DAVID Rose writes (Hereford Times, June 16) that it has been "known for some time" that resources for the orthopaedic department were insufficient, so why were steps not taken sooner to prevent the situation which has now arisen?

Perhaps the answer lies in his comment that only now has the Primary Care Trust (PCT) confirmed that it wishes to buy more orthopaedic services. If there has been reluctance by the PCT to purchase orthopaedic services at the County Hospital then we ought to be told why and whether such reluctance also applies to the purchase of other services.

Paul Bates assures us the redirection of orthopaedic patients "is not a ploy to appear to be meeting waiting times", but "is to ensure real waiting times do not exceed the targets". Perhaps I am missing some subtle point but surely these two statements are mutually incompatible.

And when David Rose urges patients to choose the County Hospital for their treatment, at a time when he has suspended the rights of many orthopaedic patients to make that very choice, I am reminded of Alice's adventures in Wonderland.

As regards the wider issues raised in my previous letter, it is interesting David Rose describes the decision to provide an adequate number of beds at the County Hospital as "bold".

In what way is such a decision bold, unless it is because the relatively small size of the County Hospital makes such a venture of borderline financial viability?

Paul Bates suggests that "it is dangerous to make a giant leap from a temporary problem in orthopaedics to casting doubts about the future of the County Hospital".

First, let us hope the problem in orthopaedics is indeed temporary. Its solution appears to depend on recruiting additional staff and we know that recruitment of consultants is proving difficult in some other specialties.

Second, the problem is not confined to orthopaedics. For example, the Ear, Nose and Throat Department in Hereford can no longer provide a 24-hour service and patients have to travel to Worcester for specialist services outside normal hours.

Third, we should not be waiting until such problems occur. They need to be anticipated if there is to be any chance of preventing them and this is important because, once a service has been lost or curtailed, it is difficult to get it restored.

It was as the main author of a report on some of the problems faced by smaller DGHs that I was asked to address a Parliamentary committee on this subject. It is therefore something which I have studied in depth and it concerns me that neither chief executive seems willing to address an issue which will cause increasing difficulties in areas like Herefordshire.

To raise this issue is not in any way, as David Rose suggests, to undermine the excellent work which is done at the County Hospital; on the contrary, to ignore it is to risk compromising the range of services which can be made available locally in the future.

Henry Connor, Retired Consultant Physician, Vineyard Road, Hereford