The Department of Health could be in line for the most far-reaching shake-up of its existence, with outside organisations invited to feed into its internal review.

The departmental review, led by NHS chief executive and DoH permanent secretary Nigel Crisp, has opened the corridors of Whitehall to a range of outside organisations in a search for 'greater coherence, clearer leadership, better corporate management and smarter, more creative ways of working'. A DoH spokesperson said there were 'bound to be some structural consequences', but this was 'not the main emphasis'.

As part of the review, an all-day workshop has been held for an external reference group including NHS managers, social service directors and patient groups, while nine working groups - also including members from outside the department - are examining different areas of the DoH's work.

Mr Crisp is leading two groups - on 'creating a single integrated department', and on 'consistent leadership and direction' - which include two chief executives from each region.

Chief nurse Sarah Mullally heads a group on citizens, patients and the public, while chief medical officer Professor Liam Donaldson examines cross-governmental action in health and social care.

NHS Confederation chief executive Stephen Thornton, a participant in the external reference group and member of a working group on performance monitoring, praised Mr Crisp's initiative as 'very comprehensive and brave'.

He added: 'Looking at some of the material produced by some of the civil servants about themselves and what they do, there was quite a lot of complacency - but It is being shaken. '

At the workshop, he called for the review to be extended into the 'intermediate tiers' of the NHS.

'We need to look very seriously about whether we need the [current] number and size of regional offices, ' he told HSJ.

Cliff Prior, chief executive of the National Schizophrenia Fellowship, praised the efforts to ensure NHS plan values are embedded in the DoH's structure:

'It was set up in the days when 'professionals knew best'', he said, stressing that cultural change had to be accompanied by structural change.

But Patients Association assistant director Simon Williams said the review was 'another navelgazing exercise'.