The NHS needs new blood. Are you up to the job?

We are moving towards the NHS becoming a funding mechanism, a guarantor of standards and ethos and a device for ensuring that care remains (largely) free at the point of delivery and available to all.

The old assumption that it was also a delivery device has been dropped. The state will remain a huge provider of health and social care for many years but, increasingly, it will be joined by other providers: mutuals, community investment organisations, quasi-autonomous trusts as well as the more familiar voluntary organisations.

Of course, we already have diversity. The hospice movement is led by the voluntary sector, Macmillan Cancer Relief delivers frontline care and Turning Point offers services for a range of disadvantaged groups with mental health, alcohol and drug problems. Social housing providers have also been moving in this direction through the £1.8bn Supporting People programme.

But the signal that the £90bn NHS market will be opened up to new players must be seen as an invitation to innovate. And nowhere is there greater potential than around the health/social care divide.

There are 630,000 people in touch with specialist mental health services, 210,000 with severe learning difficulties and 240,000 class A drug users. Many of these people have multiple and complex needs.

What will be needed is services that can meet those needs – treating a mental illness with drugs will be of little use if the individual is denied access to good and supportive housing, a circle of friends and a job. Those are the basics for most of us – it is extraordinary that we should assume others could do without.

Treating a mental illness with drugs will be of little use if the individual is denied good and supportive housing, friends and a job. Can providers develop services to meet these needs?

The challenge for potential providers is straightforward: can they develop fresh styles of service to meet those needs? Already, new types of organisation are emerging: Bradford & Northern Housing Association has become Accent, a community investment company offering a range of services for people.

But for this revolution to take place, the new players will have to ensure that they offer something different in style and content, with greater emphasis on involving users in shaping the services.

Providers will also have to look closely at their existing practices. Success will depend on the ability to prove standards are being met, and that organisations are transparent and accountable. Users must be able to find their way to and through the new system.

All this will require a transformation in the mindset of some health service commissioners. From the earliest days of the first internal market, the commissioning of services has been a weakness in the NHS. Now, they must use the process to shape a landscape with a greater range of providers, many bridging the health/social divide and some employing new types of staff.

There are dangers: that the new market will destabilise good services that are now working effectively; that when the money stops flowing at its current rate, quality will be lost and price and volume will become the dominant considerations; and that the NHS will hive off some of these activities but leave them as Cinderella services without the resources or the managerial commitment needed to make a difference.