Having had the opportunity to participate, as a service user, in the King's Fund living values project (cover story, 25 February), I applaud the strengths of this research.

The views of managers, clinicians, patients and carers were all considered with commendable parity.

First-hand experience is essential for complete appreciation of a situation. Changing roles, such as managers acting as patients or temporarily exchanging duties with clinicians, have been successfully tried as a means of heightening awareness across health services. However, permanent role-reversal, together with accompanying perceptions of responsibilities and interests, is the only means by which complete appreciation is achieved.

As role-reversal does not consistently happen in the NHS, further opportunities for equal participation of stakeholders in the evaluation and development of services must be encouraged.

Joy Dale

Salford