The prime minister's interview with HSJ this week poses important questions for health service managers. Among the familiar - the NHS is important, managers do a good job - are some more subtle but pointed messages.

The prime minister's interview with HSJ this week poses important questions for health service managers. Among the familiar - the NHS is important, managers do a good job - are some more subtle but pointed messages.

The key message he wanted to get across was that the drive for efficiency was itself a drive to deliver the NHS's values; that a failure to achieve good value for money rendered them abstract. He tells HSJ: 'Every pound that you waste, that isn't spent on better patient care, is not spent on the values of the health service.'

Most managers believe this, but are they able to communicate it to staff groups, the people who often know where the worst waste is happening?

The second message was that the system reform will largely be in place next year and the incentives needed for sustainable self-improvement locked in. Does this mean the prospect of an end to continual restructuring? Mr Blair has certainly suggested there will be 'less need' in the future. But the crucial proviso is that NHS organisations must demonstrate the same kind of flexibility and fast learning as private sector organisations. As an aside, there are plenty of dull-witted and inflexible companies; they just don't tend to compete.

Third, the prime minister is putting his weight behind foundation trusts. If Monitor's diagnosis is that only half of trusts can get foundation status by the 2008 deadline, the belief is that existing and imminent foundation trusts are best placed to provide a cure.

In the words of Foundation Trust Network director Sue Slipman, they are the 'engines of change whether by support, joint venture, merger or 'acquisition'