NHS London chair Sir Richard Sykes has resigned over Health Secretary Andrew Lansley's over-ruling of the Healthcare For London reconfiguration plans, the Evening Standard reveals.

Sykes' letter of resignation to Lansley states that the resignation is prompted because “our visions of healthcare delivery bear so little in common”. It also says that other NHS London board members are also “considering their positions”.

Sykes will not be out of work for long. The bigger question is about how political the replacement appointment can be ... or whether there will be a substantive replacement, given recent announcements.

NHS London has significant problems - many hospitals, many PCTs and of course media attention galore. It wasn't just Lansley who was campaigning on keeping everything open, of course (although he was).

Perhaps Lansley has a few quid on NHS London beating NHS West Midlands to the 'first bankrupt health economy' prize?

UPDATE: HSJ has the text of Lansley's reply to Sykes. It is very curious.

Lansley writes that "many of the things achieved through the Healthcare for London programme are entirely consistent with my vision for improved healthcare". Which raises the question why he did not order the HFL programme to be reviewed, rather than cancelled. Reinventing minor bits of the wheel is not what the Age Of Austerity requires.

Lansley's suggestion that "decisions that patients make through choice, and which GPs make through commissioning, should not be pre-empted from on high" fits with his stated intention of decentralising policy.

Nonetheless, it prompts a question: what's the point of setting an a la carte menu in front of an NHS due to save £20 billion over three years, and cut 1/3 of management costs?

The concept that the soon-to-be-abolished SHAs are now meant to "set out a range of innovative and challenging solutions for how to improve the quality of care and outcomes for patients and service users" gives them the job of a waiter in one of those quaintly sexist, old-school restaurant, presenting the woman with a menu without prices.

The Age Of Austerity means the set menu, Andrew.

Lansley also suggests that London has "the opportunity to lead the NHS in the future development of quality improvement strategies, with NHS London supporting the decisions made in each area across London".

Lansley thus regards an SHA's (temporary) role to be that of allowing and enabling a thousand flowers to bloom. That's not an intermediate tier management function; it's a rubber stamp.