BMJ  2005;331:1272 (26 November), doi:10.1136/bmj.331.7527.1272-a

Letter

Invest in people, not restructuring

The first 150 words of the full text of this article appear below.

EDITOR—O'Dowd reports mixed views but palpable overall concern from health service managers about current proposals to merge primary care trusts.¹ Some argued that such restructuring would put trusts back 18 months or more, but others thought not.

The little evidence available shows that restructuring is often futile, fails to achieve its objectives (usually, of saving money), causes disruptions that may last beyond 18 months, and has unintended consequences such as pushing people into new relationships they may not want and causing others to leave because they dislike the new arrangements.^2-4 It is not difficult to imagine this: many organisational relationships are built up over years, and wholesale restructuring can perturb them. Some relationships never recover, and morale suffers. Fulop et al's work on NHS trust mergers underscores this view.⁵

One peculiarity of restructuring is what it tells about those who sponsor it. Advocates of restructuring are promoting a . . . [Full text of this article]

Centre for Clinical Governance Research, University of New South Wales, Kensington, NSW 2052, Australia
j.braithwaite@unsw.edu.au

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