Good morning. Today we have new Maynard Doctrine on the charged topic of managing poor performance by consultants and on the 'featherbedded' retirement deals of senior managers.

'The case here is not that incompetent consultants are widespread in the NHS; but that there is likely to be a normal distribution curve of performance in the profession. Current systems to address poor performance do not, in Maynard's opinion and experience, work well and are expensive if 'gardening leave' is involved.'

As ever, Maynard picks a serious topic and writes provocatively. The clinical governance and resource issues around poorly-performing consultants are significant challenges.

As NHS performance data becomes more available, and more used, and thus of better quality, we would hope that public scrutiny will lead to a more effective, and strongly data-led, system of performance review. The case here is not that incompetent consultants are widespread in the NHS; but that there is likely to be a normal distribution curve of performance in the profession.

Current systems to address poor performance do not, in Maynard's opinion and experience, work well and are expensive if 'gardening leave' is involved.

Nor does he spare senior managers being retired early with pension enhancements, suggesting that they should be offered less senior posts and lower salaries. Here, with the greatest respect, I think Alan's diagnosis is spot-on, but his solution probably illegal - for reasons of employment law.

Conservative times
The buzz in Birmingham, host to the Conservative Party conference, is all about the 'buzz'. If you want a market measure of the party conferences (and I'll quite understand if you don't), then a 3x3 metre stand in the Conservatives' exhibition would have cost you £10,050 as opposed to just over £8,440 for Labour and £7,400 for the Lib Dems.

This afternoon, we will be reporting on Andrew Lansley's speech to the conference. As a backdrop, Lansley and his savvy media team have placed a feature on MRSA and C Diff-related deaths in the traditionally Labour-supporting Observer. It suggests that almost 37,000 patients died after catching one of those two healthcare-associated infections between 1997 and 2007. However, wisely, the report merely notes the correlation and cannot demonstrate causation.

The impact of the credit crunch and what looks certain to become a recession on the economy and thus public spending remains unknown, but looks potentially serious. Shadow Chancellor George Osborne has already started to make noises about rethinking the Conservative policy commitment to matching Labour's three-year spending plans.

It will be interesting to see if any thinking about un-spending makes its way into Lansley's speech.

Scots cheer?
And finally, The Guardian reported a hypothesis that Scotland's high mortality and morbidity rates are related to a lack of sunshine.

Oliver Gillie, a former health journalist who now runs a not-for-profit foundation (www.healthresearchforum.org.uk), has developed the hypothesis that a key reason behind Soctland's worse health (the most deprived areas of Scotland have a premature mortality rate 17% higher than similar places in England and Wales) is to do with a Vitamin D deficiency related to a lack of UVB sunlight exposure. Gilie suggests that an average healthy person in Europe obtains more than 90% of their vitamin D by exposing skin to the sun.

The Guardian report notes that Vitamin D deficiency is associated with "higher risk or severity of heart disease, strokes, multiple sclerosis, diabetes and several cancers, as well as the bone fractures that frequently lead to death in old people. People living in Scotland have a lower average of vitamin D than people living in England".

Well, it looks like a plausible and interesting hypothesis. What we might need is a large-scale study of the health status of Scottish-born expatriates in sunnier climates.