Published: 22/07/2004, Volume II4, No. 5915 Page 22

While Kieran Walshe's team at Manchester University's Centre for Healthcare Management have made a significant contribution to health policy, his article (Ideas, pages 14-15, 8 July) was unnecessarily alarmist, and predicated on some erroneous assumptions.

Firstly he argues that since the private sector has to make profits, it must either charge a higher price or offer an inferior service for the same price.

This is patently untrue - look at any sector where private and not-for-profit companies compete and it is clear that private companies have made profits only through being able to innovate at a faster rate to become more efficient.

Look at food retailing: not-forprofit Co-ops were by far the largest players 50 years ago, but Tesco, Walmart et al have pushed them aside. I have not heard any serious arguments that this is not in the consumers' best interests.

Second, Professor Walshe argues there is evidence that notfor-profit healthcare providers consistently perform better in terms of cost, quality and access.

While there may be examples where this is true, the root cause must by definition be weak commissioning arrangements which allow the private sector to get away with worse performance.

Provided commissioners negotiate lower prices for equal or improved quality, outcomes and access, and monitor performance, private sector providers will only be able to make profits through positive innovation, which must be good for patients and tax-payer alike.

Hugh Risebrow Associate director Performance development team NHS Modernisation Agency Professor Walshe's comments on independent acute medicine are well rehearsed and cover no new ground. But I take exception with the observation that patients in non-profit psychiatric hospitals do better than those in for-profit institutions.

Private psychiatry runs the gamut from the worried well to working effectively with some of the more challenging patients in the psychiatric healthcare system.

I challenge Professor Walshe to produce evidence from the UK (after all, we are discussing the NHS) rather than Canada to support his hypothesis.

Peter Handy Executive director Kemple View Psychiatric Hospital Partnerships in Care