Published: 24/04/2003, Volume II3, No. 5825 Page 21

As chair of one of the new local health boards, you might expect a robust defence of the new arrangements in Wales (news focus, pages 12-13, 3 April), but I wish to bring a wider perspective to the debate.

While not underplaying the difficulties associated with this change (and ones English readers will also be familiar with), such negative press misunderstands the radically different role of LHBs based on a new set of assumptions and principles.

Two points must be challenged, namely that the new organisations are not fit for purpose and we have not attracted sufficiently high calibre staff to these new roles.

If the purpose of LHBs was to replicate on a smaller scale the roles and functions of a health authority then, granted, we might not be fit for that purpose. But that is not what we are here to do. LHBs are predicated on a number of simple but challenging principles.

A primary care-led, patientfocused NHS - delivering high standards of care in partnership with, and closer to, service users, simple to understand and to access - is a new challenge precisely because it is one which the old organisational forms were not able to meet.

Allied to this is the Welsh Assembly's commitment to sustainable communities, requiring us to work upstream to tackle the determinants of health and wellbeing, and to get away from the current NHS focus on beds and buildings.

On this occasion, big is not better. I believe smaller boards working, as we can, closer to our communities and our local partners, can concentrate more on building these crucial relationships and services.

They can then make sense to local communities, rather than fitting within organisational boundaries which we invent and reinvent with predictable regularity.

The size of the boards, in contrast, is one of our major strengths; of course we will not be able to work in the traditional (and dull) bureaucratic ways.

But the diversity around the table, reflecting a better crosssection of stakeholders in health and social care, will enable us to explore and implement imaginative solutions. We can be confident such solutions will emanate from, and are supported by, a fuller range of professional and community knowledge and experience.

As to the calibre of staff recruited to the boards and the organisation, I have completed the first phase of our organisational development to establish ourselves as fit for our new purpose. By the end of our last session we had covered tremendous ground, building new relationships, respectful of our different perspectives, clarifying our priorities for action and initiating a programme of work so the board can make its best contribution. It was with pride, and not a little humility, that I looked around the room at the talent, experience, commitment and, most importantly, passion that will make a difference.

The doomsayers can claim what they want. I can tell you, with absolute confidence, I do not recognise their gloomy picture round my table.

Sue Pritchard Chair Monmouthshire local health board