By the time this piece is published, prime minister Gordon Brown will, according to most commentators, have named a new secretary of state for health. Perceived by many to be the most poisoned chalice in cabinet, the new incumbent will inherit an in-tray of problems to cause enough insomnia, dyspepsia and migraine to last for years.

The Department of Health will get its 11th secretary of state since 1985. None of the last 10 incumbents had any previous knowledge of healthcare before they came to office; there is little cause for optimism that this tradition will change. The absence of front line hands-on experience may be of no relevance when the diktat from on high is to maintain the status quo, but it becomes a matter of serious import when reform is on the agenda.

If it happens the sacking of Patricia Hewitt will be greeted by sighs of relief from most quarters. Regardless of the political doctrine of the time, regardless of which party is …