This year's complete list of the 50 best restaurants in the world as voted for by Restaurant Magazine's panel of judges
Jay Rayner: the decision to omit El Bulli from this year's list raises fundamental questions
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guardian.co.uk, Monday 18 April 2011 21.30 BST
Article history
The world's number 1 restaurant: Noma in Copenhagen. Photograph: Casper Christoffersen/AFP/Getty Images
1. Noma
Copenhagen, Denmark
Last year's position: 1
Noma is best known for its fanatical approach to foraging but there is much more to this ground-breaking restaurant than the mere picking of Mother Nature's pocket. It's the entire package, from its ingredient ingenuity to flawless execution, that makes it a beacon of excellence and which leads to an emotive, intense, liberating way of eating, unlike any other. Many have copied chef Rene Redzepi's approach, most have failed. For the best in class, Noma really is the number one place to go.
• noma.dk
2. El Celler de Can Roca
Girona, Spain
Last year's position: 4
El Celler de Can Roca is possibly the least well-known restaurant to have ever held the much-vaunted number-two spot on the list, a quirk which, far from being a hindrance, has allowed the three brothers Roca to get on with what they do best. Their "emotional cuisine" with different ingredients and combinations can trigger childhood memories or take you back to a specific place in your past.
• cellercanroca.com
3. Mugaritz
San Sebastián, Spain
Last year's position: 5
Mugaritz has two dégustation menus that change daily according to what chef Andoni Luis Aduriz can get his hands on at the street markets and what's growing in the restaurant's herb garden. Whatever happens, you can expect to sample the team's intricate dishes that seek to reconnect diners with nature. His self-dubbed "techno-emotional" approach sees the appliance of science and a rigorous understanding of ingredients jostle with produce-driven cuisine.
• mugaritz.com
4. Osteria Francescana
Modena, Italy
Last year's position: 6
Much of the food at Osteria Francescana takes its inspiration from the art world, but this is only half the story. The unrivalled culinary heritage of the Emilia–Romagna region is chef Massimo Bottura's other great muse, and the kitchen offers a menu of traditional food alongside more left-field creations. The cooking is exciting and gratifying, the overall experience progressive and relaxed.
• osteriafrancescana.it
5. The Fat Duck
Bray, UK
Last year's position: 3
Heston Blumenthal's world-famous, but still tiny restaurant in Bray, has blazed a trail for experimental cooking in this country, but one of its enduring features is also that it is brilliant fun. Sure, guests' sensory perceptions are challenged, their notion of possibility expanded, but never in a po-faced way. Instead, gourmand pilgrims can be witnessed smiling and laughing their way through a foodie marathon.
• fatduck.co.uk
6. Alinea
Chicago, USA
Last year's position: 7
Alinea represents one of the most radical re-imaginings of fine food by any chef in American history and has propelled Grant Achatz to chef superstardom. Everything about his restaurant is unique, from the deconstructed food, unfamiliar flavour combinations and theatre to the tableware, with dishes served in and on all manner of implements: test tubes, cylinders, multi-layered bowls that come apart. It's boundary-shifting stuff.
• alinea-restaurant.com
7. D.O.M.
São Paolo, Brazil
Last year's position: 18
D.O.M. has become a priority destination for all globe-hopping gastronomes, not that chef Alex Atala is resting on his laurels. Instead he scours the Amazon to pepper his with indigenous ingredients, from the staple manioc tuber and its tupuci juice to Amazonian herbs and the huge white-fleshed pirarucu fish to ensure his restaurant is unlike any other on the list.
• domrestaurante.com.br
8. Arzak
San Sebastián, Spain
Last year's position: 9
If you like your food pretty, this is the place. Father-and-daughter team Juan Mari Arzak and Elena Arzak Espina's plates look fantastic: striking, colourful and imaginative, yet for the most part unfussy. The pair run the kitchen as equals and are a major presence in the dining room. Like the food, it pulls off the neat trick of balancing tradition and innovation, with warm, familiar service.
• arzak.es
9. Le Chateaubriand
Paris, France
Last year's position: 11
It's hard not to be excited by Le Chateaubriand. It is effortlessly cool, understated yet accomplished, democratic, affordable and, perhaps most importantly, fun. Its lack of airs and graces - hard chairs and bare tables, the take-it-or-leave-it five-course fixed-price menu and the championing of natural wines – is not to everyone's tastes, but Le Chateaubriand doesn't really care.
• +33 (0)1 43 57 46 95
10. Per Se
New York, USA
Last year's position: 10
Per Se, Thomas Keller's "urban interpretation" of his French Laundry in California, has changed its menu every day of its nearly eight years — that's something like 30,000 different dishes, some re-introduced from prior seasons but continuously refined. With three Michelin stars it has succeeded as much by consistency as by creativity and remains one of the US's true destination restaurants.
• perseny.com
11. Daniel
New York, USA
Last year's position: 8
Daniel Boulud's desire to meld unexpected ingredients and create dishes you won't see on any other menu make for one of Manhattan's most exquisite eating-out experiences. Today his restaurant empire is blossoming, with openings across the world, but for a true taste of the Lyonnaise lion, to Manhattan you must go.
• danielnyc.com
12. Les Créations de Narisawa
Tokyo, Japan
Last year's position: 24
Much has been made of the fact that the first Japanese restaurant to make this list has a distinct French accent, but chef-owner Yoshihiro Narisawa is not just producing Gallic haute cuisine with a Pacific edge. Themes of soil, water, fire, charcoal and forest permeate the menu to reflect Narisawa's bringing of nature to the plate, resulting in dishes complete with the smell, aspect or texture of the landscape from which they were drawn.
• narisawa-yoshihiro.com
13. L'Astrance
Paris, France
Last year's position: 16
Pascal Barbot opened L'Astrance after making his name at Alain Passard's L'Arpège. That was back in 2000, and since then he has built up a serious reputation and is now regarded as one of the most innovative and distinct chefs in France. There's no menu as such – just tell him what you can't or won't eat and he'll prepare a bespoke succession of wildly creative dishes.
• +33 (0)1 40 50 84 40
14. L'Atelier Saint-Germain de Joël Robuchon
Paris, France
Last year's position: 29
With its emphasis on conviviality, L'Atelier moved Joël Robuchon from fine dining into fun dining. Interaction between diners – seated at a sushi-bar – and chefs, who performed in an open-plan kitchen, was encouraged and kitchen theatre quickly became the rage. That the original remains so popular is largely the result of Eric Lecerf and Philippe Braun, two of Robuchon's most trusted lieutenants, who man the Parisian fort while Robuchon trots the globe.
• joel-robuchon.net
15. Hof van Cleve
Kruishoutem, Belgium
Last year's position: 17
Chef-patron Peter Goossens lives and breathes local produce, and a meal at Hof van Cleve shows both the considerable extent of his regional larder and his talent at exploiting it. Fish and shellfish feature prominently, suiting Goossens' style of cuisine, in which he highlights freshness of flavour and reminds you of the source of your food. That said, he's no one-region pony and has an increasing interest in Asian cuisine.
• hofvancleve.com
16. Pierre Gagnaire
Paris, France
Last year's position: 13
Pierre Gagnaire's eponymous restaurant in Paris is still one of the most vaunted places to eat in the French capital, demonstrating the resilience of one of the food world's true greats. Gagnaire's approach to cooking combines a touch of the poetic with a dash of simplicity and a soupçon of wistfulness for dishes that appear as mini art forms.
