THE Government is hoping that yesterday's "bonfire of the boundaries" in the NHS will produce a more manageable, efficient health service.

The changes to primary care trust boundaries will certainly go some way to simplifying the region's NHS.

In most of County Durham, instead of a patchwork of relatively small primary care trusts (PCTs), each with its own jealously guarded boundary and small army of administrators, there will be one "super-trust" in charge of commissioning health services and providing community services such as district nursing.

A similar exercise will take place in North Yorkshire with four trusts merging to form one, including the city of York.

Trust boundaries remain unchanged in Northumberland, Tyneside and Wearside.

Health economists who preach efficiency would probably welcome such mergers.

But for many MPs, councillors and health workers the Government's axe-wielding represents a backwards step.

Some areas of the region that have lagged behind in terms of their share of the NHS cake, such as Easington, in County Durham, have benefited until now from having a local NHS organisation fighting its corner.

But yesterday's decision to abolish Easington PCT will be greeted with dismay in the district.

Elsewhere in the region, communities that have unitary councils running all local government services, such as Darlington, Hartlepool, Middlesbrough, Stockton and Redcar and Cleveland, maintained that the abolition of local trusts would damage the close working relationships between social service departments and the local NHS.

Health Secretary Patricia Hewitt appeared to heed those views yesterday when she spared Darlington and Teesside trusts from the merger.

Ironically it was Darlington MP Alan Milburn, the man who as Health Secretary dreamed up the idea of the self-contained primary care trust, commissioning NHS services for local people and setting priorities according to local needs, that led the North-East opposition to trust boundary reforms.

He argued forcefully that having decisions about social services taken in Darlington but decisions about health services taken in County Durham was "a recipe for total confusion".

He was backed by Darlington borough councillors who remembered the bad old days before the town achieved unitary status and when services such as education and social services came under the control of Durham County Council.

Until yesterday, it seemed national political considerations, compounded by a looming cash crisis, was about to force the Government's hands into a mass cull of trusts.

For some time, the Department of Health has had to defend itself against accusations that the Health Service had too many managers and not enough nurses and doctors.

But balancing savings against an unwillingness to sabotage good working relationships between the NHS and local councils seemed to underpin the Health Secretary's approach to the latest round of reforms.

It remains to be seen if the reduction in trusts has gone far enough to obtain the kind of savings the Government needs to offset deficits in a substantial minority of hospital and primary care trusts.

Professor David Hunter, of Durham University, last night expressed surprise at the limited scale of the cull and wondered how the anticipated savings could now be achieved.

He said: "The changes are nowhere near as radical as we anticipated. That can only reflect the power of local opposition. It certainly means there will be less pain for those who work in the NHS in the North-East."