Health will be the department to watch under Gordon Brown. It can expect a big makeover, with not only a new Secretary of State, but also a fresh approach at the top to accompany the announcement in October of its budget for the next few years. As Mr Brown said when launching his leadership campaign, while education is his passion, a priority for the coming months will be the NHS.

The need for action is underlined by the publication yesterday of a highly critical capability review, an external assessment into how the department is run. Organised by the Cabinet Office, these reviews are about Civil Service performance, and do not cover ministers.

Health comes second worst of 15 departments so far reviewed, just above the Home Office, the only other to have an area of “serious concern”. There are also three areas requiring “urgent development”. The review criticises the department’s leadership, notably the absence of “a clearly articulated vision for the future of health and social care and how to get there”. Staff morale is low. The department “too often operates as a collection of silos, and corporate governance structures are not as effective as they need to be”. Moreover, “policies are not well-integrated and there is inconsistent priorisation”.

There are some positive aspects, notably in areas of most interest to patients such as being on course to meet targets for heart disease and cancer mortality, some health inequalities, cutting adult smoking, and waits for treatment.

But the overall message is “ouch, must do much better”, and an action plan is promised for next month by the department’s top civil servants on how “raise its game on staff engagement and corporate leadership”.

But what of the politics? Patricia Hewitt has had a very rough few months, notably over the shambles of the system for appointing junir doctors and over hospital closures. But her record is better than her headlines. She can fairly claim that NHS finances are at last under control. And many of the problems – for instance, the flaws in the consultants’ and GPs’ contracts – were inherited from her predecessors.

But there is general acceptance of the need for a fresh political start. Labour strategists are worried that the party has recently been shown as behind the Tories on the NHS in some polls, reversing past trends.

There is unlikely to be a big change in the overall strategy, and, as Ms Hewitt said in a wide-ranging speech last week, ideas of making the NHS independent with its own board have been rejected by Labour, though not by the Tories. Instead, the emphasis is on more control and autonomy for GPs and patients. The big question is over the increased use of the voluntary and private sector to deliver services, which David Nicholson, the NHS chief executive, this week said was “irreversible”.

However, the tone and emphasis could change. Under Mr Brown, there might be much more about the values of the NHS as a collective national service providing care to all. It is an issue he is determined to keep for Labour.

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