'Central control is a far more natural response from Brown than trusting local freedom and competition'

Is health secretary Alan Johnson backsliding on reform? Monitor chair Bill Moyes thinks he may be.

In a robust interview with HSJ to mark the regulator's annual report (see 'Monitor to government: do not let foundation trusts slip'), the outspoken Mr Moyes has questioned Mr Johnson's commitment to driving forward key planks of the current NHS reform programme, amid fears the government is already being tempted back towards the centralist road.

Policies at risk, he fears, include autonomy for foundation trusts and putting power to shape services in the hands of commissioners.

Monitor wants reassurance that the freedoms written into the foundation trust model are going to be honoured.

Prime minister Gordon Brown's natural tendency has always been to accrue power, not devolve it - a criticism first levelled at him more than 30 years ago at Edinburgh University. Since reversing public opinion on Labour's handling of the NHS is crucial to his chances of winning the next general election, central control is a far more natural response from him than trusting local freedom and competition.

In this context, a firm indication that the whole ministerial team - not just Professor Sir Ara Darzi - sees local commissioning as key to driving service improvement would clear the air.

It is unusual for a regulator to make such hard-hitting public remarks about government policy, particularly when the secretary of state has been in post for barely a few days.

Mr Moyes' concerns highlight the risks inherent in the health service of shouting too loudly about the need for stability. While centralised structural change must of course be avoided, the current phase of reforms needs to move forward if the idea of driving service improvements through local autonomy, commissioning and competition is to succeed.

Monitor's chair is right to give voice to his fears while policy is still in a state of flux. Returning to the centralist model would be reversal, not stability, and would in its own way trigger another bout of precisely the sort of upheaval that the health community so abhors.

And more centralism would fail to deliver the service improvements or public support for his government that Mr Brown seeks.