THE potential merger of East Lancashire's two hospital trusts, mapped out in an NHS discussion document today, may point to patients having to travel between hospital in Blackburn and Burnley in future. But although this departure may bring upheaval, the prospect hardly comes as a shock.

For it is the fact that it is part of an existing trend that makes its likelihood all the more probable - in which case, patients and their representatives on watchdog bodies and local authorities need to be putting down markers at the outset.

We have, after all, already seen centralisation of maternity services in East Lancashire - a move more driven by health chiefs than by the preference of mothers.

We have also seen the so-called federation of some specialities - ophthalmics and ear, nose and throat services - by the Blackburn, Hyndburn and Ribble Valley NHS Trust and its counterpart covering Burnley, Pendle and Rossendale - giving us a glimpse of what may be in store overall.

And the scheduled closure of the time-worn Blackburn Infirmary, with the centralisation of hospital care at Queen's Park - a move that is steered by sound logistics - also fits in with the latent policy for the increasing concentration of services which is alluded to among the options in the discussion document.

But while there may be evident practical and economic advantages for health care providers in the increasing centralisation of services, it does not follow that they automatically benefit patients or are sought by them - if only for the inconvenience they may suffer as a result of having to travel further to receive treatment that was formerly available much closer to home. And while the prospect is also dangled of merger bringing a boost to specialist services in East Lancashire so that patients would have to travel less often to centres of expertise in Manchester, Preston or elsewhere - a departure that expects consultant talent to move away from the existing city-baed teaching centres - there is a worrying flipside, too.

For there is in this trend the potential for the federation of accident and emergency services and their concentration in one location, with perhaps either Blackburn or Burnley being the base for our region's casualty department, with the other having some sort of office-hours-only clinic as a reduced back-up.

Any merger must be for the tangible benefit of patients and bring manifest improvement of services, without risk or inconvenience. That must be the immovable marker put down by patients' representatives at the start of this debate.

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