Reid moves first on emergency services

New health secretary John Reid has vowed to continue with the reform agenda set out by his predecessor - and took his first step by driving accident and emergency services yet higher up the political agenda.

On his first full day in post, Mr Reid sent out a message to NHS chief executives promising to 'press ahead with the reforms and drive them forward so our vision of a patient-centred health service becomes a reality'.

Allocating the ministerial portfolios to his largely new team, he upgraded the brief previously held by then-junior health minister David Lammy - which focuses on emergency care - by giving it to (senior) minister Rosie Winterton, along with responsibilities for mental health.

The elevation of A&E is a reflection of Number 10's desire for the NHS to get to grips with this issue.

NHS chief executive Sir Nigel Crisp said the upgrading of A&E as a priority was intended to reinforce the message about how 'extraordinarily important' emergency care is. He said the service had learned from mistakes last year, 'when we did not give it enough focus until late summer'.

But the rest of the social care agenda has been downgraded.

With mental health gone to Ms Winterton and children's care to children's minister Margaret Hodge, a smaller portfolio resides with new junior health minister Stephen Ladyman. Melanie Johnson is public health minister, while Lord Warner takes up the vacancy and brief left by Lord Hunt. John Hutton remains health minister, with responsibility for primary care. Precise details of the portfolios were being fine-tuned as HSJ went to press.

In the briefing note, Sir Nigel added that Mr Reid had 'made it very clear that he will be continuing with the existing direction and policies of the department'.

Managers' leaders said they were pleased at the news that the policy direction would remain 'steady as she goes'. But the NHS Confederation said it would be 'an immensely sensible political decision' to give the service some space now to implement the policy agenda.

Chief executive Dr Gill Morgan said it would be 'interesting' to see if Mr Reid adopted a less interventionist style than predecessor Alan Milburn, who resigned last Thursday.

She asked: 'One of the issues that I think will be very important is how does John Reid want to engage with issues?

'We have had a very direct, intervening and hands-on secretary of state.What will be interesting is to see whether That is the style John Reid adopts... I think we are at a point in terms of the change cycle where opportunities and freedoms for the service are important. Giving them space would be an immensely sensible political decision, ' she added.

One SHA chief executive said the reason Mr Milburn was so busy was because he was trying to do Sir Nigel's job as well as his own.

Sir Nigel said he did not know if the new ministerial appointments would mean a change in style. But he urged the service to make good use of any freedoms on offer.

'The NHS should take this opportunity to demonstrate to its political masters just how effective it is. It should move forward with confidence and come up with ideas. I am sure ministers will be very appreciative. It is an opportunity for the NHS to show how good it is.'

Priorities for the new health secretary will include the first wave of foundation trusts, attempts to introduce the consultants' contract on a local basis and the GP contract, currently out to ballot.

But some managers were concerned that a new team with little background in health might not be able to see beyond the headline stories to the complex issues meshing the reform agenda together.

However a senior government source said that prime minister Tony Blair and his advisers would ensure that the broader agenda, including areas like primary care, patient choice and financial flows did not go neglected.

Robert Naylor, chief executive of University College London Hospitals trust, one of the firstwave applicants for foundation status, agreed. He said he did not believe the change of minister would result in lost momentum for the reform agenda.

'The changes [Mr Milburn] was enacting, not only on foundation trusts, but in health reform, were part of a wider reform agenda from the prime minister. I am not worried - I am confident that the reform agenda will continue to be driven by Number 10.'