"Andrew Lansley has, within a week, become the Frank Dobson of the Tory party." So quipped Paul Corrigan on his blog this week after hearing the news that the coalition health secretary had called a halt to Labour's long-gestated plans to reconfigure the NHS in London. What did he mean? Presumably that Lansley, for all his modernising rhetoric on health reform, is just another weak-willed sentimentalist. That may be very unfair on Dobson, by the way.

Corrigan, who was health policy advisor to health secretaries Milburn and Reid, as well as prime minister Blair, followed that up with a more thoughtful posting yesterday. Lansley's decision, he argued, highlighted a massive contradiction at the heart of the Conservative party that will "tear [coalition] health policy apart within two years."

"Lansley has taken political control of hospital change because he believes that the NHS has been reckless with these vital institutions. He feels, as a good Conservative, that closing a maternity ward or an A and E department is a wanton destruction of a part of the community, and for these reasons will not countenance their closure. So does his boss David Cameron. They think that in wanting to close hospitals 'NHS bosses' have been playing fast and loose with the national heritage and they won't have it. Both also believe that the NHS needs many more market interventions to increase efficiency and bring about quicker change. They think that the modern world they want to create will work much better with much more movement and change driving the NHS. They think that NHS bosses have been resisting the development of these modern changes."

Wanting to unleash the markets and mask the effects of markets at the same time, says Corrigan, is simply unsustainable:

"Obviously over a five year period this creates a very unstable situation and the sweepstake doing the rounds at the moment is betting on the exact date when the NHS goes bankrupt - since it will not have enough money to keep redundant wards open. This contradiction cannot last. You cannot pile a great deal more movement into the drivers of the system and then hold still one of the main outcomes of all of that change. For example if you correctly follow the policy of "any willing provider" and more non-NHS providers come into the system, then by definition there will be less work for NHS hospitals - and you have to do something with that empty capacity. Leave it there doing nothing and it burns up your money."

Stopping closures of hospitals and A&E departments has always been a favoured option of politicians in tight corners. You may recall that a few days before the general election the former health secretary Andy Burnham called a halt to (hugely unpopular plans) to downgrade the casualty department at the Whittington hospital in north London. Labour may well have hung onto south Islington as a result.

Lansley doesn't have an election to fight, but he has election promises to keep, and coalition agreements to follow. The Lib Con policy statement on the NHS promises to "stop the centrally dictated closure of A&E and maternity wards, so that people have better access to local services". In a Department of Health press release Lansley explains why:

"We are committed to devolving power to local communities - to the people, patients, GPs and councils who are best placed to determine the nature of their local NHS services. Local decision-making is essential to improve outcomes for patients and drive up quality."

In future, he says, NHS reconfiguration plans have to meet four criteria. They must: focus on improving patient outcomes; consider patient choice; have support from GP commissioners; and be based on sound clinical evidence.

This suggests the NHS - seeking £20bn in efficiency savings - must now revisit its reconfiguration plans. It's not immediately clear to me why the plans already developed by Labour peer Lord Darzi, at the cost of many millions dramatically fail any of those those criteria.

Significant medical and patient support exists for reform. In the past few weeks, a group of senior doctors from the royal medical colleges (representing two thirds of doctors, including GPs but not A&E doctors) and a leading Patient Voice organisation (representing 15 million patients) have each made clear that hospital mergers and closures must happen because there is clinical evidence that it will improve care, and save lives. Both are convinced that a "no change" policy is financially unsustainable.

Blogger James Gubbs at the right of centre think tank Civitas is baffled by Lansley's position:

The problem is that these 'centrally dictated closures' are predominantly decisions of Primary Care Trusts – or coalitions of them working under Strategic Health Authority umbrellas – the local commissioners that the coalition want to otherwise empower. The central direction by and large has not come from the DH or government. But now it is: to keep them open, apparently regardless of their quality and viability.

So what's the cost? Sally Gainsbury at Health Service Journal alerted me via Twitter to NHS London's affordability study of the Darzi reconfiguration plans, published with brilliant timing yesterday - the day Lansley announced he'd scrapped them. The report essentially says that the NHS as currently constituted in the capital is unaffordable, and the only realistic way of filling a projected affordability gap of between £1.7bn and £2.7bn is by - you guessed it - reconfiguring services.

One could read the timing of the NHS London report as an exasperated two fingers from the NHS to Lansley. As Gainsbury argues in a subsequent tweet:

"Basically they are telling the Secretary of State [Lansley] "here's our hole, you find another way of filling it".

It's hard not to disagree with Corrigan about where this is taking us. He concludes:

"They [The Tories] want to be really radical change agents and they thrill to those changes brought about by empowered consumers and markets. They want to hold certain institutions still as they are a part of the rich fabric of our society. What will become clear – in between 18 months and 2 years time – is that markets create change; changes create successes and failures; and some hospitals will fail and will have to close."

I liked ...

"ihobo" homelessness phone app created for the Depaul UK charity is persuading rival charity Shelter to take out a sponsored link on the ihobo google search results page

"So many people have been using the app that no single server was big enough to keep up with it."

Philanthrocapitalism's revelation that big society big cheese Nat Wei is three times cleverer than Universities minister David "Two brains" Willetts:

"One encouraging sign has been the appointment of the ferociously clever Nat Wei as the government's lead adviser... (Known by some of his colleagues as 'Seven Brains', his elevation to the peerage presumably means that he will now have to be called 'Lord Seven Brains'.)"

Rick at FlipChart Fairy Tales on the Coalition's "pretend localism":

"Just seen the new coalition's programme for government. It reminds me of those attempts to consolidate all the outputs from a management away day. All the groups write overlapping or contradictory ideas on flipcharts then some poor sod has to write them all up and make sense of them. Invariably, that person gives up and just summarises each flipchart one after the other, removing any obvious howlers and hoping that no-one will notice the rest."

New Philanthropy Capital's Martin Brookes' four part 'to-do' list for civil society minister Nick Hurd, including this call for a Charities' Data Act:

"Information sharing speeds up learning and improves practices. If such data was available, it would improve accountability, help decision-making by charities, make donors better informed, and enable public sector funders to allocate their scarce resources more effectively. In short, the public benefit delivered by charities would be greater. Of course, there will be some exceptions where questions of confidentiality, whether commercial or personal, override the need to publish. These should, though, form the exceptions, not the rule. Without good reason not to do so, charities should be compelled to share their data with the public."

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