• pierre-gagnaire.com
17. Oud Sluis
Sluis, Netherlands
Last year's position: 19
Oud Sluis has run for three generations and current patron, Sergio Herman, has remained true to its founding principles – capitalising on the Zeeland coast's fresh fish and oysters. This is no ordinary seafood restaurant, however. Herman's quest for flavour-matches of Italian and Japanese influence, such as langoustine with artichoke, Iberico ham and makrut lime leaves, has earned him a reputation as one of the country's most inspiring chefs.
• oudsluis.nl
18. Le Bernardin
New York, USA
Last year's position: 15
Fish is the star of the show at Le Bernardin but only when you eat there do you fully realise the high regard chef Eric Ripert holds for our underwater friends. The menu is a who's who of the sea, with red snapper, monkfish, fluke, turbot, salmon, king fish, halibut, lobster, bass, skate and kampachi in forms including "almost raw", "barely touched" and "lightly cooked".
• le-bernardin.com
19. L'Arpège
Paris, France
Re-entry
Alain Passard cut red meat from his menu back in 2001, but the Breton-born chef is no drum-banging vegetarian: the menus at this elegant restaurant, close to the Musée Rodin, still include top-notch game, poultry and seafood. However, L'Arpège remains veg-centric and is a haven for pescetarians, vegetarians and even – whisper it – vegans. It's also hallowed ground for chefs and Passard's light touch and flawless presentation has made him a true French master.
• alain-passard.com
20. Nihonryori RyuGin
Tokyo, Japan
Last year's position: 48
The menu at Nihonryori RyuGin is built around the seasons and chef Seiji Yamamoto takes great care to retain the integrity of traditional Japanese ingredients and cooking methods while pushing the boundaries of the cuisine. Yamamoto delights in avant-garde techniques – he's not afraid to flex his Arnie-like culinary muscles at times – but his overall approach doesn't overlook tradition. One dish features 30 kinds of Japanese spring vegetables and 10 types of shellfish.
• nihonryori-ryugin.com
21. Vendôme
Bergisch Gladbach, Germany
Last year's position: 22
The minute you turn into the drive of the imposing Schloss Bensberg – the hotel in which Vendôme is housed – you know you're in for a treat. Here, chef Joachim Wissler invites diners to accompany him on a small or grand "expedition", where they can feast on simply prepared dishes that come thick and fast. It's a surreal Alice in Wonderland-like jaunt through Germany's forgotten culinary landscape: fun, but with an underlying seriousness.
• schlossbensberg.com
22. Steirereck
Vienna, Austria
Last year's position: 21
Steirereck, housed in a beautiful Art Deco building in Vienna's central city park, is a grand affair with a 35,000-strong wine list and stunning views over the river Wien. Yet the food has stayed true to its old-world heritage with chef Heinz Reitbauer using national and regional Austrian cooking to create small moments of surprise through the discovery of previously unknown ingredients or the resurrection of those long forgotten.
• steirereck.at/wien/restaurant
23. Schloss Schauenstein
Fürstenau, Switzerland
Last year's position: 30
With only 26 covers, Schauenstein is one of the smallest restaurants in the list and since being awarded three Michelin stars last November is even harder to get into than previous years. Its chef, Andreas Caminada, is a serious talent who eschews the whizz-bang style of cuisine. Instead, he prefers to tease out the extraordinary potential of simple ingredients to create masterpieces of craft, taste, colour and precision.
• schauenstein.ch
24. Eleven Madison Park
New York, USA
Last year's position: 50
Eleven Madison Park is increasingly making waves within international circles and is the second-highest climber on this year's list. The restaurant recently underwent considerable change with chef Daniel Humm and general manager Will Guidara reducing capacity from 114 covers to 80 and completely revamping the menu. There's no more à la carte. Instead, a card printed with a grid of 16 ingredients hints at the dishes available.
• elevenmadisonpark.com
25. Aqua
Wolfsburg, Germany
Last year's position: 34
Aqua's location is corporate in the extreme – the Wolfsburg Ritz-Carlton overlooks Volkswagen's Autostadt visitor attraction – but this is no soulless, carbon copy, could-be-anywhere, hotel fine-dining joint. Sven Elverfeld applies his considerable skills to peasant food, resulting in avant-garde re-workings of boiled lamb fillet with Frankfurt green sauce and beef with sour cream, gherkins and beetroot. In a place where you'd expect absolutely no reference to location, it's here in spades.
• restaurant-aqua.com
26. Quay
Sydney, Australia
Last year's position: 27
Long before it was so deeply fashionable, chef Peter Gilmore was perfecting his "nature-based cuisine" at Quay with his dazzling array of dishes. The restaurant has retained the coveted "Three Hats" from the Australian Good Food Guide for a ninth consecutive year and Gilmore recently published his first book – Quay: food inspired by Nature – a visually sumptuous but deeply informative exposition of his work.
• quay.com.au
27. Iggy's
Singapore
Last year's position: 28
Iggy's made the move from The Regent Singapore hotel to new premises at The Hilton late last year, doubling the size of the original restaurant, but owner Ignatius Chan has resisted the temptation to use this as a way of ramping up the number of covers for the sake of more Singaporean dollars. The kitchen has lost none of its flair and precision with flavours strong and uncompromising, with dishes that have a true international grounding.
• iggys.com.sg
28. Combal Zero
Turin, Italy
Last year's position: 35
Anyone somewhat fatigued by samey high-end restaurants should definitely consider a trip to Combal Zero, where its hyper-creative, conceptual tasting menu will be equivalent to a round of electric shock therapy, stimulating mind and body alike. Chef-proprietor Davide Scabin is out to blow his customers' minds and challenge perceptions with cutting-edge dishes served with incredible creativity - including Around the World in Five Soups and a helium balloon, supplied with Campari and soda-water capsules.
• combal.org
29. Martín Berasategui
San Sebastián, Spain
Last year's position: 33
Martín Berasategui may have taken a bit of stick for being the only heavyweight Basque chef to take his brand of cooking worldwide (he has an outlet in Shanghai), but the food at his flagship continues to impress. The menu comprises 13 tiny, neatly presented dishes and foams, jellies and spherified balls abound, but Berasategui stays true to his roots: he uses very little non-regional produce and all his plates reference traditional dishes.
• martinberasategui.com
30. Bras
Laguiole, France
Re-entry
Working on the top of a hill in a remote slice of the French countryside, Michel Bras (pronounced Brahs) forages little-known herbs and vegetables and gently coaxes the best out of them, creating beautiful, organic plates such as his signature dish of Gargouillou containing more than 50 varieties of vegetable, herbs and flowers. Bras has never worked in anyone else's kitchen (aside from his mother's) and this is reflected in his simple, distinctive cooking.
• bras.fr
31. Biko
Mexico City, Mexico
Last year's position: 46
If you're hankering after a taste of techno-emotional Spanish cuisine but can't stomach the inevitable €300 bill, you might consider a trip to Mexico City's Biko, where a tasting menu is a snip at just under €40. At Biko, Mexican food gets the modern Basque treatment: the gentle appliance of science to get the best out of local produce, combined with deft use of big, concentrated flavours in complicated, artfully presented dishes.
• biko.com.mx
32. Le Calandre
Padua, Italy
Last year's position: 20
Le Calandre represents contemporary Italian cooking's middle ground. That's not to say that Massimiliano Alajmo's cooking is in any way average, but his cuisine is not extreme; it doesn't seek to challenge or confuse but is rather grounded in what is in season and what tastes good. Last year the restaurant underwent a major refurbishment, doing away with tablecloths in the process, to better reflect the philosophy of the kitchen.
