Mergers are in the air in the North-East's health service. Health Editor Barry Nelson hears the latest news from the man who now heads the NHS from the Tees to the Tweed.

DAVID Flory must like hard work. Overnight, the health authority chief's workload has doubled. As boss of Northumberland, Tyne and Wear Strategic Health Authority, his territory extended from Berwick to Newcastle. But after the retirement of the County Durham and Tees Valley chief executive, Ken Jarrold, on Monday, the new man's fiefdom now stretches from Scotland to the south bank of the Tees.

In a region in which local jealousies and tensions lie just below the surface, paranoid types could interpret the move as a takeover by big city 'suits' from Geordieland.

But David shakes his head, points out that he has lived in the village of Heighington, near Darlington, for years and indicates that he will be spending a lot of his time at the Durham and Tees SHA office in Stockton as well as his Newcastle base.

The fact that David was invited by the Department of Health to take over the vacant chief executive's post is an early indication of which way the wind is blowing in the NHS.

"We are heading for fewer organisations in the health service and we will be looking to significantly reduce the amount of money going into management functions, moving it into front-line patient services," he says.

"The steer we are getting from the Department of Health is that we are moving towards fewer strategic health authorities and fewer organisations. My anticipation is that the two SHA boards will begin discussions in the autumn as to whether a merger would be sensible."

Over the years, NHS organisations have been merged, de-merged and then merged again as successive governments have sought the right formula for success.

David, who has worked in a senior capacity in the North-East NHS for 14 years, says the new wave of reforms which is beginning to take shape is a sensible reaction to changes in how a transformed and much improved NHS functions.

When the old health authorities were scrapped and replaced by 300 new primary care trusts under former Health Secretary Alan Milburn, it made sense to give the new bodies as much management support as possible.

But with the system securely bedded in, David believes it is now time to trim management costs.

"We need to be responsive to the changing world around us. As more foundation hospital trusts develop, the roles of other organisations in the system will change," he says.

Whether that will mean existing primary care trusts merging or sharing management costs by nominating particular trusts to commission services - a trend which is already happening on Tyneside and is set to happen in County Durham and Teesside - time will tell, says David.

Two of the daunting tasks facing the new chief executive is the financial crisis at James Cook University Hospital in Middlesbrough and the implementation of the Darzi plan on Teesside and Hartlepool.

David is prepared to give the chronically overspending South Tees trust as much support as it needs but implies that there will be no bailing out the Middlesbrough-based trust.

"We will agree a set of financial and service targets with the South Tees trust board then we will work with them to ensure they can meet these targets," he says.

When the Darzi plan was announced a few weeks ago, it seemed straightforward - follow the blueprint to the letter and divide services between the University Hospital of North Tees and the University Hospital of Hartlepool so each will retain a complementary range of services.

But this week, a senior surgeon from the Stockton hospital strongly criticised plans to close the consultant-led obstetric and gynaecology unit at the North Tees site, arguing that it made more sense to make Stockton the new centre of excellence in women's and children's services envisaged in the Darzi plan for Hartlepool.

David is sticking to his guns. "Professor Darzi did a very thorough job. There has to be some reconfiguration of hospital services and his plan keeps all the hospital sites viable and allows the highest clinical standards to be achieved. Our starting point is the plan."

Before any reconfiguration proposals are put out to public consultation, they will have to be approved by all the NHS and local authority partners involved.

While much of these discussions will be behind closed doors, David gives the commitment: "We will look at everything very carefully. We will listen to what people say."

There are still improvements to be made in the North-East NHS but David says the landscape has changed completely in recent years.

"If you went back a decade and compared it to now, there is a huge difference. The number of under 65s dying from heart disease has been halved. Ten years ago, people could wait two years for an operation yet now we are working towards a situation where by 2008, no-one will wait longer than 18 weeks from the time they see their GP to having an operation." The good news is that David believes that the North-East will achieve that target before 2008."