The King's Fund is undergoing a massive shake-up as well as something of a slimming exercise. Pat Healy looks at the organisation that is emerging

The King's Fund is offering bottles of champagne to anyone who can come up with suitable titles for the five new 'directorates' emerging from a massive shake-up of the organisation.

The temporary titles of 'public health', 'health systems', 'health services', 'health professionals' and 'people' are felt not quite adequate to express the breadth of the new programmes.

They perhaps also obscure two less welcome facts.

First, some areas of work are being dumped in the drive for a more focused approach. Work on learning disabilities will go as projects come to an end, and the Fund is withdrawing from work on physical disabilities.

It is a question of priorities, says Angela Coulter, policy and development director and the driving force behind the shake-up. Physical disability work is going on elsewhere and there is no need for duplication.

Second, restructuring means that most people, including senior managers, are having to re-apply for their jobs. Not all will be re-appointed and a steady stream of people are taking voluntary redundancy or early retirement.

That has given rise to some concern about loss of creativity as people depart who were given their heads by former chief executive Robert Maxwell.

Ms Coulter affirms that 'it was great working under Robert Maxwell' but does not accept that the new regime will necessarily mean less creativity.

There will be less freedom for individuals, she acknowledges. But the old system meant people did not work together and there was less sense of a team.

In the new order, the Fund's work will be much more integrated, and arguably there will be more creativity through bringing people together.

So far, three programme directors have been appointed from existing King's Fund staff. The remaining two are being recruited externally after an internal trawl failed to produce appropriate candidates.

One of the lucky ones is Nick Mays, former director of the Fund's policy institute, which 'vaporised' last December on the day Julia Neuberger arrived as chief executive. He joined in 1994 and says: 'It was a very good time.'

Like all senior staff taken on then and since, Mr Mays was given a contract that would expire at about the time Dr Maxwell was expected to stand down, in order to give the new boss a free hand in appointing staff.

Mr Mays now directs the health systems programme with a brief to research and analyse health systems in London and the UK. He doesn't know yet how many institute staff - mostly on contracts expiring this year - will join him.

'All the jobs in this directorate are regarded as new, so they have to apply if they want to be part of the new core-funded King's Fund staff, ' he says.

He says that people are 'slightly apprehensive' but accept that this is 'the fairest way of doing it'. There has been extensive consultation with staff as part of the process.

Staff have developed four themes reflecting the Fund's aims and values, which Mr Mays sees as 'slightly odd' because they are from the Maxwell era.

They are social justice, responsiveness to cultural diversity, public participation, and co-operation between health and social care agencies.

Each programme is expected to incorporate those themes into its work.

Mr Mays says it will take some time for the new programmes to establish an identity. 'It isn't just about having a new director and new staff, ' he says.

His department will not be self-managing, as the institute largely was, but he says he does not get a sense that there will be greater restrictions.

People with different skills and backgrounds will be expected to work together more.

'It is challenging and ambitious. It is a rebalancing. But at the moment, it doesn't feel like a drastic change.'

It is more evolution than revolution, since the changes are rooted in talks that began in 1996. But Ms Coulter accepts that the changes are unsettling for staff, and there might be compulsory redundancies.

'It is important that people don't think this is a place they come and have a job for life. We need new blood. We always find we can recruit good people.'

She says the changes have evoked 'a lot of enthusiasm', adding: 'People are egging us on, both internally and externally.' Change is about bringing the Fund's work together to increase its impact, particularly on health policy.

There will be a renewed emphasis on London in keeping with the Fund's founding aims, less dependence on Department of Health grants for special projects, and an end to management consultancy work.

There will also be more emphasis on issues of race and diversity, especially through the appointment of Naaz Coker as a senior adviser to develop the Fund's corporate policy on ethnicity and race.

'We have to remain independent but we also have to be relevant, ' Ms Coulter says.

She denies that the Fund became a bit too close to the last government.

'We were often very critical, ' she says. The new government can expect to find the Fund irritating as its work throws up holes in its policies.

'We will always fiercely defend our ability to say what we believe to be true, ' she says.