• calandre.com
33. Cracco
Milan, Italy
Last year's position: Re-entry
Carlo Cracco is often credited – and occasionally derided – as being the ringleader of a small but important group of Italian chefs attempting to break away from the constraints of cooking "traditional" food. At his eponymous Milan restaurant he creates challenging cuisine that has won him considerable acclaim from the major Italian guides and two stars from Michelin. If you're not a fan of sea urchins, snails and slugs, though, it may be one to swerve.
• ristorantecracco.it
34. The Ledbury
London, UK
New entry
Tucked away in the affluent but relatively off-piste Notting Hill neighbourhood of west London, Brett Graham's small but perfectly realised restaurant has become one of the city's ultimate dining destinations. The tone is set by impeccable service, with the largely Antipodean front-of-house staff successfully walking the tightrope between formal and relaxed. Graham's equally outstanding food combines elements of French cuisine using traditional British ingredients, presented with charm and personality.
• theledbury.com
35. Chez Dominique
Helsinki, Finland
Last year's position: 23
Chef-patron Hans Välimäki has been flying the flag for Finland's cuisine since 1998 at Chez Dominique, regularly voted the country's best restaurant for its innovative cooking based around Nordic and French flavours. The idea behind Välimäki's cooking is to surprise by providing an experience unlike any other restaurant – an act he achieves through offering mystery menus where the diner places their trust at his mercy. It's a gamble well worth taking.
• chezdominique.fi
36. Le Quartier Français
Franschhoek, South Africa
Last year's position: 31
Part upmarket auberge, part award-winning restaurant complex, Le Quartier Français nestles in a corner of the Cape winelands. Dutch-born chef Margot Janse's nine-course African-inspired Surprise Menu, paired with local wines, takes diners on a gourmet safari, highlighting southern African flavours, many of which are sourced from Le Quartier's gardens. Others, such as Kalahari salt, hail from Namibia. Janse's aim is to be 100% African in all her produce – she's 80% there.
• lequartier.co.za
37. Amber
Hong Kong, China
New entry
Dutch-born Richard Ekkebus is at the helm of newcomer Amber, the signature restaurant of Hong Kong's five-star Landmark Mandarin Oriental Hotel, and is perfectly placed to procure the best Japanese line-caught fish and other produce that passes through the former silk and spice crossroads. The restaurant has high standards of on-plate artistry and imaginatively explores French conventions and combinations of tastes and textures, amplified by a daily-changing wine list.
• amberhongkong.com
38. Dal Pescatore
Mantua, Italy
Last year's position: 36
This family restaurant notched up a Michelin first when it was awarded three stars in 1996: Nadia Santini became the first female chef in Italy to gain top marks. Even now, it's easy to see what attracted the little red book to this out-of-the-way corner of Mantua – the setting is luxurious and while the cuisine is still rigorously authentic Italian, the kitchen remains ever-receptive to new ideas or ingredients.
• dalpescatore.com
39. Il Canto
Siena, Italy
Last year's position: 40
Working out of a former Carthusian convent, Paolo Lopriore boldly offers decidedly non-traditional food in a region with one of the most fiercely protected culinary identities in Italy. He may use Tuscan classics such as ribollita and tonno e fagioli as a jumping-off point, but from there it's anyone's guess what will happen next. A few diners report 'challenging' flavours but the vast majority come away raving about the confidence of the chef's direction.
• certosadimaggiano.com
40. Momofuku Ssäm Bar
New York, USA
Last year's position: 26
Pork takes a starring role at David Chang's informal and buzzing restaurant, either slow-cooked shoulder or braised and grilled belly served in steamed buns or wrapped in lettuce (Ssäm means wrapped). There are small plates, too, that reflect Chang's eclectic approach: Short Rib Sandwich – Taleggio, Beet Slaw and Bacon or maybe Spicy Honeycomb Tripe with Ginger, Scallion, Celery and Pickled Tomatoes. Think of it as a Pan-Asian St John.
• momofuku.com
41. St John
London, UK
Last year's position: 43
Founders Trevor Gulliver and Fergus Henderson have been busy becoming hoteliers this year but it's business as usual at their stalwart British restaurant-cum-canteen. Here you can eat some of the best meat dishes in London, from whole suckling pig to roast mutton, in refreshingly unfussy surroundings. What's lacking in pomp is more than made up for in technical ability. Its Welsh rarebit is easily one of the finest of its kind in the world.
• stjohnrestaurant.com
42. Astrid Y Gastón
Lima, Peru
New entry
Gastón Acurio's flagship restaurant in the Peruvian capital may be a newcomer to the list, but its chef-owner is already a well-established star of international gastronomy. At Astrid Y Gastón, Acurio uses myriad indigenous ingredients, led by Pacific seafood, and traditional cooking methods fused with the international influences for beautifully conceived dishes such as Warm Amazonian Ceviche, Suckling Goat with Loche Pumpkin and Lucuma Panacotta on Cocoa Alfajor.
• astridygaston.com
43. Hibiscus
London, UK
Last year's position: 49
Claude Bosi moved Hibiscus to London from Ludlow four years ago and his intense focus has paid increasing dividends with discerning diners. Bosi's dishes tread the fine line between classic and modern. He is not interested in bizarre flavour combinations or hi-tech methods that change the intrinsic nature of ingredients, but instead focuses on originality and flair. The result is a restaurant that stands proud among its peers not only in the UK, but across the globe.
• hibiscusrestaurant.co.uk
44. Maison Troisgros
Roanne, France
Last year's position: 44
Maison Troisgros has held three Michelin stars since 1968 and is currently under the control of Michel Troisgros, who picked up the reins in the late '80s. Though very much grounded in classical French food, Michel Troisgros has embraced other influences, most notably Japanese and Italian, for an unfussy and distinctly modern cuisine, yet in a nod to its mighty gastronomic heritage, its Escalope of Salmon with Sorrel signature dish has remained on the menu unchanged since 1965.
• troisgros.fr
45. Alain Ducasse au Plaza Athénée
Paris, France
Last year's position: 41
Alain Ducasse has gone back to basics at his eponymous flagship restaurant. There's now much less going on in his dishes – just two or three main ingredients presented simply, yet artfully – and his key aim is to strike a balance between acidity, bitterness and sweetness. He's using less salt and fat too, confident in his team's ability to introduce great flavour by other means – although the presentation remains as flamboyant as the interior.
• plaza-athenee-paris.com
46. De Librije
Zwolle, Netherlands
Last year's position: 37
Twenty-five years before it became fashionable, a passion for local, seasonal ingredients was the foundation upon which chef Jonnie Boer built his career and De Librije regularly features perch, eel and gurnard on its menus. The kitchen has a philosophy of simple purity, with Boer stating "it is not a laboratory" and the current menu features plenty of robust, earthy flavours, perfect to ward off winter's lingering chill.
• librije.com
47. Restaurant de l'Hôtel de Ville
Crissier, Switzerland
Last year's position: 14
While many restaurants take a shock-and-awe approach of pairing unusual ingredients as an obstacle course for the palate, chef patron Philippe Rochat's cooking is refreshingly straightforward, dare we say old-school. Attention to detail plays a major part of the dining experience and the kitchen sources the very best caviar, truffles and cheeses, whatever the price; bread is baked daily on-site and each dish contains only three main constituent flavours.
