I read your Independent Sector Guide with interest.

But the timeline (page 3) omits two significant items, since it was arguably BUPA that initiated the first PPPs in 1985 with the launch of the lithotripter centre with St Thomas' Hospital, and the UK's first open-access MRI scanner with the National Hospital, Queen Square. As one of the managers responsible for these ventures, I recall with some nostalgia that they were so unique we were accused of operating ultra vires.

Though both were successful in the short term, only one has stayed the distance. There is still much to be learnt from programmes such as these when it comes to ensuring the success of commercially operated, sustainable clinical services 'within' the NHS.

Mike Boyd Commissioning manager Noble's Hospital Douglas Isle of Man