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NHS management continue to delude themselves that big mergers and or shared services are the answer to the Nicholson challenge. Look at South London healthcare Trust (as 1 of many examples) - has the merger of troubled trusts led to an improvement or worsening of the situation.

The problem in the NHS acute sector is around poor process as a consequence of poor management, poorly aligned incentives, low staff morale etc. the NHS should focus on the root cause problems, not look for a false silver bullet in mergers like this