Andrew Lansley’s keynote speech at this week’s NHS Confederation conference could be the largest audience of health service managers he will ever address as health secretary.

As the secretary of state has made clear in his tough-talking interview with HSJ and through the revised operating framework issued this week, by this time next year he expects management costs to be shaved by at least £220m.

He is unapologetic about moving the goal posts on this one - it will come on top of the “cut NHS management costs by a third” mantra that all parties were espousing before the election.

Any NHS organisations that were still claiming they could meet the necessary reduction through natural wastage should think again - redundancies now look inevitable.

As HSJ’s survey last week revealed, there is no shortage of managers waiting for the added incentive of a redundancy package to jump ship but the NHS will need to keep a close eye on the costs, and how they are received and perceived.

The good news is that the revised operating framework did not contain any major surprises. The targets we expected to go are going; the new rules on reconfiguration and discharge had already been trailed. As Mr Lansley tells HSJ, in 2011-12, he hopes to have both GP commissioning and the NHS board up and running in shadow form. The future is now, or at least imminent.

The question is: what happens in the meantime? Few managers will mourn the passing of targets per se, but none wants to see waiting times slip back to mid 1990s levels. Mr Lansley explicitly says he does not either, but the risk is that pulling the plug on performance management of targets now will create a hiatus in which it is too soon to expect greater transparency of information and patient choice to fill the gap - and the worst performers will get away with it.

Primary care trusts have been given more options in the medium term for what to do with their provider arms, and Mr Lansley has admitted that he does not expect all trusts to be foundations before March 2014. A lot will have happened by then. In the meantime, Mr Lansley and his department must keep fleshing out the details. Roll on the white paper.

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Lansley must keep information flowing while NHS targets ebb away