'It would have taken a chainsaw to separate Ms Hewitt from the job, despite everything'

John Prescott's unlikely fondness for croquet (he doesn't play by the rules) is just one unlikely bit of fallout from Tony Blair's hasty reshuffle. Less noticed on Fleet Street front pages since 6 May has been the trickle of letters sent by Mr Blair to senior ministers, setting out their new challenges.

You can find them on the Downing Street website, though not very easily: open government has its limits. Indeed, the last time I saw the late Anthony Sampson, famous for his Anatomy of Britain dissection of the power structure, he joked: 'Secrecy is the new openness'.

Patricia Hewitt's Letter From Tony is dated 15 May. It starts off by thanking her for 'agreeing to continue in the important role of secretary of state for health'. Thank her for agreeing! It would have taken a chainsaw to separate Ms Hewitt from the job, despite everything. But the PM was being polite - he was brung up right - and all the Cabinet letters contained similar flannel.

In the Department of Health's case, Mr Blair's declared context is one of success. Never mind the furniture crashing all around several key policies, he notes in the sixth year of the 10-year plan that waiting lists and times are down and survival rates up.

But 'there remain many challenges to address before we can see this investment and reform deliver the full benefits'.

Quite so. It is the complaint of some insiders that, despite Blair-Brown promises and threats, too much cash was handed over to outdated structures and working practices. The critique could prove to be the termite in the NHS woodwork. So what does TB propose?

- To 'continue the pace of reform' by improving choice which empowers patients and, when linked with payment by results, drives improvements and efficiency which 'new providers' in both hospitals and primary care will assist.

- To ensure that 'the NHS as a whole returns to financial balance'.

- To achieve better access, not least the crucial 18-week target from GP referral to an operation, by December 2008 (a 'tough target', he concedes).

- To evolve a better social care policy, one that is more personalised and 'fosters independence and dignity' via individual budgets and direct payments.

- To build on the white paper on public health to 'create an environment that makes it easier for people to make more healthy choices' - small ones often work. He singles out public health minister Caroline Flint to achieve cross-cutting initiatives with other ministries to further this wholesome goal in line with the 'Small Change, Big Difference' campaign slogan. Wow!

She is not alone. In Mr Blair's closing remarks he urges Our Trish to improve the department's communications skills with NHS staff and public, and the involvement of doctors and nurses in the reform agenda, especially commissioning. Handy Andy Burnham is tasked to help with this alongside his day job. Wow again!

One small point here. The Blair letter confirms what Mr Burnham has been telling irate MPs of all parties during debates on their PCT cash problems: that wayward NHS bodies must make 'inroads' into their problems, not solve them in one year.

I should add that the goal is indeed that they should eventually be in month-by-month balance which sounds a bit scary (or do I mean daft?) to me.

The context for all this, as TB points out, is the zero-based and efficiency reviews also under way, whereby all Whitehall departments are being asked to consider what they do and if it should be done differently and better.

Parallel with that, there is a departmental capability review which seeks to ask more basically what ministries should be doing to achieve the outcomes they seek.

In John Reid's Home Office clich? of the moment, is it 'fit for purpose'? You may feel that targets and agreements and goals have been the curse of this government. Time will tell if it has been worth it. When I rang a top source at health, he/she said the Blair letter was 'really marvellous'. I think that was sincere, though I could hear a party in the background. l

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