As Lorne Williamson surmises (Open Space, 18 June), reorganisations will continue to have an impact on the NHS for the foreseeable future. He also expresses concerns about the process of change within the service and its effect on staff and clinical services.

The NHS tries to find more acceptable words to manage change, such as 'integration' rather than 'merger' or 'takeover'. But whatever the words, change is still happening. It is threatening, disruptive and time-consuming.

And even when people and structures are in place, the 'new' organisation may not be functioning with optimum efficiency.

The changes' impact goes beyond the restructuring phase. New working relationships need to be formed, and different cultural approaches need to be absorbed. Often the process has disrupted the normal flow of information.

The usual sources of knowledge and expertise may no longer be around. Staff may cling to their own information reserves as an insurance against loss of status or another reorganisation. The reorganisation will have an impact on relationships within the organisation(s) and with external groups. There are certain qualities in a relationship that people will value: a sense of parity and fairness.

Knowing who to contact and that the person you contact will know about you and your information; getting the right balance between, for example, the use of e-mail and face-to-face contact; and bringing clarity of direction to, and sharing a common purpose in, the area within which we work are all essential if the organisation is to run effectively.

It would be encouraging if it was accepted as good practice to take account of the relationship dimension in any major organisational change. There are approaches available for organisations to use.

Kate Wortham

Oxford