Before last weekend’s manure hit the coalition fan I had taken the trouble to dig out the Orange Book for further scrutiny. No, not the widely consulted guide to generic drugs, but the volume of essays published by the free market wing of the Liberal Democrat party. It caused so much trouble in 2004.

Why re-read it? Because the chapter on desirable health reforms was written by David Laws, shiny new chief secretary to the Treasury who had just made such a polished Commons debut defending the first round of coalition cuts.

But a week in politics is a long time, as the old cliché constantly reminds us. Laws is gone, a victim of what I thought was a mean attack by the Telegraph for an avoidably rule-breaking expenses claim that was motivated by privacy rather than money.

In any case my attention had already been diverted to another resignation, one that got rather less attention than Laws - that of Sir Richard Sykes as chair of NHS London.

You’ve read about it on and elsewhere. But it got less media attention than would be the case if the new government were at a more careworn stage of the cycle - for instance if someone like Sykes had abandoned the Labour government, not the brand new one.

That’s life and the coalition is entitled to its honeymoon. But Richard Sykes is not any old quango chief walking out in a huff over a ministerial policy shift. He’s a proper scientist who also managed to become chairman of GlaxoSmithKline. It’s one of the world’s major pharma companies, for heaven’s sake.

Sykes is a quangocrat, too, a past president of the British Association for the Advancement of Science. He’s even got a medal from those hard-nosed folk who run Singapore. If that’s not enough, between 2001-08 he was £300,000-a-year rector of high-tech Imperial College, usually up there in the world’s top 25 universities along with Oxbridge (natch) and UCL, with which he cheekily tried to merge Imperial in 2004.

In other words, Sykes is a major league player who, at 66, accepted the NHS London job, probably at the behest of Ara Darzi, whom he will have known well. If you recall, Darzi wrote the blueprint for reorganising the capital’s less-than-perfect NHS; Sykes, the corporate big beast, undertook to do it and strangle that looming £5bn deficit.

Other than to report that he likes to have his way, I’m afraid I can shed no further light yet on why Sykes and Andrew Lansley clashed so soon. But the exchange of letters is sharp. “No sense in trying when our visions are so different,” wrote Sykes. No-one should “dictate” London health decisions, replied Lansley. Calm down, dears, as Michael Winner likes to put it.

But Lansley made clear in halting London’s plans that greater consensus is needed, requiring patients, GPs, even councils. During the campaign he promised to reverse ward closures, too. His populist tone made me nervous then and still does.

It’s not as if Sykes is some bleeding heart liberal. He’s chair of Reform, the pro-market think tank whose zeal also periodically scares me.

And bless my soul, he has also urged a lifting of the £3,000 cap on student tuition fees - a hard-nosed decision the coalition looks set to take.

Tory friends have not rushed to explain this one. Labour insiders tell me: “Lansley is going to need a proper policy on NHS reconfiguration pretty soon or he’ll have very little credibility with the HSJ-reading classes.”

Quite so. This is a big blow. Or was until Laws went, too.