As another ex-nurse, I write in response to N Brown's letter (22 January) about the amount of money spent on chief executives.

One example of such waste is in East London and the City, which has six trust chief executives.

As there are two teaching hospitals in the group, one logical move would be to merge management of the Homerton with St Bartholomew's Hospital, and Newham General with the Royal London Hospital. As well as cost reduction, the other huge advantage would be to redress dire recruitment problems at Homerton and Newham.

It would be gratifying if the London strategic review panel thought to take an overall view of these problems, and recommended such a suggestion to the government.

East London and the City HA's responsibility is to improve health services to those in its area. This would be a good way of doing it.

Ann Toms,

Berwickshire.