Published: 07/06/2002, Volume II2, No. 5808 Page 21

The contents of your article about developing links between the NHS and the independent sector ('Flexible friends', cover feature, 23 May) come as little surprise to those of us who have held executive positions in both sectors and had watched with some excitement as the government gave unprecedented encouragement to this area.

The root cause explaining the lack of progress in longer-term plans involving the independent sector lies surely in the suspicion that still characterises the attitudes of many senior NHS managers towards the sector.

That patients are being denied the possible benefits of closer collaboration with the independent sector because of the seemingly unthinking favouritism towards NHS providers revealed in the survey - despite clear government direction to the contrary - suggests this suspicion is deeply embedded.

Perhaps it is the comparative lack of experience of many senior NHS managers of working outside the public sector that has created this unfortunate state of affairs.

The article concludes that 'something more than the concordat alone' will be needed before we can see longer-term arrangements with the independent sector becoming commonplace.

Insistence on testing NHS providers' expansion proposals at the capital approval stage against independent sector non-private finance initiative alternatives available would be a useful start.

Peter Reeves Farnham Surrey