NHS England chair warns the buck now stops with ministers

He also defended the idea of quangos – the term used to describe publicly funded organisations at arm's length from the government. "I've worked with six secretaries of state and complete changes of ministers. So there is an argument for a construct that would separate the delivery vehicle from government."

The advantage, he said, is that "it brings in a steady engagement from relevant expertise on a particular topic. And the difference from the political world is.... they don't all necessarily come with relevant experience to run and oversee those areas".

And he argued that NHS organisational changes can't do much to change the underlying health of the population: "The NHS deals with whoever or whatever comes through the gates in whatever condition. And many of the conditions of poor health are driven by factors outside the NHS."

As Mr Meddings was setting out the case for the defence, the debate about the shake-up rages on.

One well-placed source argued that NHS England's leaders had the chance just after the election to re-set the relationship with government but failed to do so as "there had been too much suspicion of politicians".

The organisation, said the source, had become a bureaucracy that was "intellectually stagnant" and that its position interacting with both the health service and ministers "wasn't right".

Ministers have argued that cutting around 9,000 jobs with the shift of NHS England into the Department of Health would free up resources for frontline services, perhaps as much as £500 million a year. Having two organisations often duplicating work, they say, led to wasted time and needless costs.

But one NHS source noted that the government claimed credit for the fall in the overall waiting list for planned treatment since the election and a two million year-on-year increase in the number of appointments and operations – performance delivered on NHS England's watch.

The same source pointed out that "with decrepit hospital buildings a new leadership structure won't make it any easier to carry out operations and care for patients".

These are huge structural changes for the leadership of the NHS and health administration in England. But they will take time to implement.

Moving two large organisations into one and implementing 9,000 redundancies will take up a lot of management time and there are warnings of possible distraction from the day to day running of services. Patients won't see much difference for a while yet.