I would like to reply to the letter (page 21, 27 July) in response to my article 'Careers without Tiers' (page 30, 22 June). I was referring to the fact this was the first surgeons' assistant course to be nationally recognised by the ENB, ie the ENB D10.

This gives students the opportunity, if required, to transfer their skills with a national and professionally recognised qualification. I am fully aware that other 'in-house' courses existed before the one at Manchester University.

Jane Farrell Nurse tutor Manchester University