This week two visions are being offered for how the NHS can find its way out of the funding and quality crises. One is a myth, the other might make a difference.

The myth is, of course, being peddled by a politician. This week it's the turn of health secretary Jeremy Hunt (again). In an HSJ interview he claimed that safety and technology are all that are needed to get the NHS through more years of deficit reduction. Eradicating mistakes while installing new kit appears to be the way forward.

Of course safe care saves money, but it is specious to suggest the potential savings are anything like the size required. In support of his argument Hunt deployed the now familiar 'if only the whole NHS was like Salford Royal' line. It is no doubt true that if every organisation in the health service was suddenly rammed up to the top of the performance curve it would alleviate some financial pressure, but it is not going to happen any time soon and certainly not for free.

Technology, like integrated care, is a beguiling solution which offers benefits, but again will not close the quality and funding gaps. Of course NHS systems need improvement, but the infamous back office could be run for free and it still wouldn't fill the projected financial hole. Clinical kit such as telehealth can help clinicians provide more timely and preventative care and improve the quality of life of individual patients, but it is not going to drastically cut the demand for services.

The solution that might make a difference is being developed by the poster boy for management excellence, Salford Royal chief executive Sir David Dalton. He has given some early indications how his work for the government on establishing European-style national hospital chains is developing.

Dalton is building a variety of options, from loose federations to accredited excellent providers running or managing failing trusts.

His work offers new approaches to ending the cycle of failure in which some trusts have been engulfed for a decade or more, and certainly seems more imaginative than endless inspections or fantasies about foundation status.

However, if management excellence is the solution then providers need the management capacity to think strategically, which means not stripping manager numbers back to a bare administrative minimum and paying salaries that will attract top talent from across the economy. Running two or three failing organisations is a very different skill to running a single successful one. Many members of the public will hate it, but the truth is that managers with experience in running chains with consistent standards of quality and performance are likely to come from the private sector.

There is a risk of assuming that senior NHS staff have turnaround skills just because they work in an outstanding organisation. Dalton built success at Salford over many years, but not everyone has that experience. Perhaps a blend of NHS and private sector skills will be the right combination for running NHS hospital chains.

But are we really saying failing organisations are there simply because they have been unable to appoint competent managers, or are their problems rooted in a dysfunctional local health economy? Changing the faces round the board table will make little difference without facing up to underlying problems.

The funding system underpinning chains would be a perilous balancing act. With financial incentives certain to be part of the package, there is a risk that failing local hospitals could end up, in effect, pumping money into wealthy and successful foundation trusts in return for their management wisdom. The distribution of risks, costs and rewards will need to work both financially and politically.

Even if all this can be worked out, the Department of Health needs to remember that most mergers and acquisitions in the private sector fail. The chain proposal will put significant risks on currently successful organisations. That does not mean the idea should not be pursued, but it is far from certain that it will produce widespread success.

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