One of Andrew Lansley’s first acts as health secretary was to declare a moratorium on hospital reconfigurations until the plans had passed his four tests of clinical and public acceptability and credibility.

Nearly all did and Mr Lansley’s intervention achieved little more than delay at a crucial time. When he became a victim of reshuffle politics and an equally surprised Jeremy Hunt found himself at Richmond House, the biggest concern among many NHS leaders and senior civil servants was that previous understandings achieved with ministers would have to be renegotiated.

Specifically, there was a fear the new health secretary would want to review all contentious reconfiguration plans for potentially explosive political implications and seek to intervene.

Within days, a story appeared in the national press seeming to suggest he was planning to do just that. HSJ’s inquiries soon established the story had little substance, but it is unlikely those planning major changes to hospital services will believe they are free from political scrutiny.

After all, it would surprise few if Mr Hunt’s first question to NHS chief executive Sir David Nicholson was “tell me what’s happening to hospitals”. The reforms may have the greatest implications for commissioning, but the highest profile change will take place in the acute sector.

The answer to Mr Hunt’s theoretical question would be a very long one. Reconfiguration fever is sweeping the country. This week HSJ reports on the joint service review launched in Worcestershire’s health economy. Its story of three unsustainable sites needing to rationalise the services they provide is repeated across the country, often to fierce opposition.

But even those hospitals not caught up in a reconfiguration are facing changes which would be dominating healthcare headlines in quieter times. The decision by Maidstone and Tunbridge Wells Trust to offer all its staff the chance to apply for voluntary redundancy as part of a bid to save £20m underlines the parlous financial state of many provider organisations. The health secretary may welcome trusts’ new appetite for supplying private patient care facilitated by the Health Act, but he will be equally aware that the idea of NHS organisations replacing lost revenues in this way will be identified as the thin edge of the wedge by many.

HSJ readers will know these issues represent only a proportion of the iceberg on the hospital horizon. Those charged with convincing the public and staff about the sense and need for these changes face a bewildering task. Especially as they know the evidence for change is often likely to be incomplete and open to challenge, as Sarah Davies’ critique of Manchester’s lauded maternity restructure demonstrates. They will also understand that timescales required to bring all parties onside rarely mesh with the deadlines to improve quality and, especially, delivering savings.

So can they expect any active help from politicians? It is unlikely. For the foreseeable future there is unlikely to be anything in it for a politician to be associated with change which is perceived to move hospital services out of their constituency.

So let us hope that when Mr Hunt has finished wrapping his head around the new portfolio, he decides to take a watching brief on hospitals, to trust local decision making and to intervene only when absolutely necessary - for example, following referrals from health and wellbeing boards. However, HSJ cautions against assuming this approach will be adopted.

Renewing England’s hospitals is a difficult road and, given the time it will take to win the arguments, one on which healthcare leaders will have to travel alone for much of the journey.