to be true, and some, a smaller number embrace it.
History tells us that the smaller, hungry, driven start up will win out in such arenas.
So what then for the existing players, the big trusts, the large providers, the incumbent practices, what is their future?
Doing nothing is an option, being herded by policy and victim to competition may actually feel like business as usual. However it is not a successful option.
Consolidation of the old ways is also an option, actively perusing a policy which seeks to ensure that all of a particular disease comes our way, "because we're good at it" is also comforting and attractive.
Unfortunately the really successful solution is the most challenging to pull off. The transformation of a big player, to new ways of working, new patterns of care, is almost impossible. Riding the changes of policy, finance and technological innovation is tricky.
New models of care will require considerable effort and disinvestment in older ways of working.
Is it possible for most clinicians and managers to buy in to this vision? Is it possible that a declining status quo will be so attractive to those whose institutions have institutionalised the minds of their key clinicians and managers, that the alternative routes to diversity, transformation and success in a new world will look far too risky?
The next two years will be critical times for the NHS, innovate or die- you decide.