Innovation? Give us more. Grand plan? Let's start tomorrow. The New Health Network conference was painfully on-message. Maura Thompson was there

When Alan Milburn told last week's New Health Network conference that the NHS was about to embark again on wholescale reform - 'a reconstruction of the 1948 settlement'- no-one batted an eyelid.

The health secretary stayed to answer questions, but no-one queried the wisdom of another overhaul of the system, raised the problems involved in amalgamating health and social care, or doubted the merits of the 'war on waiting'. It wasn't that he was given an easy ride. It was just that the audience was so clearly on-message.

It seems that key staff in the NHS (and social services) are already so engaged in the government's modernisation action teams and the wider discussions on next month's national plan that dissent has become impossible.

In the few days after the teams were established, various individuals and organisations complained about not being invited to join the inner circle that would contribute to the future development of the health service.

That soon subsided, as everyone with a worthwhile opinion, agenda or axe to grind found themselves invited to join one team or another.

And now it all seems to be coming together nicely.

So when the NHS Confederation floated its idea of primary care trusts taking responsibility for the social care of elderly and disabled people, and when the Royal College of Nursing and Help the Aged mooted the idea of a new breed of elderly care nurse, it soon became clear these weren't proposals drawn up in isolation.

Silo thinking - where misguided souls see only their own little sphere of orbit - has been replaced by the grand plan, whose key elements Mr Milburn revealed. 'We've got to stop thinking of the healthcare system and social services as two separate systems, 'he said. 'They are not.'

Outlining his department's ideas about a new kind of PCT with responsibility for health and social care, he referred to the NHS's 'big capacity gap'- the need for intermediary services providing the full range of rehabilitation and support for elderly people occupying acute beds.

Before the teams have completed their deliberations, before even the five days for public consultation on the national plan have elapsed, it is clear where this is heading.

'The national plan will include new roles for staff and new means for integrating health and social care services'- not much doubt about that even if the 'census' reveals views to the contrary.

Mr Milburn shared a little more with delegates. 'Tony [Blair] and I were over at Tommy's [St Thomas' Hospital] the other day.' And apparently when they asked managers if they had enough beds - well, they do, and they don't. In theory, there are enough for their throughput, but there are a few dozen with a frail old person in who is well enough to leave but has nowhere else to go. Meanwhile, people are waiting in accident and emergency on trolleys.

And so when this next lot of reforms is implemented there will be a nurse-led minor injury unit in every A&E department, fast-tracking patients who don't need the full range of hospital care and linked into the local primary care system. There will be PCT-run, nurse-led 'cottage hospitals' for elderly people, bringing together the NHS and social services. And - in theory - there will be enough acute beds to end the trolley waits and cancelled surgery. Nirvana.

Delegates cited many examples of the sort of innovation that makes this possible - joint assessments, joint training, computerised triage systems, single management structures. . .

It seems Mr Milburn's schemes aren't particularly radical for people already pushing the boundaries with new local initiatives. It is everyone else he and Tony have to worry about.