I would like to take issue with your editorial on mergers, 'Upheaval, mayhem, poor morale and for what?' (comment, 21 January).

Your perspective was at best one-dimensional, focusing on management cost-reduction and economy of scale issues. Without doubt, this taps the rich vein of organisational angst that routinely grips the NHS at times of major change, but it also misses some of the point.

Speaking as a health service manager with experience in steering organisational and service change, other issues are at stake, such as:

Creating organisational frameworks that facilitate service reconfigurations which can deliver quality services and educational infrastructures that are fit for the 21st century. Can we really suggest that current structures, particularly in acute services, are capable of doing this?

Breaking down the artificial barriers that are an endemic feature of current structures, so that whole-systems thinking and patient-centred systems can be effectively developed.

Creating new and exciting opportunities for the workforce to be developed in the context of larger systems providing greater flexibility for redesign, redeployment, recruitment and retention.

If at the same time management costs and overheads can be reduced in the interests of patients and the public purse, all the better.

Stephen Eames

Chief executive

Acute Services

West Hertfordshire