Last month, after Amanda Pritchard announced her decision to stand down as chief executive of NHS England, the health secretary was asked by a journalist at an event at Apple's headquarters in London if he asked her to go.

His response: ‘I have so much respect and time for Amanda Pritchard.'

That exchange, or rather the lack thereof by way of follow-up, reminded me both how political journalism has softened since last year's General Election and of that infamous Newsnight exchange in May 1997 between Jeremy Paxman and former Home Secretary Michael Howard.

Fortunately for Mr Streeting, he was on this occasion asked the question just once (not 12 times) and consequently we're left to work out what really happened.

I said at the time, the truth will come out in the wash (or the podcast) but we now know – as some but not all suspected – there was a lot more to it.

Having previously (and wisely in my opinion) ruled out early legislation and restructure as a ‘distraction', Wes Streeting is now embarking on exactly the top-down reorganisation he once decried.

The abolition of NHS England will require primary legislation and, speaking from first-hand experience because I was part of the team who took the 2012 Act through the Commons, a Health Bill is all-consuming and very distracting.

Given how it has been hollowed out in recent weeks – with pretty much the entire senior team falling on their sword – NHSE may as well be abolished but as so often we're left with more questions than answers.

Why now and when did ministers decide (I'll bet it was more recent than you think) to redraw the map of the NHS in England? What now for the New Hospital Programme led of course by NHSE? How many staff will need to simply move to DHSC to fulfil NHSE's many roles (some of them such as ‘responsible officer for the Mental Health Act' which are statutory) and what will it cost to make thousands of highly skilled people redundant?

Above all, how will this reorganisation of the health service fit into the three important shifts the secretary of state wants to see; primary of which must surely be the move from sickness to prevention which holds the key to NHS sustainability?

While ministers again grapple with structural reform, the media must ask what will patients notice at the frontline in primary care, dental care or those waiting for hospital tests and treatment. And when will they notice?

Assuming ICBs are to escape the ‘bonfire of the quangos,' we have to see all of this ‘new money' for patient care (in the words of the Prime Minister) in the context of the edict this month from Sir Jim Mackey which said they are to cut costs by 50% by the end of the year.

This brave move will, as predicted, hug everything close into DHSC but I predict that won't deliver the change patients want and ministers desperately need before they face the electorate in 2028.

Everyone, including my many colleagues who voted to create NHSE, now seem to agree it's a no-brainer to abolish it but my hunch is ministers may do the right thing but come to the wrong conclusion.

The clever part would be to use its passing – coupled with a reduction in the size of DHSC itself – for true service transformation and local leadership.

That would be to truly devolve health and care, including budgets which is the tricky part given the controlling nature of HM Treasury. The creation of a new layer of Government across England courtesy of devolution, and the election of a swathe of new mayors, is the opportunity to do that which didn't exist before.

ICBs can absolutely be part of that, their leadership locally appointed and accountable via a directly elected figure from the community it serves; not a secretary of state chosen for their loyalty to the Prime Minister of the day in London.

As the minister, I started this in 2018 by devolving certain health competencies to Greater Manchester but it was never taken to its logical conclusion and it never included the money.

Now is the time to be bold, to let local leaders lead and that really would usher in a new era of democratic control which Sir Keir Starmer says is at the heart of all this.

The Swedish model (others are available) would be to truly reimagine the state when it comes to health and care and is, increasingly in my opinion, the only way the NHS survives and thrives into the 2030s and beyond.

I was genuinely surprised we have another reorganisation of the NHS - in the first term anyway - because the Labour manifesto implicitly promised not to do one and because delivery of 18-weeks the PM has put all his chips on doesn't need primary legislation to get in the way.

But one way or another sooner or later my hunch was a Labour secretary of state would not be able to resist the temptation to re-order the health service in England and so it proves to be.

Mr Streeting will now have 100% of the control centred on Victoria Street in London, with which comes 100% of the responsibility. Whether he chooses to immediately give it away in the opposite direction and set the system free will determine whether this huge roll of the dice makes him one of the greatest health secretarys we've had or another one who re-arranged the deckchairs on the Titanic.