Last-minute wrangling at the Department of Health over the shape of regional offices this week looked set to hold up a crucial document outlining NHS bodies' new roles and responsibilities under the Shifting the Balance of Power in the NHS reorganisation.
The publication date for the roles and responsibilities document - promised for the end of November - was still up in the air as ministers prepared to face a barrage of criticism over Shifting the Balance during the committee stage debate on the NHS Reform Bill this week.
Conservative MPs have tabled a series of amendments to replace 'strategic' health authorities with 'area'HAs throughout the bill, following shadow health secretary Dr Liam Fox's attack on the 'deluge of change' in the 'dangerously centralising' bill during last week's second reading debate.
Dr Fox pointed to primary care trusts' lack of management capacity, highlighting the fact that one in seven primary care groups and PCTs were still without a finance director.
Liberal Democrat health spokesman Dr Evan Harris, a member of the standing committee that will consider the legislation, branded the shake-up 'the emperor's new clothes'.
He told the Commons: 'It reflects a desire to be seen to be active in making changes to the structure, while the NHS continues to fail to deliver what patients deserve.' But reform 'for its own sake' was 'simply sabotage', he said.
A senior HSJ source said the roles and responsibilities document had gone through several drafts, with the new SHAs and regional offices jockeying for position and the role of the regional office - once set to be scrapped - being 'built back in'.
It now seems that the final document will show regions with their own sizeable offices and teams of staff.
One said the delay was 'to do with internal wrangling between people who believe in strategic health authorities and people who believe in regions'.
'Why would regional offices have performance-improvement staff? is not that what the Modernisation Agency is going to do? But they're going to have them.'
Such a move would represent a significant growth in remit for the four new health and social care regions, since the DoH launched its consultation on securing delivery of Shifting the Balance in September.
An annex on roles and responsibilities outlined the remit of PCTs, trusts and SHAs but excluded regions.
As the proposals stand, in addition to securing provision of primary care, PCTs will assume responsibility for pharmacy, optical and patient transport services as well as commissioning acute care and mental health services.
SHAs will be responsible for making sure local health communities meet an annual delivery agreement with the DoH and will hold trusts and PCTs to account through performance agreements.
In turn, the four regional directors of health and social care will performance-manage the SHAs.
SHA boards will include managers with specific responsibility for IT and for public health.
Approximately 60 candidates have been shortlisted for the 28 SHA chief executive jobs, having been through an assessment centre, panel interview and personal interview with NHS chief executive Nigel Crisp.
Thirty-five successful candidates are due to be selected within the next two weeks, allowing for a degree of 'succession planning'.