Hello. I’ve been away finishing up a stint editing a journal about continence. Insert your own joke here.

I’m also just getting over a quick bout of something-or-other, so this will be very concise.

HPI associate director Tom Smith has written a useful piece on the Obama speech to Congress on healthcare reform. Contrary to many pundits' predictions, the US President wants the public plan option to be left in the bill. The maths on the voting for this bill are going to be extremely tight indeed.

I once chaired a conference at which Claire Rayner spoke about patient dignity. She's a lovely woman, and a bit of a national treasure, so it pains me to point out that her article on the Guardian website following up yesterday's Patients' Association report (of which she is President) is a bit silly.

From the silly season’s decline and fall, we are warming up to the party conference season. On Tuesday, The Indpenedent’s Andrew Grice revealed that Gordon Brown has now accepted that public spending will have to be cut: an announcement of some kind of review should probably be expected for the leader’s speech.

The new report from the Patients Association, Patients, not numbers … people, not statistics has cornered the headlines today. Cataloguing 16 incidents of appalling patient care reported to them (only one of which is anonymised), the report focuses repeatedly on incidents of bad basic nursing and ancillary care.

Perspective was one of the great additions in fine art painting. It involved the creation of the horizon line, which is often implicit. Where parallel lines are involved in a depiction, then one or more vanishing points are involved.

Why am I writing about perspective? Due partly the reflection from returning from a good holiday. One thing that a good holiday can provide is enough of a break from routine to give you a sense of perspective.

Hello. Hope you're well.

Holiday ends today, and to mark the bitter-sweet prospect of a return to the coalface, please find the latest instalment of The Maynard Doctrine, in which the good Professor looks at what the US could learn from UK efforts at healthcare reform.

See you tomorrow.

Good evening. This is another dispatch from abroad. We are away to celebrate my birthday, so there will be intermittent bits and pieces, but less for the next ten days or so. I know you’ll cope.

Localising NHS IT: the Tory solution to the CFH dilemma
The Conservative Party’s independent review of the NHS IT programme is out, and what in interesting document it is.

Professor Alan Maynard OBE, HPI's esteemed columnist, reflects on the blinding stupidity of currently prevalent NHS treatment of 'wet AMD'.

For several years, it has been known that there are alternative treatments for ‘wet’ age-related macular degeneration (AMD): Lucentis and Avastin. The former costs some £700 per dose; the later can be obtained for less than one-tenth of this high cost.

Whooppeee! That champion of socialist wages policies the Daily Mail has discovered that GPs can earn a lot of money for working out-of-hours.

Wow. This is investigative journalism of a high order of magnitude ... a mere four years or so after everybody else noticed this one.

Missing links

First, there was 'world-class commissioning' maestro Mark Britnell's departure, which few people apart from himself were expecting.

Then, there was Lord Darzi's departure: although DH officials knew of his irritations with the system, it was not as common knowledge that he was heading out the door as has sometimes been suggested subsequently, with the virtue of 20-20 hindsight.