The election of Catherine McLoughlin as chair of the NHS Confederation this week represents a partial break with the past (See News, pages 2- 3). Though she has been co-chair since the organisation's inception, she has none of the political baggage which made her rival and former co-chair, Marco Cereste, a leading figure in the trust movement before the general election. Nor did the mud of this year's financial near-disaster of a conference sully her reputation.

As a relatively clean pair of hands, Ms McLoughlin can now set about the task she has set herself - that of making the confederation an organisation which uses its influence to drive policy for the NHS.

In doing so, she will need to ensure that the confederation develops policies which reflect the influx of new chairs and non-executive directors over the past year. Since the election, there are far more local councillors involved in NHS decision making, and what they expect of a representative body may differ widely from their predecessors.

Harnessing their expectations, and building a coherent vision commanding widespread support, will be quite a task.