The modernisation action board is diverse, if nothing else. Alison Moore reports on the chemistry and mechanics at its first meeting

What do three knights of the realm, four professors and one of the country's best-known rabbis have in common?

The answer, of course, is they are all members of the NHS modernisation action board, which met for the first time on 11 October.

Health secretary Alan Milburn took the chair for the meeting - which overran its two-hour time slot - and new NHS chief executive Nigel Crisp, whose appointment was announced that morning, was also present.

But for much of the meeting the civil servants took a back seat, perhaps slightly bemused by this new body which does not fit easily into any standard model of departmental structure. 'What was missing was a clear sense that the civil servants had a grip,'says one board member. 'It was Milburn and us having a chat and the civil servants sat offstage. Milburn handled it a bit like question time.'

Many board members were enthusiastic about the meeting's feeling of partnership and common purpose. 'There was a clear commitment right from the top that this was the start of things being done differently, ' says Melinda Letts, chair of the Long-Term Medical Conditions Alliance.

Underlying much of the first meeting was the need to balance both long and short-term goals.

'The NHS has had an awfully long period of short-term fixes by successive administrations, to the neglect of the long-term issues, ' says Cliff Prior, chief executive of the National Schizophrenia Fellowship.

Getting and keeping the right staff was also seen as a priority. 'We need to address the workforce issue as a priority if we want to deliver the national plan,' says Heather Drabble, director of nursing at Northern General Hospital trust.

'That is one of the priorities for discussion at the next meeting.'But there is also a need to win 'the hearts and minds' of NHS staff, she adds.

Communicating with staff was one of the main issues discussed, and the idea of a separate communications taskforce was raised.

The board will meet again in December but is then expected to meet only once every three months, with much of the basic work being done by the taskforces, each with a board representative to link the two processes. The taskforce teams are divided into 11 areas, looking after access, cancer, capital and capacity, coronary heart disease, children, inequalities and public health, mental health, older people, quality, workforce and performance.

But quite how the board and taskforces will work is still not totally clear in many members' minds. 'I don't think people really know what the board's role is, ' says one member, who also expressed concern about how effective such a large group could be.

Mr Milburn has said the taskforces will play a key role in highlighting and spreading good practice throughout the NHS, but some members still feel in the dark about what will be expected from them.

Officially, they are 'charged with driving forward the implementation of the NHS plan' but also 'supporting conventional line management arrangements', which would appear to severely limit their powers.

'All I have is the national plan, a press release and a list of members, 'moans a taskforce member who does not even know when his group will meet.

Some taskforces did, however, meet last week.

The board's scrutiny role is obvious - it has to produce an annual report on progress implementing the plan and must advise and help to oversee this - but Mr Milburn argued that the terms of reference of the board should not be tightly drawn, to allow development of the board's role.

NHS Confederation chief executive Stephen Thornton points out that to carry out this role the board will need proper back-up with detailed information and reports available to members.

He also wants to see the board splitting into smaller groups to tackle some issues.

So is the modernisation board going to be a hive of radical thinking? It seems unlikely, given its overwhelming composition of the great and the good from established organisations. More radical proposals may emerge from the taskforces, which have many 'leading-edge modernisers'.

Your name's not down, you're not getting in Already the composition of both the board and its taskforces has aroused some criticism. 'They have picked people they can work with,' points out one board member. 'There are some notable omissions - I'm surprised not to see Mind there, for example.'

Both the Patients Association and community health councils have been excluded. This is not surprising in the case of the CHCs, perhaps, but the absence of any general patients' representation - other than the National Association of Citizens Advice Bureaux - on the main board seems strange.

Patients Association assistant director Simon Williams says: 'We have had no official invitation to participate in the work. Yet we are the only non-disease-specific organisation.'

The taskforces include several representatives from PCTs - both managers and doctors. But neither the NHS Alliance nor the National Association of Primary Care has a representative on the board, and NHS Alliance chief Dr Michael Dixon is calling for a separate taskforce devoted solely to the sector.

NHS Confederation chief executive Stephen Thornton says primary care is not 'a hermetically sealed box but an absolutely integral part of the NHS'.

'I think what Dr Dixon is saying is that the NHS Alliance is not being represented on the board but what I would say to that is, tough, 'he adds.

Voluntary organisations have been completely cut out of the inequalities and public health taskforce. Malcolm Bailey, a voluntary sector manager who sat on the action team which pre-dated the taskforce, says it is not certain whether this is 'conspiracy or cock-up' but that the government could be trying to take away some of the positive tension created by voluntary groups.

On the mental health taskforce, Paddy Cooney, chief executive of the innovative Somerset Partnership, which crosses social and healthcare boundaries to provide integrated mental healthcare, is likely to take a lead. The access taskforce may be enlivened by the presence of Lance Gardner, who runs a nurse-led primary care centre.

But the taskforces will presumably have to tackle some sticky questions where professionals may clash, either with each other or with patient representatives. The access taskforce will have to reconcile the desire of patients for round-the-clock convenient healthcare with the difficulty in staffing such care.

Quality, workforce and performance are also areas where professionals may feel threatened.

A challenging voice on the workforce taskforce is likely to be Roger Kline, MSF national secretary for the health service.He intends to pinpoint the difference between government intentions on workforce and what is happening on the ground. 'Hopefully I'm there as an intelligent critical voice.'