Published: 15/07/2004, Volume II4, No. 5914 Page 21

I was not intending to 'attack' our two partner organisations in pointing out the dangers of NHS membership bodies becoming politically impartial or too cosy with the establishment.

As both correspondents pointed out with passion, they are excellent and demonstrably well-led organisations - none of us survive these days unless we are. I accept their commitment to political debate and welcome it.

My statements came from a feeling that alliance is too often left on its own as a critic on issues that range from undue pressure on primary care trust chief executives, targets and star ratings down to insufficient money for developing primary care IT and premises.

I was simply calling for a more honest debate within the NHS to give a voice to frontline managers and clinicians struggling too often against the dead weight of centralism and insufficient time, staff and resources. They sometimes get forgotten among the big ideas, the grand political debates and the embellished statistics.Yet we all depend on these staff to make a difference.

Dr Michael Dixon Chair NHS Alliance