• philippe-rochat.ch
48. Varvary
Moscow, Russia
New entry
Chef Anatoly Komm is turning heads with an approach that is unashamedly "traditional Russian" on the one hand, but exciting and contemporary on the other. Fans of Komm include Ferran Adrià, who praises the chef for turning clichéd Russian cuisine on its head by combining traditional dishes and contemporary techniques with spectacular results. His 12-course "Gastronomic Show", for example, features Borscht with Foie Gras and a Russian Salad using ingredients sourced in Russia.
• anatolykomm.ru
49. Pujol
Mexico City, Mexico
New entry
Head chef Enrique Olvera has switched from fancy dining to Mexican food "with soul" at Pujol with market-inspired dishes that nod to a strong cultural legacy. Cooking in clay pots has ousted the water bath but the food is no less modern – think coffee, corn and flying ants toasted and ground into a powder, stuffed into a dried pumpkin and wrapped in corn leaves, then heated to evoke a balmy Mexican street scene.
• pujol.com.mx
50. Asador Etxebarri
Atxondo, Spain
Re-entry
To see a true culinary workshop in action, head to Asador Etxebarri, where part chef, part blacksmith Victor Arguinzoniz deals almost exclusively in grilled food. If you can eat it, he'll grill it. Caviar, cockles and even milk are cooked over locally felled oak and, unlike at many asadors, few of the ingredients arrive charred or blackened. If you're tired of your dinner being mucked about with, this is the place to go.
• asadoretxebarri.com
Apr 19, 2011
NHS reforms live blog
Join us for our daily live blog debating the government's controversial restructuring of the health service
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Photograph: Christopher Furlong/Getty Images
5.52pm: For those of you who were too busy to follow the blog closely throughout the day, here is a brief round-up of events to close today's coverage:
• There was a lively debate between you readers, NHS consultant radiologist Jacky Davis and Jean-Jacques de Gorter of Spire Healthcare, over the involvement of the private sector in the NHS. Jacky put forward her view that the NHS was heading towards a future – unwelcome to her – as "a funder of but not provider of healthcare". De Gorter said he felt "the proper question that needs to be asked and tackled is whether the NHS is exhausted in its current format".
• There was an exclusive interview with Mike Farrar, the chief executive of NHS North West, who is set to become head of the NHS Confederation in the next few weeks. Farrar told us that the reforms were "inexorable" despite the "pause" in the government's bill.
• There was also an interview with Sir Richard Thompson, the president of the Royal College of Physicians, who welcomed David Cameron's intervention this morning (see 11.51am), but said he still had concerns over competition in the bill especially "cream skimming" where private providers take away easy work and live "off the back of the NHS".
We'll be back tomorrow morning headlining with new research from the King's Fund. The author of the research, respected economist John Appleby, will be live online from 1-2pm to answer your questions. Thanks for all your comments.
4.35pm: Mike Farrar (left), chief executive of NHS North West, who is set to become head of the NHS Confederation in the next few weeks, spoke to Rowenna Davis after a lunch hosted by the thinktank Reform, which believes in liberalising the public sector. Despite the "pause" in the government's health reforms, in this audio interview Farrar described some of the changes as "inexorable":
Some of the trends around health services are inexorable... I was born in Rochdale and at the top of my road there was a hospital, it doesn't exist any more, and there was another hospital now that is part of Rochdale infirmary.... Maternity services [in Rochdale] are moving to a smaller number of sites but we know we're going to save 30 babies' lives a year so as I say a lot of this is inexorable.
Do I think we have communicated enough of reasons for change to local people? Probably not, and it worries me sometimes when we hear people say we shouldn't be travelling further, but if it means you have a better chance of survival, I, for one, with my family, I would rather travel 15 miles further to make sure I had a 50% better chance of surviving a particular problem.
Farrar went on to say that some trusts should have been making plans to adapt to the cuts several years ago:
Given the economic circumstances, we should have been thinking about some of these changes two years ago - that's what I was trying to say. However, working with different industries in different sectors they all say it's difficult to do massive reform at a time when resources are tight so you don't have the money to "oil the wheels of change", if I can put it like that.
Finally, towards the end of the interview, Farrar said that we could expect more of the "Tesco Local" model of delivery – by which he meant stripped-down hospitals with a small offering of essential services provided close to the local community:
We are getting that notion of health services on the high street ... They don't say "Tesco Local" although if I remember we used to have NHS walk-in centres that had some of those characteristics. But I think we will see more of that model emerge because I think a lot of health aims that you used to get 30 years ago in hospitals are now much more readily available without having to use those services.
4.20pm: The doctors' union, the BMA, looks askance at last week's instruction from the head of the NHS Sir David Nicholson to "press ahead" with Andrew Lansley's reforms.
Nicholson wrote to all NHS chief executives last week urging them to "press on" with aspects of the bill, adding that the timeline for transition "remains unchanged". Doctors' leaders warned against "irreversible decisions" being made under NHS reforms despite legislation having been put on hold while a listening exercise takes place.
BMA council chairman Hamish Meldrum said:
We have always maintained that changes in the NHS must not anticipate the legislative process, leading to irreversible decisions or unnecessary risks if some or all of the bill is not implemented.
Nicholson did anticipate a delay — until July 2012 at the earliest — to key statutory changes, such as:
• The abolition of strategic health authorities.
• The assumption of full statutory powers by the NHS Commissioning Board.
• The assumption of full powers by Health Education England, Public Health England and the NHS Trust Development Authority.
• The first phase of Monitor's powers.
• The establishment of HealthWatch England and other changes to arm's length bodies.
This has done little to reassure doctors. Meldrum said it was "even more important not to rush into changes if the government was serious about the listening exercise because its findings could result in some elements of the bill being altered".
3.56pm: Dave Clements of the Social Policy Forum thinktank sends some comments following on from yesterday's Q&A and debate on this blog. Clements writes:
I suppose it isn't too surprising that the "Cinderella service" should find itself once more in the shadows. Nevertheless, I think it is worth pointing out the "NHS reforms" are not just about the NHS. The health and social care bill (the clue is in the name) will have much broader implications. With this in mind, we might, for all the understandable cynicism about the motives behind this "listening exercise", welcome the pause for reflection.
This live blog began by describing the "almost unprecedented opposition" to the reforms. What is remarkable, though, is how confused and, again, cynical that opposition is. As a recently redundant worker in social care this is all too familiar. Any notion of "radical" change is greeted knee-jerk fashion with resistance, whether its personalisation or GP consortia, by supposedly liberal and progressive Guardian-reading types. While it is understandable that, faced with massive public sector cuts, any reform can be construed as "cover" for some hidden agenda, this response is all too automatic and far too conspiratorial to be credible.
While I am no cheerleader for marketisation, neither do I buy the assertion that the NHS is "one of the UK's best loved and most respected public institutions" as the intro to this blog also claimed. My suspicion is that any reform, almost regardless of its content, is going to be experienced as negative. Unable to come up with an alternative of our own and already a little battered and bruised, there is a tendency to oppose anything that might bring a wrecking ball to our supposedly beloved - but in reality already crumbling - NHS. This is indeed a pause to reflect, and start questioning everything ... including the NHS.
3.47pm: Andy Cowper, who runs the healthpolicyinsight blog and was cited in our thread, makes the point that private hospitals - including Spire - might be too optimistic in thinking that there will be lots of business in the future. Cowper says there's no economic growth in sight and with NHS budgets flat the private sector will struggle to find lots of paying patients.
