By Mark Easton BBC home editor

Tony Blair has met with local NHS bosses at Downing Street. He conceded that some parts of the health service faced big challenges but pledged to push on with reform.

The issue is one of perception.

The drip, drip of bad publicity - cuts, cancellations, closures - undermines the government message of reform, progress and improvement.

It matters.

And not just in a short-term political sense with local elections just a few weeks away.

The health service needs to have public confidence - after all it pays enough for it, some �84bn this year and �92bn next.

So Tony Blair moved the health 'seminar' from a functional conference room at the Department of Health to the glittering grandeur of a Downing Street state room.

He had taken control.

'Tremendous progress'

Next step; to find the language which acknowledged the problem without making it look more like a crisis.

The word is challenge.

"It will be a challenging year but it is a challenge we have to meet," the Prime Minister said.

Mr Blair's nightmare must be that the political sands will run out before the public can be convinced Blair to press on with reforms

Some trusts are "financially challenged", we must "take difficult decisions to meet the challenges".

Last step, contextualise.

Mr Blair kept saying that overall it is a story of "massive improvement" with "tremendous progress" as "we re-engineer the whole health service".

The deficit is equivalent to less than 1% of the NHS budget "which equates", a Downing Street briefing note helpfully explains, "to a nurse earning �20,000 pa running up a �200 overdraft over the year".

An aide described the current situation as mere "turbulence".

Legacy thing

Critics, of course, paint a very different picture.

Seven thousand health jobs in jeopardy is a consequence, not of turbulence, but gross mismanagement resulting in the wasting of billions of pounds of taxpayers' money, they say.

After nine years in office and with five years of their 10-year plan already completed, there must be questions as to how the government has allowed what they must have imagined would have been a "good news story" to become something of a political liability.

The meeting with local NHS bosses was moved to Downing Street

Mr Blair acknowledged that some financial decisions should have been taken earlier to avoid the problems now.

Did he accept the blame for that?

"There is a collective responsibility", he replied.

Did he realise when he agreed to spend the extra billion on the NHS that 40-50% of the money being put in for services would go straight out again in the wage packets of staff?

"Yes," he told me.

So what about GPs earning �250,000 a year, as recently reported - was that a good use of public money?

"I think it is absolutely the right thing to do, to invest in staff," Mr Blair said.

"We have put the money in but in return we expect the reform."

The Prime Minister will not want to leave Number 10 until the country comes to believe that the NHS, as he puts it, "has been transformed into a service fit for the 21st century".

It is the legacy thing.

A recent survey by ICM found a majority of people thought all the extra money had made no difference.