This week the Cabinet Office is finally unveiling its report on the progress the Department of Health has made since an excoriating “capability review” two years ago.
Then it was condemned for poor leadership, lack of clarity about its role and absence of a clear vision. It was battling it out with the Home Office to be the worst department in Whitehall.
The latest assessment reveals strong improvement, with higher staff morale, a clearer vision for the department and more effective policy making capacity (news, page 6).
But HSJ expects the report will question whether the current tripartite leadership of departmental permanent secretary, NHS chief executive and chief medical officer is sustainable.
The problem is not the incumbents - they have found an effective way to work together. But the system lacks clarity, is confusing to outsiders and may not fare so well with different personnel.
The future of the tripartite arrangement must be debated, not least because the Conservatives are planning to introduce an independent board to run the NHS.
This could provide a more transparent structure, with a clearer distinction between political policy making and running the health service, but it could just as easily add to the confusion.
There is a real danger that politicians will be unable to wean the public off the notion that every NHS shortcoming can be resolved by ministerial meddling, rendering the board’s nominal independence worthless.