I wonder if there might not be a touch of optimism at work here? Or seeking to bring about climate change? It will be very interesting to look out for Spire Healthcare's next annual report.
Cowper has also pointed out a tweet he received from Alastair McLellan, the editor of Health Service Journal, explaining that his brother-in-law, who is the finance director of a "v big private HC provider", sees no pot of gold for his firm in the government's reforms.
@HPIAndyCowper @joefd - My brother-in-law FD of V big private HC provider - no sign of him rubbing his hands in glee re NHS (just opposite)
less than a minute ago via TweetDeck Favorite Retweet Reply
Alastair McLellan
HSJEditor
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3.08pm: At last. Good news for the health secretary, who gets backing from the NHS Alliance, which represents family doctors, nurses and managers in primary care, for his plans to hand £60bn of taxpayers cash to GP consortia to commission healthcare.
Michael Dixon, chairman of the NHS Alliance goes further and dismisses the idea that there will be any real changes to the controversial health bill - a thought floated by the prime minister this morning (see 11.51am).
The alliance cannot be dismissed easily and are long time supporters of clinical commissioning. Politically they are NHS extremists - so much so they are one of the few organisations allowed to use the three letters, N H S, in their name. Dixon says:
There is no going back on clinical commissioning and GP Commissioning Consortia should not be forgotten amid political discussions which are not going to bring significant changes to this aspect of the bill. We are encouraging all GP consortia, especially pathfinders, to continue their pace of development and to not be distracted by the current hiatus in the passage of the bill.
2.38pm: I have just finished speaking to Sir Richard Thompson, president of the Royal College of Physicians. He welcomed David Cameron's intervention this morning (see 11.51am) in which the prime minister said that hospital doctors would be involved in commissioning healthcare for patients - and it would not be left just up to GPs.
He warned:
There may be errors where secondary and primary care doctors don't get on well.
Thompson, a distinguished medic and emeritus consultant gastroenterologist at Guy's and St. Thomas' Hospital, said he still had concerns over competition in the bill especially "cream skimming" where private providers take away easy work living "off the back of the NHS"
Listen to the interview below. I'm afraid my voice has come through very quietly, but Thompson can be heard perfectly:
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2.37pm: Thanks very much for all your contributions to this debate, and thanks to our two experts, Jacky Davis and Jean-Jacques de Gorter. Feel free to keep the debate going in the comments.
2.11pm: DrJazz took issue with Spire Healthcare's "why choose Spire?" section on its website. The website gives these reasons:
• Your choice of an expert consultant.
• Fast access for appointments, diagnostic tests and treatment
• Your own private room, with friends and family able to visit you when you wish with in-room entertainment facilities.
• A full range of appetising meals prepared by one of our on-site chefs.
DrJazz wrote:
The first two are provided by the NHS, although I doubt very much that Spire Healthcare can provide a full range of diagnostic services or back up when something goes wrong.
Jean-Jacques de Gorter responds:
Not true I'm afraid. If you are lucky enough to be treated by a consultant (half of surgery in the NHS is undertaken by non-consultant grades), then you will typically be allocated to the one who will most likely be able to treat you within the 18 week referral to treatment target - there will of course be some exceptions.
Patients who opt to be treated privately are able to choose the consultant of their choice in consultation with their GP.
In answer to your point re full range of diagnostics etc - five of our hospitals have intensive care units (level three) and 30 other Spire hospitals have high dependency units (level two) - the other hospital is co-located with an NHS trust.
Last year our rate of unplanned transfer out to another hospital was only 0.07% - as it was in 2009, and we participate in the critical care network for every region where we operate a hospital. We run 22 MRI scanners and 18 CT scanners etc etc. We undertake complex surgery including neurosurgery (including brain), cardiac surgery, complex bariatric surgery etc.
It is an easy soundbite to suggest private hospitals only undertake easy cases. The truth is that they operate a fully fledged hospitals (albeit with fewer beds that a teaching hospital) with the technology, facilities and capable staffing necessary to make sure they are able to deliver high standards of care. After all, our success depends on it.
2.00pm: Jacky Davis responds directly to Jean-Jacques de Gorter's comment that "I think the proper question that needs to be asked and tackled is whether the NHS is exhausted in its current format". She says:
The NHS is one of the most cost-effective and equitable health services in the world. Others can't believe our politicians are trying to dismantle it. The answer is not to start involving the private sector - when that happens costs go up, quality and equity go down.
Treatments are being delayed or denied. The solution is not to look to the private sector to fill the gap via personal health insurance, which will not help the majority who can't afford to go down this route. We need to see where we can save money within the NHS. The most obvious place to start is with the expensive and unwieldy bureaucracy needed to run the market in healthcare.
Substantial sums of money could be saved by putting an end to the buying and selling of healthcare. In the US, administration accounts for 31% of healthcare costs. In the UK, the bureaucracy involved in buying and selling healthcare is estimated to cost an extra 10% of the NHS budget (2005 estimate) ie over £10bn a year. We could save that every year, which dwarfs the £20bn we'll be struggling to save over the next four years through cuts and closures which damage patients. It makes no sense to throw money away on an idealogical market in healthcare which has no evidence base anyway. Get rid of the market – there's no evidence for it, and the money saved will mean we can avoid the cuts and closures of frontline services that we are currently facing.
It's worth noting that the devolved nations have abandoned the market model, and there's no reason why we can't too.
1.56pm: Jean-Jacques de Gorter responds to the same question from TheNabster (see 1.47pm):
I do not believe this is how the current reforms are envisaged. Remember, GPs are already independent contractors to the NHS and primary care accounts for a substantial proportion of the total NHS spend. In addition, privately funded patients are already treated in public sector hospitals, and some NHS funded patients are treated in a private sector hospitals. You cannot separate the two.
In any event, I believe attempts to compartmentalise the discussion in this way misses the point. Use of the private sector is not a rejection of the NHS. Rather, private provision acts alongside the NHS and complements it.
Being treated privately reduces the overall burden on the NHS and frees up waiting lists. However, privately funded activity accounts for only 1% of total healthcare delivered - hardly market disruption.
I think the proper question that needs to be asked and tackled is whether the NHS is exhausted in its current format. If you were to stand back and take in the symptoms we are currently experiencing, it would suggest that it is. tackling the symptoms one by one will not help deliver a long term and sustainable solution. people are living longer (I read today that one in four 16-year-olds can expect to reach 100 years), people's expectations about the standard and type of healthcare they should receive will only increase, as will the costs of healthcare technologies. Either this has to be funded through tax alone, or we had better start having a rational, unemotional debate about HOW, and not IF, we achieve this.
If you want to see real innovation, then the answer is a) create a level playing field, b) pay a fair price and c) offer patients choice.
Just to make clear, we're is not a funder of healthcare ie we are not an insurer - we are a provider of care.
1.47pm: TheNabster asks:
Do they [the government] have a clear vision as to [what] this refurbished "NHS" will look like? Will it have a private arm and a public arm?
Jacky Davis replies:
As I said above I and many others think the intention is to have the NHS as a funder of but not provider of healthcare. This will come about via mixed funding, with insurance, top-ups and co-payments. Personal budgets are also a move in this direction. The private sector will increasingly provide care under the NHS logo so it will be difficult if not impossible to tell whether your care is being delivered by an NHS organisation or by a private company badged as the NHS.
