Thanks, Alan Randall. 'Why not trust in integration?' (Open Space, 12 February) is a nicely argued article which suggests integrated trusts are the obvious and logical way to organise local secondary care. (I suppose that is why they are not favoured.)
It is clear that:
in general, people have difficulty in understanding the organisation of the NHS - a single local provider of secondary care makes sense to the public.
there are currently disincentives for integrating care across the acute/community organisational divide - a single local provider of secondary care might help remove some obstacles;
a return to specialist mental health trusts could encourage the isolation and stigmatisation of this user group within society - having integrated local providers might reduce this problem.
All good reasons for integrated local trusts. Mr Randall rightly points out that some opposition to integrated trusts arises from fear of the dominance of the acute consultant lobby. He argues this can and should be countered by effective trust management and health authority commissioning. I agree. I would add that the power and influence of the acute lobby is not diminished by the present separation of provider organisations. Indeed, one might argue that the isolation of acute providers can diminish their concern for the wider health of the local community.
North Warwickshire trust.