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This morning the prime minister's official spokesman said something important.

He was asked to comment on reports in the Financial Times that David Cameron was personally overseeing plans to prepare the NHS for a cold winter that could put pressure on accident and emergency departments.

The spokesman said this: "Is the PM working very closely with the Secretary of State for Health on health matters, with a particular focus on A&E? Absolutely he is doing that."

He was then asked if it was true that the prime minister had demanded weekly updates on how many people were being admitted to A&E. The spokesman replied: "Yeah, he does want to and he continues to be up-to-date with the very best and latest figures, including the A&E statistics."

So at a time when Labour is warning gloomily of what it calls a "winter crisis" in A&E, when some doctors are saying that emergency care is already under pressure, when some weather forecasters are predicting a bitterly cold snap as the gulf stream heads south, the prime minister has chosen to get personally involved.

As Sir Humphrey might have said, that is rather bold.

For it means that Mr Cameron will be seen to be making himself personally responsible for whatever happens in the NHS this winter. If anything goes wrong, he will not be able to blame his health advisers, his health secretary, his health secretary's advisers or even the health department as a whole. The buck will now stop in Number 10.

Government sources say it is all about the prime minister showing that he is taking the issue seriously, that he is focused on the operational details, that he cannot be accused of complacency.

But the former Labour Health Secretary Aneurin Bevan once said that in a centralised NHS the sound of a bedpan falling in his local hospital would reverberate in the Palace of Westminster.

And this winter, if A&E departments struggle to cope, it could be sound of patients complaining from trolleys that will reverberate in the corridors of Downing Street.