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When Jeremy Hunt was appointed health secretary - almost exactly a year ago - the assumption was that he would try to keep the NHS out of the headlines.

After the row over his predecessor Andrew Lansley's reforms it seemed like he would be the safe pair of hands, just as Alan Johnson was for Labour when he replaced Patricia Hewitt following the deficit problems of the mid-2000s.

But that could not be further from the truth.

Certainly, since the start of this year he has, if anything, been trying to make the headlines.

There has been a blizzard of announcements from placing failing hospitals into special measures to creating a £500m A&E bailout fund.

Along the way, he has picked a fight with GPs, saying the idea of a family doctoring has been lost - a move which prompted BMA GP leader Dr Laurence Buckman to accuse him of "spouting rubbish".

But the scale of activity does not stop there.

On Tuesday, he sat in a press briefing alongside four of the most powerful people in the NHS in England - chief medical officer Dame Sally Davies, medical director Prof Sir Bruce Keogh, chief operating officer Dame Barbara Hakin and Care Services Minister Norman Lamb - to hammer home his vision for the health service.

It includes what his press team was describing as the most significant review of emergency care since the 1960s, improvements in IT and - possibly - major changes to the way GPs work.

This is on top of a government which is already pushing ahead with reform of the social care system by introducing a cap on fees in 2016.

There is plenty of debate about how truly radical these steps are, but what cannot be disputed is the fact that the health secretary is trying to make waves.

And this is happening following reforms which were meant to take the health secretary away from day-to-day micromanagement of the health service.

So why is he doing this? According to those close to him, it is simple.

He wants to be on the front foot. His team recognise that Labour sees the NHS as a weak link and will be doing their best to rubbish the government's record since 2010.

And they are not wrong. The opposition - with former health secretary Andy Burnham taking the lead - is determined to make the NHS one of the key election issues.

The shadow health secretary was on the attack on Tuesday, tabling an urgent question on A&E just as Mr Hunt was preparing to address journalists.

He accused Mr Hunt of trying to dodge responsibility and coming up with "half-baked plans".

And this is just the start.

The election is still over 18 months away - that is two winters of potential A&E crises and enough time for plenty more trouble in terms of finances, cuts to services and failings in care.

Chris Ham, chief executive of the King's Fund think-tank, believes the proactive approach taken by Mr Hunt is understandable.

"It will be a minor miracle if we get through the next two winters without problems and so Jeremy Hunt does not want to be seen as the health secretary who sat back when the flames were at their fiercest.

"And the government is vulnerable as two to three years were taken up by the Lansley reforms which no-one saw coming. Most independent people would say the government made a strategic error there."

The shouting is here to stay, it seems.