'One insider said Gordon Brown is obsessed with the NHS and he'll have his hands all over it. That figures'

After Gordon Brown and his new deputy, Harriet Harman, had done their stuff on the leadership platform in Manchester at the weekend I was still a bit stuck for a fresh angle on Brown Labour's health policies.

In his acceptance speech Mr Brown repeated his campaign pledge to make the NHS his immediate priority, plus better treatments, more dignity (not to mention choice), more 'listening to and valuing our staff.' But he has already said much of that.

The best HSJ headline I could come up with at the time was 'Harley Street doc's daughter to be Brown's number 2' You now know who is to be the next health secretary - but I didn't then. Nor had I even picked up any good tips. Bev Hughes? David Miliband?

But I did hear this from a Department of Health insider: 'It doesn't matter too much who becomes secretary of state because the NHS and the department will have to deal with Gordon. He's obsessed with the NHS and he'll have his hands all over it. Most patients are satisfied, but our ratings have slipped. We've lost public support - and he wants it back.'

That figures. The evidence of discontent is everywhere, in this week's British Medical Association conference survey, in the Alzheimer's drugs court bid. Ministers call it the 'I was lucky' view of the NHS: people think their own good treatment was a fluke.

That nags at Mr Brown's insecurity: it shouldn't be like that, not after all that extra cash, he reasons. Whatever else, the new PM is a micro-tweaker, reminding some old lags of Sir Anthony Eden, who inherited Churchill's premiership in 1955 after an even longer wait. When Eden fell over the Suez disaster 18 months later his colleague 'Rab' Butler remarked that at least his phone would stop ringing five times every Sunday.

Back to Patricia Hewitt, who has made two valedictory speeches in recent days, one at the NHS Confederation, the other at the London School of Economics. In an odd way they amounted to an answer to David Cameron's big health speech - 'Autonomy and Accountability' - just days before.

The Conservative leader endorsed the concept of an independent NHS board to manage overall performance (no more central targets) and allocate money free of vulgar politics. Most budgets will be devolved locally to GPs and other multi-disciplinary NHS teams.

All hospitals will be self-governing trusts and free to borrow on the open markets. Patients will be free to be treated anywhere by whoever - public or private - provides services to NHS standards 'at or below' NHS costs.

Oh yes, important details for HSJ readers: primary care commissioners' salaries will be linked to 'the actual outcomes they deliver for patients', but - unlike the Tory policy until 2005 - no taxpayer funds will be used to 'top up' the cost of private care.

Well, that's a lot to be getting on with. Ms Hewitt's answer seems to be roughly this: much of what Mr Cameron says is echoing what is already being done, more foundation trusts and choice, more payment by results (via the quality outcomes framework for GPs). As for the rest, she contrasts Mr Cameron's 'no more reorganisations' pledge with his desire to create an independent management board, quite a shake-up itself. What is needed and already happening is a model which is 'neither monolith, nor market,' neither Soviet nor American.

In her LSE speech she cited Labour's creation of national clinical directors (czars), of the National Institute for Health and Clinical Excellence and the Healthcare Commission, plus foundation trusts, all proof of a more open and decentralising direction.

All have created short-term problems in public confidence, she admitted. We know it has not been as smooth as she suggests. The point is confirmed by last week's Cabinet Office review which rated the DoH as second most dysfunctional department after the 'not-fit-for-purpose' Home Office, lacking clarity of purpose and leadership.

What is Ms Hewitt's reply? That she saw this when she arrived in 2005, that is why David Nicholson is chief executive today, a happy warrior. Who knows, the worst may be over for the new boss.

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