The government believes it has to reassert its power to make policy in response to the Brown-Blair faction-fighting of the autumn. Public services is one of six policy areas under debate (the others include the role of the state, crime and security) and the first to arrive on the Cabinet table last week. We understand that key themes are already emerging.
Chief among them is the issue of rights and responsibilities and the balance between citizen and state. There is a belief inside the government that it has underestimated, or ignored, the public appetite's for acceptance of this principle.
And that, rather like geographical inequity and financial fudging, it is a case of making explicit a reality that has always existed - doctors put you at the back of a queue for a hip replacement if your excess weight is likely to destroy the new joint.
Is public support for a smoking ban a vote for paternalism or recognition that changes in behaviour have to be incentivised?
And it is instructive to look at a well-known phenomenon like Jamie's School Dinnerswhich started out as a TV prime-time attack on state provision and morphed into a broader critique of parental responsibility when it turned out that school catering merely mirrored public eating habits.
There is a conviction at the top of government that the state has limited control over health outcomes (as opposed to processes and institutions).
But a latent belief in self-reliance does not necessarily translate into active support.
A criticism of the government's current wrestling match over reconfiguration is that it jumped to explaining a solution before properly explaining the problem. This is reflected in some belated communication from NHS chief executive David Nicholson this week and the kind of consultation being carried out in Liverpool.
The government will need to ensure that it does not make the same mistake twice and push for a new contract between citizen and state without winning the argument for what was wrong with the old one.
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