Published: 19/08/2004, Volume II4, No. 5919 Page 20

The Department of Health's arm's length body review was a sensible rationalisation of the bodies supporting health, and if the management change process is handled carefully it could bring real benefits to the NHS (news, page 8, 29 July).

However, the NHS Confederation is concerned about the decision to merge the National Clinical Assessment Authority with the National Patient Safety Agency. We already find it hard to encourage clinicians to report errors, and bringing the NCAA, which deals with problems of clinicians' performance, under the same umbrella will make it more so.

The review makes it clear there will be a separation between the two areas of work, but this is an issue where perception among clinicians is more important than the reality of internal management systems. It could undermine the NPSA when it is pushing forward an important agenda in encouraging the NHS to learn from errors.

Dr Gill Morgan Chief executive NHS Confederation