Published: 29/07/2004, Volume II4, No. 5916 Page 9

Some arm's-length bodies earmarked for the axe in last week's review will become 'bolt-ons' to other organisations as the result of clumsy mergers, HSJ sources have warned.

Senior figures in the organisations fear the creation of a two-tier system within organisations that will be confused about their priorities. They believe the government's desire to cut by half the number of arm's-length bodies is driving some unlikely alliances.

Because of the differences between some of the bodies being merged, HSJ understands that some will be shifted wholesale, with their functions remaining separate from the organisation into which they are merged.

The Health Development Agency - officially earmarked for abolition - will in fact become the Centre for Public Health Excellence within the National Institute for Clinical Excellence.

The National Clinical Assessment Authority will become a separate entity within the National Patient Safety Agency.

A senior HDA figure raised concerns that NICE's clinical guidance work would take priority over public health.There were also worries that the HDA's remit to translate evidence on public health interventions into practice might be hindered by NICE's reputation for having difficulties in engaging with the NHS.

Senior figures have also raised concerns that the speed of change will lead to an exodus of experienced staff and 'transition blight' as structural change is prioritised over the focus on delivery.

These concerns were echoed by NHS Confederation policy director Nigel Edwards, who also said there was a danger that some arm's-length bodies would be given too many functions to cope with.

He feared that combining the functions of the NPSA, which encourages NHS staff to report errors, and the NCAA, which investigates under-performing clinicians, 'could undermine confidence in [the NPSA's] work'.