The speeches at Labour's annual conference mapping out the principles for Gordon Brown's stewardship of the NHS highlighted the tensions with which the new ministerial team is grappling.
Health secretary Alan Johnson promised that the old, top-down NHS structure would make way for a more personalised health service. While ministers would listen to the public and staff, staff would listen to patients and the locality - 'clinically led and locally driven'.
The localist message was underscored by a subtle shift of emphasis on service reconfiguration; while supporting the principle of centralising services such as stroke and cancer care, Mr Johnson promised to localise where possible, bringing services closer to home.
But while Mr Johnson ostensibly banged the localist drum there was an undercurrent of central control, with heavy emphasis on how Ofcare will have new powers to inspect, investigate and intervene on hygiene standards.
The hygiene message was rammed home by the prime minister the day before when he promised a 'deep clean' of every hospital. The passage misfired. It sat uneasily in a speech by a man offering a vision for a nation, reducing the country's leader to the language of an overzealous Cleaneze salesman; more substantially, the deep clean message is wasteful in practice and wrong in principle.
Spending public money on a one-off national cleaning frenzy will not have a substantial impact on hospital-acquired infection. And at a time when the health secretary and the NHS leadership is promising to move away from top-down control, there is something deeply unsettling about thousands of cleaners being mobilised not because local clinicians and managers believe it is needed, but to honour a soundbite.
The outbreak of misguided scrubbing, wiping and polishing to be unleashed across the country to deliver the hygienic Great Leap Forward promised by the health service's new helmsman is no way to run the NHS.
The simultaneous regulatory push on hygiene smacks of old-style centralist sanctions and threats - nothing about spreading the wealth of NHS good practice or improving training. It is not that substandard care should not be challenged, it is that the government needs to rid itself of the mindset that the way to improve standards is to attack the worst and control from the centre rather than liberate the best to set new standards of excellence and spread and develop their example.
If ministers fail to make this shift in thinking they will undermine the drive for a more patient-centred, locally responsive NHS.