We were surprised at your article, 'This Page is not for turning' (news focus, 11 January). Northumbria Healthcare trust's ethos, epitomised by chief executive Sue Page's attitude, has been to deliver a cost-effective service, giving best value to the patient by maximising clinical staff 's managerial input, facilitated by professional managers.

This has inevitably led to a slim managerial workforce and possibly reduced staff communication, when staff have had to develop new skills for their new roles. Any such failings have not been due to the logic of the trust board's conception but the speed at which individuals have been able to rise to meet these demands.

Difficult decisions have had to be taken. Inevitably casualties have occurred, but strenuous attempts have been made to involve staff in decision-making in an open and democratic way.

The policy-making groups' structure and management are under review, a process set in motion by our chief executive but delegated to clinical and managerial staff - hardly the behaviour of an autocratic ruler.

The speed of change in the NHS is disorienting for many, but without managers able to keep pace and act, good opportunities would have been lost. Developing the new hospital at Hexham is a good example. If this trust board had not promptly committed considerable capital investment, the redevelopment would not have happened. We find our chief executive's ability to act promptly following consultation a refreshing change.

While not everything in the garden is rosy the trust continues to listen. Ms Page is vital in this process and continues to attract our confidence and full support.

Dr DA Laffey, Chair, Medical staff committee JP Forsey Clinical director, Hospital redevelopment Hexham General Hospital