The distinction between a public arm and a private arm will be lost as private firms are welcomed into the "NHS family". Patients and the public have repeatedly indicated that they do care who provides the service and that they don't want a bigger involvement of the private sector so this loss of transparency is not in their interest.
1.40pm: Jean-Jacques de Gorter replies to Linda Cullen's email. Linda asked what (if any) role will private providers have in training doctors for the future?
Jean-Jacques de Gorter replies:
Hi Linda - training and its funding is very topical right now, and there is a consultation under way looking at this right now ("Developing the Healthcare Workforce"). Around £5bn is spent every year on workforce training in the UK.
We (Spire) currently train nurses and allied health professionals - in 2010 alone: 269 under and postgraduate nurses, 46 pre-registration allied health professionals, a further 177 members of staff took National Vocational Qualifications and 133 completed university degree modules. In addition 5,574 candidates completed critical care courses and staff completed 46,000 e-learning modules using our web-enabled platform. Why does this matter? Because staff frequently move between the private and public healthcare sectors.
However, we are unable to access funding to train undergraduate medical students, since this takes places through universities who are separately funded to deliver this training. There is one private medical school located in Buckinghamshire.
Postgraduate training eg to become a consultant or GP for example, is funded by the Deaneries. Yes of course we would like to participate and contribute to training, and we have tried. However, there are costs to be met, and we have so far been unable to have a sensible conversation about fair reimbursement. Hopefully the outcome of the current consultation will propose a way through to enabling non-public sector providers to deliver medical training. In the meantime, we fund four postgraduate research fellow positions that enable doctors to work alongside recognised experts in their fields for a number of months at a time.
1.17pm: Gwledig and pipesmokingman both ask if the coalition's planned reorganisation is a move to a US-style "no pay, no treatment" system. Jacky Davis replies:
There is no doubt in the minds of those who have been following the debate that the intention is to have the NHS as a kite mark only, with care provided by competing providers. Initially this will be NHS organisations, voluntary organisations and the commercial sector. The private sector is likely to win out in this competition for reasons we can go into if you like.
If you doubt this I strongly recommend a new book, The Plot against the NHS by Colin Leys and Stewart Player. This documents how politicians and the private sector have worked together to get the NHS to the point where this can happen.
At the same time I think we will move towards a system of mixed funding with a three-tier service – those who can only afford the basic NHS service, those who can pay for extra within the NHS through top-ups and co-payments and finally those who can pay to go outside the NHS. These current cuts and closures will accelerate that process as we see in this latest report from Spire.
The private sector recognised this long ago - last August the head of Bupa was quoted as saying: "The UK government [has] started to articulate its plans for reform of its healthcare systems and we believe that this should offer new opportunities for our businesses in the future."
1.12pm: propforward suggests:
Maybe include a desire to include more clinician input (nurses, GPs hospital & community doctors, physios etc) over time within each PCT, but leave the basic structure alone.
Jean-Jacques de Gorter replies:
Anyone who runs an organisation understands the importance of engaging your workforce. And I don't mean "satisfaction" surveys, I mean having people who feel involved in their organisation, who are able to give and receive feedback, who are recognised for their performance and equally see poor performance being addressed, and essentially feel that the organisation's challenges are their own.
Every responsible and smart commercial organisation will recognise this, and pay more than simply lip service to results. They will also engage with their staff and customers when developing their strategy and business plans. For example, we undertake annual staff engagement surveys administrated independently. Every manager will have at least one objective based on the results, and these form an important part of our development plans for the coming year. In terms of developing our annual operating plans, this starts with discussions with clinical teams, managers, and consultants, and concludes when their insights are reconciled with our strategic analysis and conclusions.
Sorry about the wordy answer - the short version is: of course you have to engage your people if you want to be successful.
1.08pm: Jacky Davis writes:
A lot of people are concerned that there might be conflicts of interest when GP commissioning begins eg "Can GPs find themselves commissioning healthcare for patients from providers they might have an interest in? If so what can be done to prevent this conflict of interest?"
Yes, this is likely to be a real problem. First, many GPs (a recent survey suggested as many as 25%) have an interest in the private sector. So if they refer you to a private clinic rather than the NHS you are likely to wonder whether their decision is based on your best clinical interests or their best financial interests. This is likely to damage the patient-doctor relationship unless it is recognised and addressed
But a bigger problem is what will happen when GPs decide that commissioning is too big and time-consuming a job and bring in the private sector to do it for them (the government has already said it wants to see this happening). At the same time you have the policy of "any willing provider" to deliver healthcare.
So what's to stop the private sector (commissioning arm) buying care from the private sector (provider arm)? There will be some weak protection in place no doubt but nothing to stop "I'll scratch your back if you scratch mine". Plus the private sector changes names on a regular basis; it will take a lot of time and money (lost to the NHS) to keep a track of this.
1.05pm: Our experts Jean-Jacques de Gorter, the clinical director of Spire Healthcare, and Jacky Davis, an NHS consultant radiologist, have
begun answering your questions below the line.
Gwledig asks:
The debate seems deceptively complex but is very simple, it's a choice between a state managed, tax funded, at-cost system, run for the national good instead of exploited for profit, or the same system they've had in the USA
Jean-Jacques de Gorter replies:
I don't believe this is as simple a choice as you suggest. It's not a binary decision. There are many different types of healthcare systems across the world, and none that consider themselves to have "cracked it". The challenge faced in funding a satisfactory and sustainable healthcare system is common to every nation.
Australia and New Zealand - both places that I have worked as a doctor - used elements of both UK and US systems effectively (to my way of thinking). Both were fair, provided universal coverage, but also included elements of competition and choice.
I also have experience of the US system - my family resides in the US. Personally, it is not a model I favour and would not expect the UK to follow suit. That does not mean I disagree with the ability of individuals to take more responsibility for their own health, the importance of some competition, and the ability for people to exercise choice.
12.53pm: David Worskett of the NHS Confederation, the body that represents almost all senior managers in the health service, sends the following:
Yes, there is plenty of evidence of private providers doing a good job – most powerfully from patient surveys, which show 97% of patients rating their NHS care delivered by an independent sector provider as "excellent" or "very good". It's also important to note that independent providers now operate at NHS standard tariffs, so the cost to the taxpayer is no different.
And although with less than 5% of all NHS work being done by independent providers (excluding GP practices, of course), the scope to become involved in education and training is small, it is now possible and many independent providers would love to do so to a greater extent: But the "system" itself seems to get in the way.
12.03pm: At 1pm today there we will be holding a live Q&A session on Spire Healthcare's new survey, which shows waiting times creeping upwards for a number of procedures. Online debating the pros and cons of turning to private providers for the answer will be:
• Dr Jean-Jacques de Gorter, clinical director, Spire.
• Jacky Davis, NHS consultant radiologist.
We want the questions to come from you in the comments below, but here are a few suggestions:
• Can private providers help reduce waiting times?
• Do private providers save money? There's evidence they cost more.
• What are the risks of using private providers?
• Do we have any examples of private providers working well and working badly? Why?
• If we do use taxpayers' money to fund private contracts, how can we get the most out of them?
• Can GPs find themselves commissioning healthcare for patients from providers they might have an interest in? If so what can be done to prevent this conflict of interest?
• If private providers take all of the work out of hospitals, what will this mean for the training of junior doctors?
Photograph: Dan Kitwood/Getty Images
11.51am: My colleague Hélène Mulholland has filed a story on David Cameron's comments that "changes need to be made" to the NHS reforms (see 10.03am). Here are the key quotes from the prime minister (left):
Yes, I think they do need to change. We need to get this right. But I don't think it was wrong to get started rapidly on a process of change. While it's an option to stick with the status quo, I don't think it's a sensible option. So I think it was right to get moving.
