As your news story and leader make clear, major reviews of hospital services do severely test the NHS's internal partnerships and do create tension between local NHS organisations.

East Kent's recent experience has been no exception but we, the chief executives of all the NHS organisations involved, are committed to working together constructively in the interests of local people as a whole. We have all agreed that the status quo is not an option and that a rational debate on the pressures for change and the possible options for the future is essential.

Our review aims to improve healthcare services for patients as well as to respond to the pressures for change. The review process is co-ordinated by a steering group involving the chief executives and medical directors of the trusts and health authority. This group will consider any alternative proposals to those in the consultation document that may be put forward, and develop any that are likely to be workable.

As the leaders of the NHS in East Kent, we are doing everything possible to fulfil both our collective responsibility to local people and our individual responsibilities to our particular organisations.

Mark Outhwaite,

Chief executive,

East Kent HA.

James Smith,

Chief executive,

Kent & Canterbury Hospitals trust.

Barry Page,

Chief executive,

Thanet Healthcare trust.

Mark Addison,

Chief executive,

South Kent Hospitals trust.

Peter Goddard,

Chief executive,

Canterbury and Thanet Community Healthcare trust.

Karen White,

Acting chief executive,

South Kent Community Healthcare trust.