The departure of junior health minister Paul Boateng from the Department of Health in the wake of the Ron Davies scandal has raised concerns about the future of the government's new mental health strategy, due to be announced next week.
Mr Boateng's replacement by 'Blair loyalist' John Hutton is seen by mental health specialists as a clear sign that the government will hold the line on its tough approach to community care.
Mr Boateng had 'begun to deliver' and had 'grown into the job' according to Matt Muijen, director of the Sainsbury Centre for Mental Health.
He added: 'This is a very, very sensitive point in time with a new strategy to be delivered. If ever we needed strong leadership, the time is now. Mr Hutton is an unknown quantity. It is certainly a change that will create concern.'
Mr Boateng has been key to the development of the government's 'safety first' approach to community care, which includes controversial plans for forced medical treatment of potentially violent mentally ill patients. He moved to the Home Office last week, to replace Alun Michael, the new Welsh secretary.
Mr Hutton was parliamentary private secretary to Margaret Beckett, leader of the Commons. One seasoned observer told HSJ: 'He's a Blair loyalist ... and a highly intelligent guy.'
He has no obvious direct link to the health brief. An academic lawyer, Mr Hutton lists his political interests as defence, industry and the welfare state.
Mr Hutton will have to master quickly his complex mental health and social services brief. As well as the imminent announcement of the government's detailed mental health strategy, a review of the Mental Health Act is under way, and the first draft of the new mental health national service frameworks is being circulated.
Mental health is also a key issue in the first ever national priorities guidance to be jointly issued to health and social services.
Mr Hutton and Mr Boateng will have to work together on inter-departmental plans to separate the care of offenders with personality disorders from those suffering from mental illness.
The development of mental health strategy has been characterised by tension between ministers and health professionals over the government's insistence that 'community care has failed'.
Health secretary Frank Dobson failed to convince when he appeared to modify that stance at the annual social services conference in Brighton last month.
But Mr Muijen said Mr Dobson's continued hard line was shown by his insistence that the mental health national service frameworks will start from the recognition that community care has failed a substantial number of people, including a minority who were 'a threat to others.'
Mind's chief executive Judy Clements said she did not believe Mr Boateng's departure would unduly disrupt the ambitious mental health programme.