But we have a moment now where the legislation is almost finished in the Commons, where I think it is right to stop and to pause, to rethink and improve because I think we can make further improvements to our policy. I think that is a different thing for the government to do.
Normally governments just plough ahead regardless, but I think it's important to see if we can further improve those policies and, at the same time, make sure we have more full-throated support from people working in the NHS, most of whom know change is necessary. I want to get them on board for the changes we are considering and see if they have ideas for further improvement.
11.33am: Sunny Hundal (left) at the left-liberal blog Liberal Conspiracy has just written this post criticising the NHS reforms. He says the government is confused and points to a recent YouGov poll for the Sunday Times showing that the public remains unconvinced.
Response? Total support 27%, Total oppose: 52%, Don't know: 21%. That's a big thumbs-up from the public then.
11.23am: Peter Ward Booth, who describes himself as a partially retired NHS consultant and who followed the blog yesterday, sent this email to Rowenna this morning saying that practitioners and patients need more information about the reasons about the government's reforms. Ward Booth tackles the important point about whether GPs are really in a position to cut the cash flowing into highly specialised hospital specialities.
Of course we all know it's about saving money - specifically targeting secondary specialist or hospital care - however you want to describe it. Yes, it is expensive, because it is super-specialised, with beds and highly trained healthcare workers.
Yes, if GPs hold the funds, they will restrict referrals to save money, just as PCTs restrict referrals by declaring certain procedures "low priority" - euphemism for not treating a condition. Either way the quality of care will go down, unless you can afford private care.
In the past governments tried to reduce the cost of secondary care by trying to have managers micromanage the running of the hospitals; the price was we have statistically a manager for every hospital bed. Managers are, however bright or motivated, driven by their political masters, not by patient or doctor needs. They are also very expensive.
So let's be honest and recognise we need secondary/specialist care, but address the costs issue separately. Let's give the power to the consultants to run their own departments and have "costs" league tables as well as "outcome" league tables. Have teams of peers to review the failing units with the power to hire and fire.
Above all the "reforms" should not be allowed to reduce specialist care to only those who can afford it. Yes, GPs are specialists, but not in surgery (or) cardiology.
10.37am: The health secretary got a boost today with a sympathetic and pithy portrait from the Independent's health editor Jeremy Laurance. Laurance gets the health secretary's deadpan humour to a tee, recalling his funniest personal anecdote about suffering a stroke while playing cricket.
"People imagine politicians are a bit brain dead," [Lansley] would say. "Well I am – and I have the MRI scan to prove it."
On a less humorous note, in the Guardian former Labour chair of the health select committee David Hinchliffe attacks the government for its pro-market tilt.
The same market philosophy which impacted upon my constituents 20 years ago is at the heart of the health and social care bill. Its proposals are driven by an ideology totally alien to a health service whose success has been rooted in co-operation and collectivism.
In the FT there's more bad news for the government as one of four NHS trusts chosen to be early adopters of the electronic patient records pulled out – plunging the health service's £12.7bn programme to create a vast patient database into "yet another crisis".
Also in an ominous sign of things to come, news that Trafford General Hospital is in a financial mess. It's an iconic place in NHS history - treating the first ever state-funded patient when the health service was inaugurated in 1948. The Manchester Evening News says "the hospital where the NHS was founded could find itself £75m in debt by 2015".
And trust the Daily Mail to come up with a holiday story in health. The tabloid claims that a hospital is considering flying foreign patients overseas rather than fund their long-term care. One way to beat the Easter traffic.
10.32am: Rowenna points out a political spat in Scotland where Labour claimed that knife injuries cost the NHS in Scotland £500m a year – almost 5% of Scotland's £11bn NHS budget.
Nigel Hawkes on Straight Statistics has an interesting take on how politicians are using stats on the health costs of knife crime to score political points.
He says the Scottish Labour party has promised a mandatory prison sentence for anyone found in possession of a knife outside their home. To justify the policy, they say knife injuries cost Scotland's NHS £500m a year, or 4.5% of the health budget.
But after some digging, Nigel says that even with the "best will in the world" it's hard to see the total cost of knife crime exceeding £10m a year – or 50 times less than the Scottish Labour party is claiming.
Scottish Labour's policy doesn't make much sense, Nigel argues, given that they are setting aside an extra £20m to provide the extra prison places that will be needed if more people are sent to jail as a result of their policy."
(Disclaimer: Rowenna is standing as a candidate in local elections next month in England for the Labour party.)
10.03am: Hello. I am Randeep Ramesh, the Guardian's social affairs editor, and my colleague Rowenna Davis and I will be liveblogging the government's radical NHS reforms all day. Today there will be a question and answer session on Spire Healthcare's new survey, which sees waiting times creeping upwards in a number of procedures. No surprise perhaps that families are not getting fertility treatments at a time of cuts, but worryingly patients are facing long waits for hip replacements and hernia repairs. Online debating the issues will be Spire's clinical director, Dr Jean-Jacques de Gorter, and NHS consultant radiologist Jacky Davis.
Also Rowenna will be at a conference on looking how to close hospitals painlessly. Earlier this month welfare secretary Iain Duncan Smith marched to save his local hospital; while his cabinet colleague Andrew Lansley has to marshal insufficient resources to meet rising demand, this is one of the most vexing political issues of the day.
For those who missed it Andrew Sparrow has already caught up with David Cameron's interview on the Today programme. The main take away is that there will be changes to the NHS reforms. Interestingly Cameron made a point of saying hospital doctors would have a say in how GPs commission services for their patients. The prime minister's brother in law, Carl Brookes, works as a cardiologist in Basingstoke for the North Hampshire NHS trust and memorably told him he was concerned that family doctors would become too powerful under Andrew Lansley's plans.
You can email me at randeep.ramesh@guardian.co.uk or tweet at tianran. Rowenna's email is rowenna.davis@guardian.co.uk and her Twitter name is rowenna_davis.
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Photograph: Christopher Furlong/Getty Images
5.52pm: For those of you who were too busy to follow the blog closely throughout the day, here is a brief round-up of events to close today's coverage:
• There was a lively debate between you readers, NHS consultant radiologist Jacky Davis and Jean-Jacques de Gorter of Spire Healthcare, over the involvement of the private sector in the NHS. Jacky put forward her view that the NHS was heading towards a future – unwelcome to her – as "a funder of but not provider of healthcare". De Gorter said he felt "the proper question that needs to be asked and tackled is whether the NHS is exhausted in its current format".
• There was an exclusive interview with Mike Farrar, the chief executive of NHS North West, who is set to become head of the NHS Confederation in the next few weeks. Farrar told us that the reforms were "inexorable" despite the "pause" in the government's bill.
• There was also an interview with Sir Richard Thompson, the president of the Royal College of Physicians, who welcomed David Cameron's intervention this morning (see 11.51am), but said he still had concerns over competition in the bill especially "cream skimming" where private providers take away easy work and live "off the back of the NHS".
We'll be back tomorrow morning headlining with new research from the King's Fund. The author of the research, respected economist John Appleby, will be live online from 1-2pm to answer your questions. Thanks for all your comments.
