First, in April, came the “pause” in the passage of the Health Bill. Then the “listening exercise” and the appointment of the NHS Future Forum. And, along the way, the Liberal Democrats’ humiliation in the May elections.

Now the schedule for health secretary Andrew Lansley’s legislation is again in question.

In practice, however, two parallel NHS reform processes have been running during the past year. There’s the one Nick Clegg seeks to restrain: the process of white paper and bill, of competition and GP consortia. And there’s another, driven by hard economics, which rolls remorselessly ahead. That’s the process of £20bn savings by 2014-15, of 2 per cent of funding withheld by strategic health authorities to fund the pay-offs, and – crucially – of a one third reduction in NHS “superstructure” costs by 2014-15.

There’s no “pause” in the quest for savings. The pace of the finance led reforms was set last summer when the government announced the demise of primary care trusts and strategic health authorities. In recessionary times, fear, uncertainty and the wish to survive have their own logic.

When the final 2010-11 NHS accounts are published, it will be interesting to see exactly how much managerial redundancy, early retirement packages and mutually agreed resignation scheme deals have already cost the Department of Health. Including, naturally, the transfer of more than £10bn of PCT-provided services – the essential enabling stage of the PCT cull. Certainly there are fewer managers now waiting to be swept away.

With GP consortia taking shape, further delay may now cost more in double-running costs. Will that one third target reduction in “superstructure” costs flex enough to pay the extra salaries? Answers on a postcard, please.

Besides, change on this scale gathers a momentum of its own. Yes, we could yet retain PCT clusters beyond April 2013. But that supposes PCT managers will stick around. And why would they?