Paul Wright (Your Letters, October 21) is quite correct in highlighting the "nimbyism" that has held Malvern back for decades. However, our other great problem is the myopia of our so-called leaders, in both the local councils and quangos, like the PCT.

This is typified by the farcical approach to our hospital facilities. Worcester Royal is already too small, with inadequate parking and insufficient room for expansion. In any case, it was not designed to operate in isolation, it was supposed to be supplemented by smaller, but improved, satellite hospitals in Malvern, Pershore and Evesham.

Yet, we now learn that Worcester, which is already taking casualties from Kidderminster, is also to receive patients from Redditch. This was announced on the very day that some unfortunate lady from Canterbury Road, a stone's throw from the Royal, was refused admission because the hospital was full, so she had to be transferred to Redditch!

What of our own local hospital? After 30 odd years of inertia, the PCT and district council offer us the choice of a barely satisfactory site or an unsatisfactory site and a 'public consultation' is arranged (I would have said organised, but that would be stretching the truth). In the meantime, the unsatisfactory site is withdrawn, so we have no choice at all. The consultation still goes ahead and the contributors frequently make the point that they don't want the mistakes of Worcester to be repeated. But, when the process is finished, and the public have chosen the only site on offer, the chief executive of the PCT tells us that some of the site will have to be sold off to provide funding and then leaves to take up another job.

Now, a local landowner comes forward and offers an ideal site, free of charge, that will solve several of Malvern's problems at a stroke, provided our local authorities seize the initiative. But no! Apart from a few honourable exceptions, the nimbys and myopics pop up to say it's too late, we should just go ahead with half of Seaford Court; or that it's too difficult, we would need to alter the local plan etc, etc.

They are quite prepared to give permission for the construction of yet another "convenience" store in the Link, or the redevelopment of North Site, without the major road improvements everyone, except the highways authority, realise are necessary.

I am afraid that, very soon now, our increasingly dictatorial central government will be making these choices for us, as John Prescott is determined to press on with his pet project of regionalisation.

Malvern is going to change whether we like it or not. We need our local authorities to show some vision and leadership, so the change is managed locally and not by a remote quango in Birmingham.

Richard Spencer, Court Road, Malvern.