TWO new health boards have come into being in Scotland. Both hope it will be business as usual, only better. This is also the wish of Andy Kerr, the health minister. NHS GreaterGlasgow and Clyde, an amalgamation of the old NHS Greater Glasgow and the lion's share of the formerArgyll and Clyde board, is now the biggest health service organisation in this country. NHS Highland has absorbed the parts of Argyll and Clyde within Argyll and Bute Council's boundaries.

In financial terms, Argyll and Clyde had become a basket case, accruing debts that threatened to cripple services. Dividing it between two boards in better financial health will mean Argyll and Clyde's GBP80m losses being wiped out by the Scottish Executive. Cause for cautious celebration, then? Both new boards were correct not to make a fuss about their emergence, for one compelling reason. There is no guarantee that redrawing boundaries on existing lines will result in the taxpayers' money being better spent or services for patients being improved.

Anne Hawkins, who was in charge of grafting the bulk of Argyll and Clyde on to Greater Glasgow, tells The Herald today that the exercise will result in another review of hospital services in the now-defunct health board area. Vale of Leven Hospital and Inverclyde Royal Infirmary, Greenock, had been downgraded by Argyll and Clyde, which earmarked the Royal Alexandra Hospital (RAH) in Paisley as its top hospital. But the RAH's proximity to the planned multi-discipline "super-hospital" at the Southern General site in Glasgow under the new arrangements means that its long-term viability could be put in doubt.

As for the other element in the Argyll and Bute carve-up, will the future of consultants' cover at Lorn and Islands Hospital in Oban be raised again now it is in the same health board as the Belford Hospital in Fort William? Removing cover had been proposed, and withdrawn in the face of public resistance, when there were two boards. Under one, will this be seen as a cost too far?

Reorganising hospital services on existing boundary lines could be the equivalent of jumping from the frying pan into the fire. There is a certain inevitability about the scenario, not just in these cases but in other areas where the exercise is conducted on health board lines, but where the impact has a much wider effect on patients and the public. GreaterGlasgow is not part of the controversial proposals for accident and emergency (A&E) provision in Lanarkshire but, depending on the outcome, it will see an influx of emergency patients - as it, too, rationalises A&E. It is a recipe for potential chaos. If ministers are serious about making the (as yet unmade) case for a mix of centralised and locally-provided health services, reorganisation from the top down within existing boundary structures is not the way to do it. There is a bigger picture they must see.