Published: 22/07/2004, Volume II4, No. 5915 Page 23

Michael Dixon's Speak Out column (page 23, 17 June) made me want to cry out in frustration. Encouraging constructive criticism of the NHS, he highlights the responsibility 'to question, to challenge and to debate and to do so openly'.

Open debate requires that those involved disclose what troubles them. High-profile NHS organisations are understandably reluctant to do the former. Too much hangs on image: hospitals and other care providers will, of course, strive to reassure patients about safety, while competition for tight resources leaves them reluctant to rock funding boats.

I spent the last year writing a book, opening up these issues for professionals and patients alike.

It pulled no punches and had a raft of professional and lay contributors and 'test' readers who were overwhelmingly positive about its ability to stimulate constructive debate across providers and receivers of care.

An NHS trust paid me to write it, requested that its associate medical director be named as coauthor and asked a high-profile patron to write the foreword.

The trust's chief executive pulled the book 48 hours before final delivery and blocked my independent use of the material. Part of her disquiet was that it might portray her trust in a bad light.

Hunger of individuals and organisations to be seen as perfect is starving debate, denying those who could make things better for patients the diversity of views and experience that they need to achieve this.

Dr Sophie Petit-Zeman Freelance health journalist