Health Policy Insight associate editor Dr Tom Smith continues his series from the party conferences, reporting on the debate from Labour on late diagnosis.

Would direct access to specialists result in earlier diagnosis of health problems and save money, or would it swamp the system and cost us a fortune? Would it weaken the ability of the NHS to manage patients in a co-ordinated fashion? These were the issues at the heart of a fringe debate at the Labour Party conference.

Dr Tom Smith, associate director of Health Policy Insight, returns to the fray with this report on the first of the three events at the main party conferences, which asked delegates 'whose responsibility is it to ensure early diagnosis of health problems?'

Although delegates weren't allowed to vote on health resolutions at the Liberal Democrat conference last week there was plenty of associated debate in the halls, conference rooms and bars of Birmingham. Some of the best debate took place at fringe meetings organised at the Health Hotel.

Health economist Professor Alan Maynard suggests that PbR has outlived its usefulness, and that management has failed to act meaningfully on variation.

The initial purpose of PbR was sensible. Is the system now past its sell-by date?

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Professor Alan Maynard looks at the growing health problems created by obesity, and wonders when Government will start to get serious about addressing it.

Companies make money out of making people fat and unhealthy. International organisations such as McDonalds, Nestles, Kraft, Walkers Crisps (owned by Pepsi) and Coca-Cola feed our desire for sugar, fat, salt and indolence, inducing over-feeding.

Thus we, the people, are getting steadily fatter.

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We have been inundated by protests about the NHS reforms championed by Andrew Lansley.

A media frenzy has followed the (sometimes parochial) bleating of trade unions - the most vociferous of which has been the BMA - and professional associations such as the RCP, RCGPs and the RCN; all of which have some tendencies to be what George Bernard Shaw entitled “conspiracies against the laity”.

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Health economist Professor Alan Maynard looks at the integration panacea hypothesis, and points the finger at where we need to act to alter the cost curve.

The Americans spend 16 per cent of their GDP on healthcare i.e. about twice as much per capita as the UK. When President Obama was elected, 46 million Americans had no health insurance and illness could bankrupt them: it is suggested that over 60% of US personal bankruptcies are caused by healthcare costs.

Health economist Professor Alan Maynard outlines recent research into changeovers of the new staff – the July effect – and suggests that killing patients is wrong.

The mortality and morbidity effects of being admitted to hospital as a patient out of usual working hours in the week and over the weekend have been well chronicled for decades, At those times, you have a higher risk of dying and having serious morbidity effects if you survive. This is a product of staffing, delays in diagnostics and delays in treatment.

Health economist Professor Alan Maynard on proper design and regulation of any competition system, David Nicholson’s bullshit and Adam Smith’s truth.

Ray Kroc, the founder of the McDonalds obesity-inducing (if eaten incessantly) fast-food chain, was once asked asked what he would do if he saw a rival drowning. He is alleged to have replied, “stick a hose in his mouth”.

This is a nice example of competition red in tooth and claw which opponents use to throw the competition baby out with the bathwater.

Professor Alan Maynard gets back to the real issues of NHS reform: funding and quality control.

The protracted “listening exercise”, with everyone paying too much attention to the trivia of reform and the protracted machinations of the Forum and sundry pathetic politicians offering ambiguity, has disguised two underlying maladies: funding and quality control.

These twin forces could seriously undermine the NHS.

Professor Alan Maynard suggests that Health Secretary Andrew Lansley is not so bad, and that the current financial crisis means pay and pharma prices need much closer attention.

Is the current Secretary of State For Health so bad?

Reviewing the history of the NHS over the last 15 years, you can identify Secretaries of State who actively sought to improve the NHS. Three figures stand out, although you may not particularly like them and the policies they pursued: Alan Milburn, Patricia Hewitt and Andrew Lansley.