The proposed trusts merger could happen by April 2008

Health councils in Pembrokeshire and Ceredigion are concerned about joining with Carmarthenshire and neither is convinced it would save money.

The assembly government claim the merging of the trusts would cut back on bureaucracy and save �2m a year.

The reconfiguration of trusts in two other areas of Wales is also planned.

Health minister Edwina Hart has already approved one merger between Pontypridd and Rhondda and North Glamorgan NHS Trusts.

They will merge to form the Cwm Taff NHS Trust by 1 April, 2008.

She also announced in July that Swansea and Bro Morgannwg NHS Trusts were clear to begin discussions on a merger.

There is a great fear a new grand merged trust would lead to a down sizing and erosion of local services in the periphery Ashley Walker, Pembrokeshire Community Health Council

The proposed merger between Ceredigion and Mid Wales NHS Trust, Pembrokeshire and Derwen NHS Trust and Carmarthenshire NHS Trust could happen by next April.

It would follow consultation between the three trusts, community health councils and staff associations.

Managers at the west Wales trusts said a merger would allow hospitals to pool skills and safeguard and develop patient services as well as lead to opportunities for efficiency savings.

They denied it was a way of changing the services by the back door and said it would save the region �2m per year which would be put back into services.

Carmarthenshire Community Health Council is in favour of the merger but Ashley Walker from its equivalent in Pembrokeshire said that it could be a way in the longer term of introducing unpopular change to the hospitals themselves.

"It may well lead in the longer term to an erosion of local services," he said.

"I know this is very much an organisational change and not a service change but there is a great fear a new grand merged trust would lead to a down sizing and erosion of local services in the periphery."

What was fit for purpose in the 1990s is clearly no longer fit for purpose in the 21st century Meirion Hughes, chairman of the NHS merger review board

In Ceredigion, Jack Evershaw from the community health council said the new trust could be weighed down by �37m of debt, something which their current NHS trust had "little part" in creating.

"It is obviously a great concern to us that our percentage of the debt is the least," he added.

"We are also worried that such an organisation is doomed to not succeed with that level of debt."

The chair of the NHS merger review board for mid and west Wales, Meirion Hughes, said the changes would only be to management and would not result in wards being cut.

But he did say the NHS would need to evolve.

"The real argument for reconfiguration comes from the need for us to have a single larger trust that has the capability to plan and deliver services within an NHS that is changing," he said.

"What was fit for purpose in the 1990s is clearly no longer fit for purpose in the 21st century."

The Welsh Assembly Government said the changes to the trusts were required however nothing would happen unless it could be proved that it was to the benefit of patients.