I am responding to the now frequently quoted statement that 'there is little evidence that the private finance initiative produces innovative design' (news, page 5, 18 October).

Irrespective of the pros and cons of the overall PFI process, there are no reasons why innovative design should not be introduced into such projects.

However, this requires a trust to accept that there are new ways of working Future flexibility has to be built into both design and operating practice.

Judgements on types of patients and treatments, operating practices, available equipment and use of space need to look at least ten years ahead, rather than the more usual two to three years.

Equally, PFI bidders have to be capable of thinking about, planning and proposing such 'futures'.

All this must then be translated into innovative but cost-effective designs by architects who are actually capable of translating the future patterns of healthcare into a practical and flexible design.

In order for this to happen, there should be specialist health planners, who will normally have a clinical background, to lead the architects.

Both trusts and bidders need to move away from traditional thinking.

John Jackson Managing director United Medical Enterprises London