After many tremors below the surface, the detail of the restructuring of the Department of Health has emerged this week. NHS chief executive David Nicholson has created a new NHS leadership team, with new posts, and some clear water from the rest of the department (read news item on Nicholson's new team).
This is a significant shift, with many of the names active in the department for the past couple of years moving on and out.
What does it mean for the DoH, and for the NHS? Clearly the DoH will become much less about overseeing delivery and much more about facing other parts of government, exemplified by the twin finance roles - one a single point of contact for the NHS, the other turned towards the Treasury.
An issue that remains unclear is the bringing together of the commissioning and provider development roles, from their short-lived separate existence. Mr Nicholson has denied that this reflects a change in policy on dividing provision and purchasing. How this role relates to the 10 strategic health authority chief executives who will also sit on the leadership team will be a key emerging factor over this year.
The person who will see the most change in their job will be Professor Sir Liam Donaldson. His chief medical officer role will now focus much more on public protection and public health while the new medical director will focus on selling messages to the medical professions and the public. The new post is long overdue and could prove the most important of all.