'Don?t think, Mr or Ms Finance Director, that you can force Ms Hewitt out by hiring some extra doctors or buying a fleet of scanners'

First things first, I suppose. Patricia Hewitt, was widely reported last week to have told the Commons health select committee that she would resign if NHS finances are not back in order by the end of the current financial year.

Er, not quite. It is true that she was asked by an MP if she would walk, and in Fleet Street the wish is sometimes father to the report. But when I checked with those mysterious Whitehall sources I was reminded that she has said before that she will 'take responsibility' and did so again in her reply. 'A vague bromide' instead of an answer, one savage stalker-blogger later called it.

So don't think that you, Mr or Ms Finance Director, can force her out by hiring a couple of hundred extra doctors or buying a fleet of MRI scanners.

The one person who just might decide by March that the department needs a new political head is Gordon Brown, if he takes over by then. And he ain't saying.

There is a fascinating tussle going on between numbers 10 and 11 over Tony Blair's efforts to define his legacy and steer his successor towards what he sometimes calls 'self-sustaining reform' in public services like the NHS.

By that he means a responsive system which adapts itself to change at local level without having to be prodded by excessive targets which have outlived their usefulness. Rivetting suggestions of a new social contract between the state and the individual ('lose weight first and then you can have that new hip') are part of that process.

We shall see where it goes. Back in the real world ministers face a steady hail of brickbats: for instance, they can't stop the police asking for free NHS heroin for addicts (cheaper than habit-feeding crime), but get accused of stealing the money from Alzheimer's patients.

This week Ms Hewitt was battered again over mixed hospital wards, a potent issue for some newspapers since there are always bad cases.

The latest is that of Pat Balsom, sister of celebrity writer, Janet Street-Porter, who died of cancer this month after enduring some undignified treatment at Hillingdon Hospital in west London.

Mr Blair said as long ago as 1996 that ending mixed wards was 'not just a question of money [but] of political will'. So shadow spokesman Andrew Lansley felt free to quote it back at him. On radio Ms Hewitt was forced into the awkward position of admitting there is a 'clear gap' between what managers regard as separate wards (eg screened bays) and what some female patients want.

As you know better than me, many ingredients are mixed up here, including what goes on in different parts of the hospital system:admission units or critical care units are often mixed of necessity.

Older hospitals, mixed loos, mental health wards (always tricky) - it's easy to see both sides: progress has been made, but not enough. Officials take issue with some of Ms Street-Porter's characteristically dramatic claims; not everyone sympathises. But she is bereaved.

In search of insight I rang one of Hillingdon's MPs, Labour leftwinger John McDonnell, who is touring the country to win support for his cheeky challenge to Mr Brown for the vacancy at Number 10. A straight-talker, he was quick to link the hospital's admitted problems with the topic on which we started this column: the drive to end NHS deficits by March.

There are what Mr McDonnell calls 'real issues about care on the wards'. High staff turnover rates are exacerbated by high house prices and by delays in a private finance initiative project to upgrade the hospital. The local primary care trust is heavily in debt and, the MP told me, is on its fourth chief executive in 18 months.

Meeting national targets distorts clinical priorities and the PCT pays. A 'lighter touch' is needed. But Mr McDonnell admires Hillingdon Hospital trust chief executive David McVittie as he grapples with his job. When the deficits started to emerge people like Mr McVittie said 'we need two or three years to turn it around without dramatic effects on local care'.

They were told to go faster. In his travels Mr McDonnell has seen much local anger. He fears voters won't forget.

Michael White is assistant editor (politics) of The Guardian.