Sir - The future of the Nuffield Orthopaedic Centre should be of concern to us all (Report, April 4). The NOC is deservedly world-famous, well managed, and financially efficient.

The 'case' for closure or merger centres on financial practices that are beyond local - or South Central Strategic Health Authority (SHA) - control. Were the NOC to be paid for the true costs for treating the complex and acute patients it handles, there would be no case to present. The national payment system must be refined, to accommodate measurement of both the medical complexity of cases, and the additional costs involved in providing training for orthopaedic specialists.

The NOC provides what its chief executive has called a "last resort" service for one of our family. Over 13 years' treatment, we have seen, at first hand, excellent treatment of a complex case by a succession of surgeons, nurses and physiotherapists, supported by dedicated administrative staff.

Surgical and non-surgical treatment has been successful, carefully explained, expertly delivered, and effectively followed up. Some members of "our" team have progressed in their careers, retired or moved to other orthopaedic centres and more senior posts, and others have joined the team, bringing fresh insight to the NOC. The prospect of local patients losing this centre of expertise, teaching, and research because of inadequate national funding of specialist orthopaedic hospitals, is dire.

The issue of specialist funding will remain, wherever the services are delivered to patients. Destroying the NOC's world-famous mix of medical practitioners on this pretext will not serve local patients or the National Health Service well.

Pressure must be put on the Health Secretary and the SHA, to emphasise both the value of the NOC to the National Health Service as a whole, and the value local people place on the NOC.

Ruth and Cedric Reavley, Burford