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ANONYMOUS | 16-OCT-2013 8:45 PM The "infamous" Daphne invites you and your colleagues to come out into the open and present to the public your current plans to spend our taxes to deliver value for money, high quality, safe pathology services for Bristol, North Somerset and South Gloucestershire.

You say that the pathology transformation programmes implemented so far have recognised the need for clinical excellence. Is there any evidence that they managed to deliver it? If they have, great – some best practice to share.

I am sure you are right to say that the taxpayer is overpaying for many basic services and inefficient services are being protected. One way to progress this is to present the evidence to the taxpayers and enlist their support for pathology rationalisation. However the obstacle is the tendency of the NHS to only want to engage with members of the public who tell it what it wants to hear and to impose a model of public engagement where no disagreement is allowed. If the NHS cannot deal with question and challenge in a constructive manner, which has been my experience and that of other members of the public, it shuts down opportunities for meaningful public involvement.

This denotes a culture of insecurity and immaturity in some parts of the NHS. It is not a culture that will easily sustain it in the face of potential competition from private pathology providers.

You point out that the train has left the station and pathology rationalisation is inevitable. The question is what sort of rationalisation is now achievable because University Hospitals Bristol boarded the train and has decided to get off and Weston Area Health Trust hasn't decided whether to stay on board.

The Severn Pathology Programme was initiated in early summer 2010. Two years later in July 2012 the organisations involved had not produced a business case and model which demonstrated that required savings could be achieved.

In a letter to the NHS of 10 May 2006 introducing The NHS in England: the Operating Framework for 2006/7, the then NHS Chief Executive, Sir Ian Carruthers, stated ”Service or organisational reconfiguration in the NHS has too often in the past failed to deliver the required quality and cost improvements. Proposals must have rigorous business cases with integration and benefits plans and clear accountability so that quality and financial improvements are realised.”

This statement is as true now as it was then. I have never seen any NHS business plan for service change which meets Sir Ian's criteria. If my referring to such matters is perceived as “throwing stones from the sidelines” it is an example of the defensive culture of the NHS which is an obstacle to progress. Real progress is achieved when leaders have the skills and courage to take stakeholders (including the public) with them to achieve change, not try to control them.

I am unclear what prompted your advice not to confuse histopathology with 99.9% of tests undertaken by mainstream Pathology Labs. There is no confusion. My previous comments refer to pathology services as a whole, not selected bits of it.