But some of the medium-sized programmes, which fear for their survival, provide an efficient service for local patients and their families who cannot afford the emotional and economic cost of travelling to some far-flung centre of excellence.
"By putting these two networks together, we would provide better service, more efficient service to consumers, " he said at the Senate hearing in March.
Senior officers said the merger was not about saving money but would provide a more efficient service and make the most of expertise across the region.
Mr Pickles used the announcement to give a veiled warning to councils - which have a statutory duty to provide an efficient bin service - that do not have weekly collections.
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In market theory the "selfishness" of the economic agent - in this case the GP practice - drives the efficiency of the system by forcing other economic agents to compete to provide the most efficient service.
The headline of Mr Andrews' speech was that there would be significantly fewer universities in Wales by 2013, indicating smaller institutions were to be forced into mergers if needs be in order to provide a more efficient service.
Acpo has said the new service would provide a more efficient and accessible air support service that offers better value for money.
However, I am confident we will continue to provide an effective and efficient police service for the people of Wiltshire.
The Brent decision hinged on the 1964 Public Libraries and Museums Act, which says local authorities must provide a "comprehensive and efficient library service", and may determine how far other local authorities can go with their planned closures.
The North Staffordshire clinical commissioning group said it had chosen the firm because it would provide a "cost effective and efficient" service.
Transport Scotland said the freight service would provide a more efficient route for coal from the west of Scotland to Longannet Power Station and reduce rail congestion on the Forth Bridge.
Almost every business today has some involvement in corporate giving and social responsibility, but HSBC has figured out that educating new and potential customers can be cost-efficient way to provide a personal touch and perform a public service while supporting the brand and the bottom line.
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The companies said the deal is expected to create a more efficient and competitive company that will provide greater value to shareholders and better service to customers.
As Andersen Consulting's Mr Ferguson points out, once a firm is providing a service around a product, it may eventually find it more efficient to let someone else provide the product.
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