In a spectacular exclusive with major policy implications, HSJ states that Health Secretary Andrew Lansley plans to abolish England's 10 strategic health authorities (SHAs) by April 2010, once his national commissioning board is established.

This policy was a Liberal Democrat manifesto commitment.

The story suggesst that not all the SHAs' 3,752 non-medical staff would be signing on directly: some might work at new GP commissiong consortia; others at "new regional offices of the independent commissioning board".

Abolishing the intermediate tier, only to reinvent it with a new name
Do you see what they did there?

They did a nice eye-catching, age-of-austerity abolition of bodies that don't deliver front-line care (but do have an important role in training). So far, so zeitgeist.

(You wonder why the NHS has always had an intermediate tier over the past few decades, of course.)

But then, they immediately reinvent the intermediate tier under a new guise.

Given the blinding success of attempts at intelligent design of NHS restructurings of recent years, the attractions of an evolutionary approach clearly escape Mr Lansley.

Decentralising the NHS is a good idea.

Redisorganising structures, with all the attendant opportunity costs, is not.

Ladies and gentlemen, the game is musical chairs. The stakes are high.

Faites vos jeux, messieurs-dames!