NHS MERGERS Management and Mayhem By Roy Lilley and Eve Richardson Kogan Page 146 pages £14.99

At a time when there are so many provider merger proposals on the table that the centre cannot cope, Lilley and Richardson loudly proclaim: 'Look at everything before you resort to mergers.' At odds with the establishment as ever, they are seriously off-message. No one will heed them. The merger bandwagon is rolling and no one is big enough to apply the brake. Yet they have a point.

Mergers are a triumph of (re)organisation over management. Glossy consultation documents earnestly cite the benefits of mergers - largely a litany of spurious non-quantifiable patient benefits. But these documents are less revealing of the true costs - diversion from core business and the tireless pursuit of Mickey Mouse management savings. And less revealing of the real risk - that the respective weaknesses of the merging partners will outweigh their strengths and thus fatally wound the new organisation. Or, the authors declare, 'two turkeys don't make an eagle'.

As it is only the victors who write history, there is precious little in the way of any impartial, post hoc evaluations of mergers. Rather, the original rationale for a merger is obscured as time and the agenda moves on. The downside is glossed over. Lilley and Richardson are right to point the finger. Evidence-based medicine may be high on the health agenda, but evidence applied to management? Dream on.

NHS Mergers - management and mayhem is a curious little book. It is in part management textbook, in part the authors' grief-ridden personal recollections prompted by the demise of their own organisation when it fell victim to a merger in 1995. But the central core of the book is a checklist of questions which the authors assert must be answered by those embarking on a trust merger.

Yet the authors really do have to struggle to expand their checklist to '101 questions for managers', which gives the book its catchy subtitle. Many of the questions posed are fatuous, insulting the intelligence of any half-decent chief executive. Yet read on. As Lilley and Richardson observe, 'mergers are a dangerous pastime that have destroyed more organisations than they have built'. So ignore the checklist of questions at your peril, whatever its faults.

One is left to muse that, if mergers rarely succeed, why do we invariably aspire to accomplish them? For the surviving provider managers there is the promise of aggrandisement. For the health authority there is the surgical removal of£500,000 - the rule of thumb revenue cost of a trust board.

Even for the staff unaffected, there is sport to be had gossiping and speculating about who will get the top jobs.

Not much to set against the horrendously high opportunity costs. Without question, a trust would create more patient benefits and more bankable savings by tackling just one poorly performing, unproductive surgeon than from partnership in all but the most ambitious of mergers.

But then mergers 'are mostly a fig leaf to cover up for weak management unable to face tough decisions'. It is small comfort indeed that mergers in the commercial sector are no better conceived.

NHS Mergers - Management and Mayhem lacks structure and discipline (how does a short discourse on Lottery funding for the NHS get into the book about mergers? ). It is light on erudition and is just not quite practical enough for use as the definitive handbook on mergers. But it contains powerful home truths, the anti-merger arguments are persuasive, and it is tuned to the wavelength of the practising health service manager. Yes, you've guessed it. This is the quintessential Roy Lilley.

You'd better read it.