“In the crucial area of public service reform, we have found that Liberal Democrat and Conservative ideas are stronger combined… You have a united vision for the NHS that is truly radical: GPs with authority over commissioning… elections for your local NHS health board.”

So wrote David Cameron and Nick Clegg in the foreword to the coalition’s “programme for government” published on 20 May. Less than two months later the Liberal Democrat component - their flagship health proposal - has been scrapped.

What are the chances, as things stand, of enough management talent still being available?

Good thing too. HSJ advised against elections to boards during the campaign. But far more telling than the lack of influence the coalition’s junior partners have over health policy is the rapidity with which the government’s plans are forming and changing.

“Pace” is the key word, according to civil servants at the Department of the Health working on fleshing out the government’s programme. After seven years as shadow, health secretary Andrew Lansley is a man in a hurry.

He knows momentum is important in achieving public sector change, look at how Labour’s plans began to founder in the last few years.

But the price of pace is time spent working out the detail. The government’s plans still beg a multitude of questions and the timetable set out in Liberating the NHS means there is little scope for addressing them fully.

The new commander of US forces in Afghanistan General David Petraeus described his task as: “Building an advanced aircraft while it is in flight, while it is being designed and while it is being shot at.”

That is effectively the challenge the government has chosen for itself in reforming the NHS so rapidly.

The flak of course is being provided by the need to find £20bn of efficiencies while attempting widespread system change.

In one of its most euphemistic passages, the white paper declares: “SHAs and PCTs… should seek to devolve leadership of QIPP to emerging GP consortia… as rapidly as possible, wherever they are willing and able to take this on [our italics].”

The accompanying “analytical strategy paper” declares: “SHAs and PCTs will cease to exist, but there will be a reliance on them in the short term around both managing the transition period and delivering ongoing efficiency savings.”

The very last paragraph of the white paper makes a plea to retain the managerial talent it will need to meet this challenge: “There will be opportunities for managers to help build a more innovative and responsive NHS”.

However, the roles they suggest - “managing finance and contracts” - are a relatively small part of the task ahead and, wilfully perhaps, misunderstands the breadth of the management contribution.

This is a problem because, as the white paper covertly recognises, primary care trusts are still likely to have a role well into 2013, the intended date for achieving the efficiency targets. By then, the areas still left to convert to the new system will be the most problematic - and will therefore require the most skilled management input.

But what are the chances, as things stand, of enough management talent still being available? For most, the lure of the relatively secure provider sector or the more lucrative consultancy business will have proven too strong.

The day after the white paper was published, Julia Manning, chief executive of right-leaning think tank 2020health, wrote: “The reality is that no GP consortium will be able to deliver improved care without good management… There are many good people for whom today is a lot more uncertain than yesterday and without whom we would not have seen many of the improvements that have been achieved. The NHS will never be perfect, but it cannot thrive without good management, and they did not receive justice yesterday.

We could not have put it better ourselves.