Health authorities are speeding up merger plans in an immediate response to health secretary Alan Milburn's announcement of a dramatic reduction in HA numbers.
The pace of reorganisation in the wake of Mr Milburn's announcement was described as 'sending shockwaves' through the organisation by one health service manager in east London. There, a merger planned between Barking and Havering HA and Redbridge and Waltham Forest HA now also looks set to include East London and the City.
'We were doing a two-way merger, but really on the grapevine We have heard We are also merging with ELCHA, ' he told HSJ.
The manager said there was 'a logic' to the plan to create a single HA for the eastern sector of the capital, but he added:
'It is a question of pace. ' The timetable would 'really hit people hard', he said.
'There is a rather unsolid base - It is going to put a heck of a lot of pressure on primary care trusts that are not in a position to take that pressure. They're very fragile.
They just can't do it. '
He added: 'There is no recognition of the demoralised state [of HA staff]. '
Although an eventual move to sectors in London was possible, 'there was no thought that anything would happen before the election'. But project teams for a three-way merger are now being set up.
Sue Osborne, chief executive at Barking and Havering HA, confirmed that plans for a three-way merger were now being discussed.
'We think It is not unexpected and It is just slightly speeding up what we were doing anyway. '
Her HA is already tendering for a support service to prepare staff for transfer, which will include providing a helpline and personal development planning for all staff.
In west London, moves for a merger have also accelerated. A Brent and Harrow HA spokesperson said it would merge with Ealing, Hammersmith and Hounslow HA, Hillingdon HA and Kensington, Chelsea and Westminister.
Chief executives had been working to a longer-term timetable with a number of options being considered. Since the health secretary's announcement, chief executives had met to see how quickly they could move towards one large-scale merger.
A spokesperson for the North West regional office said Mr Milburn's announcement had confirmed 'we were travelling in the right direction'.
The region, currently with 16 HAs, had been conducting reviews of its structure in two zones - Greater Manchester and Lancashire and south Cumbria - before the announcement. 'If anything, It is speeded up our look at the Mersey and Cheshire zone. '
The final configuration could be as few as three HAs, although plans will depend on the outcome of the reviews.
Unison health group national officer Roy Paterson said: 'I think the message from the centre is going to increase the pace of change. Our concern is the pace of change should meet local circumstances. '
The union had already called on the Department of Health to set up a national project team to look at how the process of change could be managed to make sure the NHS did not lose the skills and experience of staff, he said.