Well, now the fun appears to be really beginning, if the emerging detail of health policy can, by any stretch of imagination, be described as fun.

Of course there’ll be a lot of the usual ‘he can’t do that!’ response to Mr Lansley’s proposals but of course he can. However, this response shouldn’t be too surprising after 13 years of institutionalisation under the previous administration. Mr Lansley could do worse than acknowledge that, and the emotional - as well as practical - difficulties it will create for many NHS leaders.

This isn’t a poltical point, it’s about NHS managers responding to a crisis largely not of their making after delivering superlative improvements in access to healthcare. It’s about them having to lead implementaion of the coalition’s policy changes (which of course is their job) and then having to cope with the human consequences including, it is increasingly likely, for many of themselves.

After all, it is going to be boards, managers and clinical leaders who will actually implement the policy changes and make them work. And history shows that it’s NHS managers above all others who actually deliver government policy on the ground. It is unfortunate that governments tend to occasionally forget that when they’re formulating major change.

And of course the NHS Confederation has a major role to play now. Not just in constructively critiquing the emerging detail of health policy (which it does very well) but now more importantly publicly empathising with managers more than ever in what they will have to do in the tough few years ahead. It’s unfortunate that the Confederation is currently without a chief executive at this crucial time, for the next few months will be a test of its own board leadership.

We know NHS managers always deliver at times like this (again as history shows) but now would be the time to acknowledge their crucial contribution to shaping the future.