Managers have been promised jobs running new strategic health authorities in 'bar-room deals' even before consultation on the new bodies has started, HSJ sources have claimed.
Detailed guidance on the creation of SHAs has been postponed by the Department of Health to allow some additional 'finishing touches'.
Meanwhile sources claim that regional offices are pushing ahead to draw up new boundaries and promise chief executive jobs to NHS managers.
It is understood that several regions have already identified HA chief executives as project managers who would take on the new roles.
But one former manager told HSJ: 'I am worried that too much of this is being done on the basis of old boys who have done each other favours in the past.We definitely need to find the best 30 leaders in the NHS - that doesn't mean the 30 that are still able to stand in the bar together at four in the morning.'
Another HSJ source expressed concern about the apparent politicisation of the appointments process for executives now that steps have been taken to depoliticise non-executive appointments.
'The Department of Health is going through this process where they are picking out the people they see as the modernisers and putting them in as heads of the 30 SHAs now that they can't influence the chairs, ' he said.
The former manager said he feared chief executives who were not being singled out for the top jobs were reluctant to take up positions at primary care trusts, which they saw as a 'demotion'.
He said it was 'unfortunate' that among HA chief executives 'the perception of PCTs as a step down had failed to catch up with the reality'.
He said running an SHA was 'a job for someone in their forties, someone at the peak of their career' and that HA chief executives who had passed that stage might now look to opt out of the NHS altogether.
Two weeks ago, NHS chief executive Nigel Crisp told delegates at the NHS Confederation conference that Shifting the Balance of Power would be out within a week and the promise was repeated in the chief executives' bulletin of 6 July.
Yet despite facing strict government-imposed timetables to get the new SHAs up and running by next April, NHS senior managers responsible for implementing the reforms are still waiting.
A spokesperson for the Department of Health said the policy document would be available 'sometime at the beginning of next week' despite delegates at the conference being told that it was already at the printers.
The delay is causing concern among managers already facing time and workload pressures as well as the limited period available for consultation. A confederation spokesperson said: 'Any delay in publication reduces the time available for consultation and implementation of such a major organisational change.'
Stakeholder consultation on the SHAs is due to be completed by the end of August, with detail on the human resource procedures scheduled for the end of this month.
There is also continuing concern that, with a limited pool of top managers, trusts will lose valuable talent to the SHAs.