We were standing on the edge of my local swimming pool discussing the inevitability of change when a fellow wrinklie walked past, saying: 'Don't talk to me about change. I work for the NHS and whenever I hear that word I just switch off.'

Patricia Hewitt might be forgiven for thinking the same, but she's stuck with it for the time being. Fresh from last week's sceptical response to the service's hair's-breadth projected surplus (just
£13m for 2006-07) the health secretary entered this week with a duffing from Professor Chris Ham.

The former director of strategy in her own department warned her that hospitals are still sucking up resources at the expense of newly fashionable primary care. Gosh! Since Professor Ham was directing NHS strategy (2001-04) in the crucial Milburn-Reid years you might think he could have acted to prevent this strategic error.

But never mind. As HSJ reports today, Sir Ian Carruthers is making more reassuring noises to the Department of Health management board about progress on hospital reconfigurations - the vast majority are driven by the drive for better services, not budget savings, he has concluded.

It was not a judgement echoed by opposition MPs when they debated acute hospital services at Westminster last week. There the charge was brutal cuts in defiance of patient needs to meet Ms Hewitt's 'Pollyanna-like vision' of healthcare.

Whatever the reality - and it varies case by case - ministers have been reminded by the Carruthers. review that they and their managers are still not being successful enough in articulating the reasons for change. It's surely not enough to protest that top-slicing and the manipulation of local NHS budgets to balance the books has been going on for decades, and that it's all more transparent now.

If voters think there's a crisis, or that 20,000 NHS staff have been 'sacked' (the actual figure for compulsory redundancies is likely to be a tenth of that estimate), it merely adds to the air of gloom - especially if Professor Ham pops up to point out that PCTs took the biggest cash hit during the recent crunch.

Ministers are parading their new agreement for a 'social partnership forum' with the NHS unions - including the British Medical Association as well as Unison and the rest - to reinforce the need for more staff involvement in change. Yesterday, the day after Ms Hewitt had announced a handful of new private finance initiative hospitals, Gordon Brown hosted a No 11 breakfast for leading clinicians ahead of a one-day 'summit' to grapple with, yes, change.

The PM-in-waiting is apparently much engaged with the need to shift attention to the prevention of ill health. You would expect that from the man who commissioned the Wanless report into health finance, which concluded that healthier lifestyles would be crucial to an affordable NHS in the long term.

No surprise then that the man Mr Brown appointed to the Treasury's council of economic advisers, Gavin Kelly, formerly of the Institute of Public Policy Research think tank, is a champion of tighter Ofcom regulation of TV advertising of food, snacks, soft drinks and other dangerous products aimed at children.

Obesity, alcoholism (all drink adverts should be banned, the president of the Royal College of Physicians said the other day), drugs and cigarettes are all the product of lifestyle choices and addressing them requires changes in attitudes.

'It's hard for the government to pull the levers that make these changes,' one Hewitt adviser conceded at the weekend, when the papers were full of talk of a 14-stone eight-year-old being taken into care if his parents refuse to feed him properly. The little lad spits out fruit and veg, insisting on factory food instead, his mum says. The implications for social services of that sort of talk are terrifying.

No wonder ministers (Chris Ham too, I expect) want closer co-operation between the NHS and local authorities. That link might be extended in the light of the latest burst of publicity for scary C Difficile and MRSA rates - 3,807 related deaths for the one in 2005, 1,629 for the other. Where do many of the elderly, vulnerable cases come from, often bringing the bug with them, but local-authority care homes?

Michael White is assistant editor (politics) of The Guardian.