I was struck by the confidence in your recent headline, Patients will get more choice NHS chief vows'.

The foundation for this seems to be that hospitals will in future be paid job-by-job on the basis of a national price list, where each type of treatment process has been carefully identified by experts, costed and priced.

Ian Cumming explains his belief that if the local hospitals carry on doing the same mix of operations as now, the new method will give them more money.

But doing the same as now is not more choice'.

The chief executive explains that they will not actually do the same operations as now. Some local patients may be allowed to go elsewhere for treatment if they choose, and patients from elsewhere in the country will be attracted to come and have the operations on which Morecambe Bay jospitals believe they can make a good profit.

This seems fine so long as it is the patient and not the accountant who makes the choice.

If the accountants have got their measurements and costings wrong, they could easily be running after work which loses their hospitals money.

I hope my caution is ill-founded and that the radical change' of which the chief executive speaks is not just one more ridiculous change!

M R Jackson, Hest Bank.