The proposed new NHS Commissioning Board “cannot afford to fail,” NHS Confederation chief executive Mike Farrar told a conference.

Mr Farrar said it was vital that clinical commissioning, a central plank of the government’s health reforms, proved effective as it was “probably the most important part of the system.”

But he said ministers’ failure to make a compelling case for change left many in the NHS without a clear sense of purpose and drive for the next decade.

As a result, it would be up to the NHS Commissioning Board itself to describe how it would work and its vision of what the health service should be. “It needs to be the leader of the …