Health secretary Andy Burnham came into the post as swine flu swept towards pandemic status; a tough start to what is inevitably going to be a tough job.

With an election looming, he has limited room for manoeuvre and must know that time constraints will probably mean he can’t push through any major policy shifts - although he has made a couple of significant adjustments, such as on competition policy. He has also had to take hold of the NHS’s future just at the moment when the money for doing much new has disappeared and the emphasis will be on preparing to do more with the same budget: he says he is a firm believer in quality and it will play a part in helping the financial situation.

The MP for Leigh was health minister in 2006-07 and once worked briefly for the NHS Confederation, so he has come to the job with considerable insight. He supports linking hospital budgets to patient experience, and is passionate about the NHS constitution, which he hopes will protect the service in the years to come and which he says was his idea the last time he was in the Department of Health.

But with less than a year in post before any election, he is bound to be a “what-if” minister. And the NHS will probably never know quite what he might have been capable of.