The honeymoon period, if such a thing can exist for the head of an organisation that represents NHS health authorities and trusts, appears to be still very much on for Gill Morgan, chief executive of the NHS Confederation.

Three months into the job, Morgan has no regrets about leaving behind day-to-day NHS management, or taking on the weekly commute from her home in Exeter. "It's absolutely fantastic," she says. "I wake up and I think, 'People are paying me for this!'"

Her enthusiasm is understandable. Two years into radical but delicately-poised NHS reforms, and two months after the Budget heralded record investment in the health service, there has probably never been a more exciting time to be leader of the body representing NHS agencies. "I see this as a real opportunity to shape things and talk about the things I care about," says Morgan, 48, with an earnestness not too often heard from battle-hardened NHS managers like herself. "It's an important time for the service, because we have to deliver. There is no place to hide."

She has spent much of her first weeks travelling widely, meeting confederation members all over the country, listening to "the things that are on people's minds, the whinges, the challenges".

So far so good. But the confederation's annual conference, which opens today in Harrogate, will be looking for Morgan to be more than a good listener. Delegates will want to know if she can make the health secretary listen.

At a time when the NHS has the prospect of more money than ever before, but also faces the stresses of tumultuous reform, the burden of endless performance targets and a nervous, controlling government, it is seen by many as crucial that the confederation provides a strong, sceptical and authoritative voice.

"Will she have the balls to slag off [health secretary Alan] Milburn on the Today programme?" was one comment made at the time of her appointment. "She's too polite, too rational, too 'establishment'," it was claimed.

It is fair to say that "slagging", and soundbites, are not Morgan's style. Her supporters talk warmly of her experience (she spent 19 years as a GP and public health doctor before becoming chief executive of the former North and East Devon health authority in 1995), her wide contacts, networking skills and political acumen.

And while there have been no early-morning fireworks on Radio 4, the confederation has been gently formulating a comprehensive critique of Labour's "new NHS". Policy documents released today question the government's reliance on structural change; its obsession with inspection; its passion for (often counter-productive) targets such as waiting lists; and its reluctance to give managers freedom at local level to take risks.

"Targets are not the be-all and end-all," says Morgan. "The problem is that there are too many negative targets, such as waiting lists; there's nothing that looks at how you might improve the service. How do we build the service around patients, for example? And by that I don't mean simply having no one on an over 15-month waiting list."

Managers, she says, need respite from "the all-consuming targets". Of course, it is politically difficult to let local leaders off the leash, and even tougher occasionally to watch them fail. But it may be essential if the NHS is to develop.

Ministers need patience, Morgan argues. She is confident that the health service will deliver the reforms and improvements envisaged in the NHS plan. But she also believes it will be "eight or nine years" before most people begin to appreciate the difference.

"I think ministers know they have got to give us space," she says. "There's a need for a real act of faith at some point, to let people innovate and experiment."

The government will answer that it has devolved money and decision-making to local level; it has created primary care trusts to bring the NHS closer to its communities; and it has talked of top-performing trusts being given "foundation" status - meaning unprecedented freedom to control their own affairs.

Morgan is impressed, but not convinced. The service, she says, has "real doubts" about how foundation status would work. She wants a genuine - rather than a rhetorical - engagement with local management. "They [ministers] have to make devolution a reality," she says. "Then the conditions will be there for the service to respond."

She is happy with the confederation's recent success, as the NHS employers' organisation, in negotiating a new GP contract with the British Medical Association. She initially believed the confederation was wrong to get involved - thinking it would make it too closely identified with the government. Now she would be pleased to see the confederation get more involved in similar contract negotiations - but not without the support of members.

Keeping her "finger on the pulse" of NHS management is her aim. "And if I can't represent those views," she concludes, "then Gill Morgan has no role."