The London Ambulance Service is infamous for dropping bombshells, we remarked four years ago when it appointed the then chief executive of Gloucestershire county council as its top manager. It dropped another last week when it announced that same chief executive's abrupt departure.
Michael Honey's resignation was a surprise despite LAS's persistent problems. It came only five days after a Court of Appeal ruling that LAS must pay six-figure compensation to a patient brain-damaged as a result of a delay in getting her an ambulance. But observers did not believe that to be a significant factor in Mr Honey's decision to go - which appears to have been heavily encouraged by LAS chair Sigurd Reinton.
Consensus soon had it that Mr Honey had been ineffectual in winning extra money for LAS, now judged to be at the root of its remaining problems. If that is the reason for his departure it is an indication of how much the health service has changed since 1996, when managing within existing resources and making annual efficiency savings were every trust chief executive's top priorities. In a service aspiring to European health spending levels, it looks like chief executives will have now to prove above all else that they can bring home a generous portion of the bacon for their organisation.
Despite the manner of his leaving, Mr Honey's incumbency has not been a barren one. As an outsider entering one of the NHS's most unforgiving environments, he has some creditable achievements to add to his CV. Sure, by the time he joined, matters had already improved greatly from the nadir of the notorious computer crash of 1992.
But it was he who saw through the successful implementation of priority despatch and ensured no millennium eve disasters. LAS staff have acquitted themselves well at major emergencies such as the Paddington rail crash. And its finance department received an important accolade in H S J 's Health Management Awards last year. All this while demand has risen 50 per cent in 10 years. As rumours of Mr Honey's imminent resignation filtered out, none of LAS's old adversaries - unions and the capital's pressure groups - were crowing, as once they might about another chief executive biting the dust.
Yet response times have stubbornly resisted much improvement. LAS reaches 90 per cent of calls within 14 minutes, about the same as four years ago and 5 per cent short of target. It is frequently tetchy in the face of criticism, arguing it is seldom given credit for improvements - a ploy which perhaps distracted attention from its problems but may account for some of the surprise at Mr Honey's resignation.
Whatever the reasoning which concluded that Mr Honey was not part of the solution to those problems, his successor will face one of the toughest assignments in NHS management. The capital's ambulance service ought to epitomise excellence; it has a long way yet to go.