Patricia Hewitt and other ministers have privately conceded that the government is in real difficulty over its efforts to sell controversial health reforms, a minute of a private briefing reveals.

At a brainstorming on the future of the NHS between the health secretary and ministers last Thursday, some raised anxieties about the way the reforms were being presented to the public. "Too often the debate on public service reforms seemed to pitch the government against frontline staff," said the minute, which was marked restricted.

One unnamed minister warned Ms Hewitt that financial pressures were mounting too.

This was because "increasing life expectancy and medical advances would lead to new pressures, which would need to be reconciled with the public's expectations about taxation".

The minute reveals that Ms Hewitt admitted that the government needed to "be smarter about communications".

She said the government needed to involve senior NHS staff to help make the case for change. "Where clinicians are prepared to make the arguments for reform, it can have a high impact," she told the meeting.

She said it was also necessary "to involve the public and patients through patient panels, working with local MPs so they focus on ensuring the best health outcomes for their constituents rather than the number of beds, pursue value for money through shorter hospital stays which the evidence shows can often result in better health outcomes as well as savings".

The minute also shows that Ms Hewitt told ministers she was determined to press on with the reform, despite the criticisms from colleagues.

The meeting was part of a frank debate being led by Downing Street and the Treasury into the future direction of all government policy. She argued that "it was true there would always be clinicians and frontline workers who did not welcome reforms, but the government has to take on the argument and win over NHS staff and the public".

The situation has become so acute that Ms Hewitt has staked her ministerial position on returning the NHS in England to financial balance by the end of March.

The health secretary will adopt a tougher approach today when she launches a counter-attack against campaigners across England who are protesting about proposals to close key facilities at NHS hospitals.

She will parade medical experts who are convinced that hundreds of lives could be saved every year if the NHS reorganised to provide specialist care in a small number of regional centres.

Five weeks ago the Guardian identified more than 50 campaigns against proposed or rumoured closures that are building up into the most widespread and prolonged unrest since the poll tax revolt in 1990.

Most of the campaigns present the closures as an economy measure to eliminate NHS overspending. Ms Hewitt will argue that her plans for restructuring the NHS are driven by the need to save lives, not money.

She will also present reports by Sir George Alberti, the government's emergency care tsar, and Roger Boyle, the heart disease tsar, calling for patients with the most serious conditions to be treated in specialist centres.

Sir George is expected to back proposals from the Royal College of Surgeons and other senior clinicians for "super-regional" A&E departments serving populations of between 400,000 and 500,000.

These plans imply that 50 or more of the existing A&Es might be downgraded into urgent care clinics providing a less comprehensive service.

Ms Hewitt is expected to stress, however, that the changes should not be imposed from the centre.

Local NHS managers should seek agreement with their hospital consultants and GPs on solutions that fit the local geography and health needs, avoiding excessive ambulance journey times for people in sparsely populated rural areas.

A Department of Health spokeswoman said: "Very few of 18.5 million people who attend A&E departments have life-threatening conditions.

"Many are just in pain, while others are just uncertain. For these people it is better to offer more convenient and appropriate care closer to home.

"But patients in a critical life-threatening emergency needed to be taken to super regional A&E departments with 24-hour consultant cover and access to state-of-the-art diagnostic equipment."

Lives could be saved if heart attack patients drove past the local hospital and went straight to a specialist centre for angioplasty, a new keyhole treatment for narrowed and blocked arteries. But not every hospital could justify employing the expert surgical team required to carry out the procedure.