Published: 13/05/2004, Volume II4, No. 5905 Page 20

The bland and complacent 'Speak out' by Bob Ricketts (page 25, 22 April) about the legal position of patients in independent sector treatment centres raises more questions than it answers, by failing to acknowledge the various ITC models or the emerging choice world.

First he implies that all ITCs have been set up by trusts with whom they have contractual and service relationships.

But Trent ITC, although temporarily based in primary care trust and acute trust premises, will eventually be housed in a stand-alone purposebuilt unit near Chesterfield. It is being commissioned by PCTs and strategic health authorities, not by acute trusts.

Second, Bob asserts that patient claims against ITCs are 'effectively claims against the trust that referred them'.

Again, in the Trent model, currently all the patients have exercised choice to be transferred off a trust waiting list. They have not been referred by the trust, and indeed the Southern Derbyshire Acute Hospitals trust consultants are boycotting the transfer process.

And what about patients who exercise choice at point of referral? Do they sue the GP?

Third, he implies that where there is a contractual relationship between a trust and a treatment centre, the trust retains legal liability for the actions of the centre's doctors.Whatever happened to transferring risk to the private sector?

Steve Elliott Assistant director Derbyshire Dales and South Derbyshire PCT