By Nick Triggle BBC News health reporter

Patricia Hewitt will have to tackle targets, MRSA and funding

While much of Labour's policy has been laid down already - perhaps with the exception of public health - the health secretary faces a challenge in making sure the goals are realised.

The overwhelming concern among the health service is what happens when the government's record-spending increases end, set to happen in three years' time.

The NHS currently enjoys annual funding increases of 7.4% to help bring it up to European spending levels.

Experts fear if there is a sizeable fall in the yearly increase when the spending programme ends in 2008, it will actually feel like a spending cut, putting at risk many of the improvements of the last few years from reductions in waiting lists to increases in doctors and nurses.

Drop

Many within the NHS want to see a gradual reduction in the increases over time, but all the indications are that it will drop to about 4% in one go.

Dr Gill Morgan, chief executive of the NHS Confederation, which represents health service managers, warned improvements were achieved through sustained commitment, not a cycle of "boom and bust".

"It must be maintained because people are living longer, the cost of new drugs and technology is increasing and the care we provide for NHS patients needs to keep pace with rising public expectations."

The health secretary also faces the tricky task of sorting out much of the controversy over targets.

No-one's arguing that we shouldn't be giving patients a say over their treatment, but the way the choice agenda is being introduced in practice is turning out to be problematic Dr James Johnson, of the British Medical Association

The subject was raised towards the end of the election campaign when Tony Blair was criticised during a TV debate because GPs were not allowing patients to make advanced bookings because of pressure to meet a 48-hour waiting target.

Mr Blair has already promised to reduce the number of targets, but in reality that may prove difficult as many of them are written into staff contracts or the regulatory system.

Patients Association chairman Michael Summers said: "It seems clear something has to be done about targets, the problems have already been raised. Patients do not want targets getting in the way of their care."

But there is also huge potential the health secretary can exploit.

Patient choice will really take off at the end of the year when patients are given the option of five hospitals, including a private sector provider, for treatment.

Future years

In future years the agenda is likely to be rolled out to other areas of the health service, including mental health and primary care.

But this in turn presents its own problems.

James Johnson, chairman of the British Medical Association, said: "No-one's arguing that we shouldn't be giving patients a say over their treatment, but the way the choice agenda is being introduced in practice is turning out to be problematic.

"For one thing, we need to ensure that exposing the NHS to competition with independent providers doesn't damage specialities and departments that the private sector has no interest in providing."

Current spending increases are due to end in 2008

Hospitals, which are paid for the amount of treatment they carry out, are also facing a threat from primary care services, such as diabetes clinics, and the greater role being given to GPs.

The King's Fund, a health think-tank, said there was a move to ensure more people were treated in primary care to keep them out of hospital and this could make it hard for hospitals.

"We have already seen hospital trusts running up deficits and this could get worse," a spokesman said.

And Dr Michael Dixon, of the NHS Alliance, which represents primary care, said many GPs were not completely convinced by what the government was trying to do and the way they were doing it.

'Win back'

"They need to win back clinicians, or it will not work," he added.

With regard to disease, much still remains to be done in tackling two of the three key health priorities.

The government is on course to meet its target of reducing the heart disease death rate by 2010 - although it was already on a downward spiral when ministers made the pledge five years ago.

However, the goal to bring five-year cancer survival rates up to European levels by 2010 is likely to prove more difficult. The UK is still below the European average and well behind Austria, which has the best rates.

And on public health, the fight is only just starting. Last autumn the white paper proposed a smoking ban in public places, but only where food is served.

Campaigners have said the proposal, along with measures to tackle obesity and binge drinking, was too soft.

And if all this is not enough, there is always the looming spectre of MRSA, which is linked to 1,000 deaths a year and was constantly exploited by the Tories in the election campaign.

All in all, the Ms Hewitt is in for a busy time.