On Monday evening, Labour figures filed into Downing Street one by one, watched by cameras and narrated in real time by journalists guessing at what each arrival meant. By the time the doors closed on the last appointment, Andy Burnham had built something more consequential than a list of names. He had redrawn the map of power that will determine whether his own defining promise, to finally fix social care, survives contact with the government.

Yvette Cooper's appointment as Health and Social Care Secretary has already drawn the obvious commentary: a heavyweight brought back to a department she last worked in under Tony Blair, replacing a health secretary who lasted barely two months after Wes Streeting's abrupt departure. That churn matters. Three secretaries of state in as many months is not the foundation on which a ten-year plan gets delivered, and Cooper will need time in post that neither of her immediate predecessors was given. But the more revealing story sits outside the Department of Health and Social Care entirely, in appointments that will shape her chances of success whether or not she has any say over them.

Start with John Healey at the Treasury. Healey resigned as Defence Secretary last month accusing the Treasury of being unwilling to fund the defence investment his own department needed, a resignation letter in which a Treasury source was reported to have pointed at the NHS and schools budgets as the place the money would have to come from if defence got more. Healey now runs the department he blamed. Whether he treats health spending as the flexible reserve that funds other priorities, or whether his experience of being on the losing end of exactly that argument makes him more sympathetic to protecting it, will do more to shape NHS capital investment and workforce pay than anything Cooper says in a select committee appearance.

Then there is Shabana Mahmood, staying at the Home Office to continue an immigration crackdown Burnham backed during his by-election campaign. The NHS and social care sectors remain heavily reliant on international recruitment, and a tightening of both legal and illegal migration routes lands directly on staffing pipelines that are already strained, particularly in social care, where domestic recruitment has never come close to filling the gap. Angela Rayner's return to Housing touches the same problem from another angle. Delayed discharges are now costing the NHS some £2.7 billion a year, much of it driven by the absence of suitable housing and care packages for patients who are medically fit to leave hospital but have nowhere safe to go. Burnham has spoken of wanting social care to operate on an NHS principle, but that ambition runs straight through a housing brief he does not control directly.

Ellie Reeves's move to Attorney General, meanwhile, places her in the middle of a clinical negligence system that paid out £3.24 billion in the last financial year alone, with liabilities now estimated above £60 billion, one of the largest provisions on the government's balance sheet and a sum the Public Accounts Committee has repeatedly said the Department has failed to control. And Jonathan Reynolds inherits an expanded business department that now absorbs science and technology policy, a rebalancing that will matter to life sciences investment and health-tech procurement even though it sits well outside any conventional health brief.

None of this means Cooper's appointment is secondary to her own department. It means her department is no longer the only place where the fate of NHS reform gets decided. Burnham has assembled a cabinet built on personal loyalty and long political experience, which is precisely why it will be tested on whether that loyalty extends to letting colleagues in other departments absorb political pain on the NHS's behalf. Social care reform has defeated governments that promised less. This one has at least distributed the risk honestly, whether or not it did so on purpose.