Structural and cultural impediments to patient and public involvement are not just confined to the NHS ('Movers and shakers', cover feature, 30 August).

The article highlighted structural trends which RAGE (Residents Action Group for the Elderly) is finding across the UK as one local authority after another seeks either to contract, privatise or sell off public residential care provision.

RAGEnational, our confederation of campaign groups, knows of 45 local authorities proposing such restructuring. In total, 8,840 public residential care beds appear to be affected.

In Birmingham, RAGE commissioned three independent reports with Unison through the Centre for Public Services (available at www. labournet. net). The second of these was a survey not just of service users but the wider Birmingham community, a key part of 'best value' reviews.

There were 1,200 responses to 2,000 questionnaires, and 96 per cent of ethnic groups are fundamentally opposed to privatising the 30 homes, a point recognised by the follow-up Social Services Inspectorate best value review published in September.

The survey also made 17 recommendations for developing services throughout the city. All were ignored.

Our third and final report on the council's proposals shows that£7.5m per year will be removed from the older people's service budget - again against the views of service users, families and community organisations.

No-one knows how this will affect joint health and social care working practices.

The scepticism of the families in your article is fully borne out elsewhere. Professionals - and in the case of many councils, elected members - refuse to listen to service users' and citizens' views.

It is not just senior healthcare professionals who can be called an 'enemy', but many other social care officials and councillors, given their complete disregard for service users' rights.

Mark Oley Citizens advocate RAGE