LETTERS

Your editorial, 'Shifting the furniture' (comment, 2 August) correctly points out that after a series of three major merger processes we will be back to having rather more organisations running the NHS than we had before the mergers.

In place of 14 regional health authorities we will have 30 strategic health authorities, nine regional integrated public health teams and four regional directorates of health and social care.

In place of 180 health authorities and 90 family health services authorities we will have rather more than 300 primary care trusts.

As a believer in 'small is beautiful' I have always been highly critical of the merger process until now that its endpoint is revealed with such clarity.

However, this raises a conundrum. At each stage of this process we have achieved economies of scale.

Presumably a further set of mergers reducing the 43 strategic entities to 14 and the 300 PCTs to 270 would achieve further economies. Yet we will be back to where we started.

The only mathematical way I can find to explain this is to assume that the cyclical process itself generates money. Which raises an interesting question.

With all the skills we have acquired in treating reorganisation as our main role in life for rather more than 40 per cent of the last decade, it shouldn't be difficult to go through a whole set of mergers in, say, an hour.

So we could go through the whole cyclical process in, say, four hours and get back to our starting point. If we did this three times on 1 April each year we would generate several billion pounds of development money through economies of scale. It would be a long, hard day but well worth it to spend only one day a year on reorganisation and have lots of money to enjoy spending afterwards.

Or have I missed something?

Dr Stephen J Watkins Director of public health Stockport WTCUT (Whatever They Call Us Today)