Structural change -in all its guisesOrganizational change is frequently structural in orientation, where the administrative arrangements are altered, for example, for strategy setting, financing, operations or accountability. Structural changes commonly inflicted on public health care services include the creation of new organizations, agencies and positions, and the merging or abolition of old ones. Operational units in particular are at great risk of being reconfigured, merged or broken up, or re-tasked to alternate sets of roles, duties and responsibilities. Reporting and accountability arrangements are also likely to be changed, perhaps alongside new financial mechanisms and even reformed legal frameworks. New vocabularies are frequently required to communicate the nature and meaning of such changes (e.g. commissioning, fundholding, foundation trust, clinical directorate and clinical governance, to take just some of the more recent).Many such structural changes have taken place in the UK National Health Service (NHS) in the past 34 years and in many other countries too.