I HAVE written a four-page response to the gynaecology patient whose letter was published in the Bury Times (September 28), but I have detailed the main points here for your readers.

Many hospitals do not have separate gynaecology wards, but have patients on female surgical wards. Fairfield's gynaecology ward has 18 beds, with high occupancy during the week but low occupancy at weekends. Following a re-organisation of operating schedules, this dropped to around five patients on Saturdays and fewer on Sundays.

We wanted to introduce a diagnostic and care support service for women with early pregnancy problems, helping them avoid unnecessary admissions and minimising emergency admissions. We could not keep the ward open for seven days and introduce this service.

We made the change in August, with the nursing resource being redeployed for the early pregnancy service. To date, these staff have seen 245 attendances, with positive feedback from those women they have helped.

The change also allowed us to increase the number of gynaecology staff available on the ward from Monday to Friday, when we see the great majority of our gynaecology patients. During weekends, the small number of gynaecology patients still on the ward are transferred to a female surgical ward.

This ward has nurses with specific gynaecological skills for four-hour shifts on Saturday and Sunday, supporting the general surgical ward staff who are experienced in abdominal surgery after-care. In addition, extra training in gynaecological issues has been -- and continues to be -- given to these staff.

Anyone who reads the Bury Times should already be aware of this change, as it published details of a staff discussion document earlier this year. I said then that we would be discussing the situation further with staff before any changes were made, and that is what happened. Implications for infection control and suitability of care were considered as part of this move.

Any change in the NHS always sparks the same question: is it about money? This change is about best use of resources to help patients. Of course that includes finances, and we believe that people would expect nothing less.

The NHS is required to account fully for its spending, providing value for the money invested with us. Each year we have a fixed sum of money from which to provide a huge variety of services to a vast range of patients, and we need to ensure that we get best use from this.

Best use of resources, however, is certainly not simply a case of "let's save money", and if it was then it would be easy -- and it certainly is not. It involves best use of staff skills and abilities to enable us to ensure that we get full benefits for patients. It involves meeting challenging, and differing, priorities which can pull us in opposite directions. We work hard to try to get it right -- we don't always manage, but we do our best.

The patient also asked if Fairfield was losing out to other hospitals in the Trust. The answer is certainly not. Recent investment includes the £700,000 pharmacy, the £250,000 critical care unit and the £1.8 million education centre, all of which have been well reported in the Bury Times.

CHRIS APPLEBY,

chief executive,

Pennine Acute Hospitals NHS Trust.