In the absence of a viable shipbuilding industry, the reconfiguration of Newcastle's primary and mental health services is surely the biggest thing to hit the Tyne for years.
From 1 April, Newcastle City Health trust ceases to exist and in its place will be a new merged mental health trust covering Newcastle, North Tyneside and Northumberland, together with a single Newcastle-wide primary care trust replacing the three existing primary care groups.
The process of forming one PCT and moving to a much bigger mental health trust has been discussed for the past two years, and the end of this month sees the culmination of that process. The restructuring has included mental health, community services, neurodisability services, children's services and older people's services. What the managers are proud of is that much of this has been achieved by a restructured management team since November.
City trust chief executive Yasmin Chaudhry has been in charge since November, following the departure of previous chief executive Lionel Joyce. The first thing she did was to change completely the management structures so that senior managers who had previously been in charge of clinical programmes became operational directors for the transition process.
According to Ms Chaudhry, the management team had previously been working as individuals and not as a team. What was needed was to start working together, and from their point of view it seems to have worked. This seems to be borne out by staff in the trust, although the legacy of bitter staff management relations going back over several years will not be forgotten so easily.
Ms Chaudhry says: 'My challenge was to deliver the transition and to make sure the people issues were dealt with. I am a great believer in giving people a chance and I am amazed that everyone has delivered. I gave the directors autonomy to deliver. '
She says one of the key things in ensuring the transition worked well was improving staff relationships and communication, so that all staff knew what was happening.
Ms Chaudhry says that previously 'we didn't inform them of the financial position of the trust. By January we had got comfortable with telling people everything.
Our communication structures are the same, but we make sure that staff are listened to. '
Senior managers agree that the process has worked well, but say it is only recently that things have become clear. Director of nursing Vida Morris says: 'It is only in the last two to three weeks that we could communicate with staff where they would be. '
Director of transition Anne Butterworth endorses Ms Chaudhry's feelings on what is important: 'The first thing you should do is work with the staff organisations. '
The involvement of staff in the process, and the improvements in communication and spreading of information, are acknowledged by Unison joint branch secretary Yunus Bakhsh, but he says past problems have not simply disappeared. 'It is true there has been consultation, but this has often required the staff side to instigate it, ' he says, adding: 'In terms of the organisation, it is in chaos. There is quite a lot of uncertainty, and the main area affects those staff who are non-clinical. '
There are differing views on the way in which a single PCT came into being.
Lionel Joyce, the previous chief executive of City trust, says that the logic of a single PCT was being pushed by trust managers and senior clinicians two years ago, but that local GPs had to be won over. He says: 'We were driven by a clinical agenda. Consultant psychiatrists wanted one PCT instead of three. The GPs wanted three PCTs and it was a battle to get them to say they should have one PCT. 'He says clinicians and managers were also committed to a single mental health trust.
Local GP and West Newcastle PCG chair Dr Debbie Freake says a debate took place about whether it should be one, two or three PCTs taking over from the current three PCGs. The move to one PCT was approved by the GPs in ballots in all three PCGs. The desire for a locality basis to the new organisation will be ensured by strong representation from all areas on the PCT board.
Dr Freake says: 'In three years' time, I would like to think we have a significantly better infrastructure and an extension of the range of services in primary care. '
As with the mental health trust, the main message from those in the PCGs is that everything should have started a lot earlier, even though, as Dr Freake says, 'we have been working together since 1994'.
Her advice to others beginning this process is: 'Start early, do not underestimate the scale of the task and communicate well. '
The restructuring of the PCGs and the mental health trust are clearly big issues. But this is just the start of a process of health authority and trust mergers.
It is generally agreed that the new mental health trust, which will cover a population of around 800,000, is not the optimum size and that between 1-1. 25 million is a much more logical size in terms of providing the range of services.
Several people HSJ spoke to said there needed to be discussions with the health organisations south of the Tyne and in Sunderland. The small size of many of the organisations makes more mergers almost inevitable.
Lionel Joyce says: 'My concern still is that the trust is too small. ' In terms of services generally, he says, 'south of the river it is very unstable. People are being entrenched and defensive. There need to be discussions about care trusts, and going south of the river. '