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What appears s to be missing is a coherent plan to migrate from the old structure to the new (as yet unclear) structure. The word chaos is not out of keeping here. In addition not only are some of the redundancy costs going to be concealed but there is a negative multiplier effect of so many put out of work and the increased total public expenditure account. In simple cash flow terms the NHS will be worse off across two financial years and the total public sector for longer assuming, of course, the jobs are now not needed!!