THE pulling apart by Labour of the Tories' market-led organisation of the NHS seems to have unleashed a merger mania in the North West - with "bigger is better" as its keynote.

Already, we have seen proposals for the amalgamation of the trusts providing hospital care in East Lancashire and have even glimpsed the possibility of our region's health authority, which plans and purchases health care for patients, being forced into a merger with a neighbouring authority.

But now that the future of Lancashire's ambulance service comes under scrutiny in the merger impetus, which is driven by the "Fit For The Purpose" discussion document issued by the NHS Executive in the North West, it is surely time to question the evidently built-in assumption that bigger units are better.

It may be that, in the case of health authorities, with their power and role having been assumed in many instances by the new primary care groups that came into existence earlier this year, that mergers are inevitable. And it is possible that some advantages - particularly in the development and strengthening of specialist services in our hospitals - could follow the actual fusion of trusts in the wake of the so-called federation of some services that has already taken place. But the criterion, we believe, must be that the gains to patients and their families outweigh the potential inconvenience of them having to travel further to obtain treatment.

Yet, it would seem that the premise for the merger of Lancashire's ambulance service with another or others - so that there could be just one ambulance trust for the whole North West or Lancashire's is joined with that of Cumbria and/or Greater Manchester - is based on an ideal assumed by the NHS executive for the size of population a trust should service rather than on the impact on quality of service that such a merger may have.

And particularly disturbing is that this discussion document seems not to have the option of leaving our ambulance service as it is - when it is rated among the best in Britain by all the official yardsticks. Why not? It is a spurious consultation process that leaves out the status quo. The fact is there is a very good case for making no change - and some disturbing worries as to the cost of reorganisation and, most important, the amount of time taken to answer emergency calls if change occurs. The proponents of bigger-is-better must prove their case that NHS users reap the advantage of merger, not the NHS management - and the doubts over the benefits of merging our top-rated ambulance service are piling up fast.

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