Sir, - I refer to the coverage regarding the North Tees and Hartlepool NHS trust's proposals to create a centre of excellence for hip and knee replacements at the university hospital of Hartlepool.

I can understand people are concerned about changing services but time moves on and health services develop, they have to in order to ensure that patients benefit from new techniques and the latest technology. I am sure all my colleagues will agree that our patients deserve the best and we want to give them the best.

But this means changing. As well as ensuring patients receive the best medical treatment available, it is important that patients receive good quality nursing care and I know our staff always strive hard to provide this.

It is a tribute to their hard work and dedication that we are a three-star trust and that we were highly praised in a recent Commission for Health Improvement report. We want to maintain this excellent performance and we can only do so by developing and modernising our services for patients.

Our Homeward service for patients needing a hip and knee replacement is nationally recognised. This service involves nurses, occupational therapists, physiotherapists and surgeons working together to ensure patients who need the service receive the best possible treatment, which is tailored to their needs, meets set standards and that their care is regularly monitored.

Homeward will continue for patients undergoing hip and knee surgery, cared for by the trust. As the most senior nurse for orthopedics at the trust, I support the trust's proposals as I know that they will ensure that patients will receive the best possible treatment and that patients will be seen much more quickly.

Of course I am also concerned for my nursing staff who understandably have some anxieties but they also know that this really is the best way of ensuring patients receive the best possible treatment whilst reducing the time they have to wait for a hip or knee replacements. We are working with our staff to resolve their anxieties.

It is important to remember that patients will still receive and attend outpatient clinics, have any tests and follow-up care at the university hospital of North Tees or in their own home.

IAN CLIFFORD

Clinical nurse manager - orthopaedics: North Tees and Hartlepool NHS Trust,

Holdforth Road,

Hartlepool.

What is vocation?

Sir, - Mr Bull asserts "it is through the churches that we hear the call to vocation and service" and the "shortage of people called to a ... vocation ...is one of the results of the liberal elite saying triumphantly that we are not a Christian country any more" (D&S, Oct 12). He says "we need to return to our Christian roots" and he implies that only Christians can have this altruistic sense of fitness for a career or occupation. He is wrong.

I have been an agnostic ever since I was old enough to think for myself which was some years before I chose to make my vocation the police service. I was conscious of, and welcomed, the opportunities given me to serve my fellow men.

Following my chosen career did not give me "God's peace and strength" as suggested by Mr Bull but it did give me a tremendous sense of satisfaction, not least in my early years on the beat.

I resent Mr Bull's apparent assumption, unfortunately not unusual in some Christians, that they have a monopoly on doing good. It is an insult to those of us without any religion and also to those who practise other religions, indeed it is un-"Christian".

I know many non-Christians who do more for their fellows than many Christians. If Mr Bull is right then the marked reduction in church-going would be reflected in a similar marked reduction in those behaving altruistically in non-vocational areas, yet this is not the case. For example, there has not been a reduction in the numbers volunteering to give blood. I myself have recently given my 80th donation.

The now very-tatty 1958 edition of The Concise Oxford Dictionary I was given for my 21st birthday defines a vocation as a "divine call to a career or occupation" and includes "a sense of fitness" only in parenthesis. But my wife's 1995 edition updates the definition as "a strong feeling of fitness for a particular career or occupation" and the divine element is now relegated to brackets about vocations in a religious context. I would suggest the modern definition is more realistic. I assume Mr Bull would think the dictionary has been taken over by the "liberal elite".

If there has been a reduction in persons entering medical vocations then the explanation is not to be found in Christians failing to maintain their strength, both in numbers and commitment, for non-Christians can be just as altruistic He must look for it elsewhere.

D F SEVERS

Borrowby Avenue,

Northallerton