4.35pm: Mike Farrar (left), chief executive of NHS North West, who is set to become head of the NHS Confederation in the next few weeks, spoke to Rowenna Davis after a lunch hosted by the thinktank Reform, which believes in liberalising the public sector. Despite the "pause" in the government's health reforms, in this audio interview Farrar described some of the changes as "inexorable":
Some of the trends around health services are inexorable... I was born in Rochdale and at the top of my road there was a hospital, it doesn't exist any more, and there was another hospital now that is part of Rochdale infirmary.... Maternity services [in Rochdale] are moving to a smaller number of sites but we know we're going to save 30 babies' lives a year so as I say a lot of this is inexorable.
Do I think we have communicated enough of reasons for change to local people? Probably not, and it worries me sometimes when we hear people say we shouldn't be travelling further, but if it means you have a better chance of survival, I, for one, with my family, I would rather travel 15 miles further to make sure I had a 50% better chance of surviving a particular problem.
Farrar went on to say that some trusts should have been making plans to adapt to the cuts several years ago:
Given the economic circumstances, we should have been thinking about some of these changes two years ago - that's what I was trying to say. However, working with different industries in different sectors they all say it's difficult to do massive reform at a time when resources are tight so you don't have the money to "oil the wheels of change", if I can put it like that.
Finally, towards the end of the interview, Farrar said that we could expect more of the "Tesco Local" model of delivery – by which he meant stripped-down hospitals with a small offering of essential services provided close to the local community:
We are getting that notion of health services on the high street ... They don't say "Tesco Local" although if I remember we used to have NHS walk-in centres that had some of those characteristics. But I think we will see more of that model emerge because I think a lot of health aims that you used to get 30 years ago in hospitals are now much more readily available without having to use those services.
4.20pm: The doctors' union, the BMA, looks askance at last week's instruction from the head of the NHS Sir David Nicholson to "press ahead" with Andrew Lansley's reforms.
Nicholson wrote to all NHS chief executives last week urging them to "press on" with aspects of the bill, adding that the timeline for transition "remains unchanged". Doctors' leaders warned against "irreversible decisions" being made under NHS reforms despite legislation having been put on hold while a listening exercise takes place.
BMA council chairman Hamish Meldrum said:
We have always maintained that changes in the NHS must not anticipate the legislative process, leading to irreversible decisions or unnecessary risks if some or all of the bill is not implemented.
Nicholson did anticipate a delay — until July 2012 at the earliest — to key statutory changes, such as:
• The abolition of strategic health authorities.
• The assumption of full statutory powers by the NHS Commissioning Board.
• The assumption of full powers by Health Education England, Public Health England and the NHS Trust Development Authority.
• The first phase of Monitor's powers.
• The establishment of HealthWatch England and other changes to arm's length bodies.
This has done little to reassure doctors. Meldrum said it was "even more important not to rush into changes if the government was serious about the listening exercise because its findings could result in some elements of the bill being altered".
3.56pm: Dave Clements of the Social Policy Forum thinktank sends some comments following on from yesterday's Q&A and debate on this blog. Clements writes:
I suppose it isn't too surprising that the "Cinderella service" should find itself once more in the shadows. Nevertheless, I think it is worth pointing out the "NHS reforms" are not just about the NHS. The health and social care bill (the clue is in the name) will have much broader implications. With this in mind, we might, for all the understandable cynicism about the motives behind this "listening exercise", welcome the pause for reflection.
This live blog began by describing the "almost unprecedented opposition" to the reforms. What is remarkable, though, is how confused and, again, cynical that opposition is. As a recently redundant worker in social care this is all too familiar. Any notion of "radical" change is greeted knee-jerk fashion with resistance, whether its personalisation or GP consortia, by supposedly liberal and progressive Guardian-reading types. While it is understandable that, faced with massive public sector cuts, any reform can be construed as "cover" for some hidden agenda, this response is all too automatic and far too conspiratorial to be credible.
While I am no cheerleader for marketisation, neither do I buy the assertion that the NHS is "one of the UK's best loved and most respected public institutions" as the intro to this blog also claimed. My suspicion is that any reform, almost regardless of its content, is going to be experienced as negative. Unable to come up with an alternative of our own and already a little battered and bruised, there is a tendency to oppose anything that might bring a wrecking ball to our supposedly beloved - but in reality already crumbling - NHS. This is indeed a pause to reflect, and start questioning everything ... including the NHS.
3.47pm: Andy Cowper, who runs the healthpolicyinsight blog and was cited in our thread, makes the point that private hospitals - including Spire - might be too optimistic in thinking that there will be lots of business in the future. Cowper says there's no economic growth in sight and with NHS budgets flat the private sector will struggle to find lots of paying patients.
I wonder if there might not be a touch of optimism at work here? Or seeking to bring about climate change? It will be very interesting to look out for Spire Healthcare's next annual report.
Cowper has also pointed out a tweet he received from Alastair McLellan, the editor of Health Service Journal, explaining that his brother-in-law, who is the finance director of a "v big private HC provider", sees no pot of gold for his firm in the government's reforms.
@HPIAndyCowper @joefd - My brother-in-law FD of V big private HC provider - no sign of him rubbing his hands in glee re NHS (just opposite)
less than a minute ago via TweetDeck Favorite Retweet Reply
Alastair McLellan
HSJEditor
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3.08pm: At last. Good news for the health secretary, who gets backing from the NHS Alliance, which represents family doctors, nurses and managers in primary care, for his plans to hand £60bn of taxpayers cash to GP consortia to commission healthcare.
Michael Dixon, chairman of the NHS Alliance goes further and dismisses the idea that there will be any real changes to the controversial health bill - a thought floated by the prime minister this morning (see 11.51am).
The alliance cannot be dismissed easily and are long time supporters of clinical commissioning. Politically they are NHS extremists - so much so they are one of the few organisations allowed to use the three letters, N H S, in their name. Dixon says:
There is no going back on clinical commissioning and GP Commissioning Consortia should not be forgotten amid political discussions which are not going to bring significant changes to this aspect of the bill. We are encouraging all GP consortia, especially pathfinders, to continue their pace of development and to not be distracted by the current hiatus in the passage of the bill.
2.38pm: I have just finished speaking to Sir Richard Thompson, president of the Royal College of Physicians. He welcomed David Cameron's intervention this morning (see 11.51am) in which the prime minister said that hospital doctors would be involved in commissioning healthcare for patients - and it would not be left just up to GPs.
He warned:
There may be errors where secondary and primary care doctors don't get on well.
Thompson, a distinguished medic and emeritus consultant gastroenterologist at Guy's and St. Thomas' Hospital, said he still had concerns over competition in the bill especially "cream skimming" where private providers take away easy work living "off the back of the NHS"
Listen to the interview below. I'm afraid my voice has come through very quietly, but Thompson can be heard perfectly:
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2.37pm: Thanks very much for all your contributions to this debate, and thanks to our two experts, Jacky Davis and Jean-Jacques de Gorter. Feel free to keep the debate going in the comments.
2.11pm: DrJazz took issue with Spire Healthcare's "why choose Spire?" section on its website. The website gives these reasons:
• Your choice of an expert consultant.
• Fast access for appointments, diagnostic tests and treatment
• Your own private room, with friends and family able to visit you when you wish with in-room entertainment facilities.
• A full range of appetising meals prepared by one of our on-site chefs.
DrJazz wrote:
The first two are provided by the NHS, although I doubt very much that Spire Healthcare can provide a full range of diagnostic services or back up when something goes wrong.
Jean-Jacques de Gorter responds:
Not true I'm afraid. If you are lucky enough to be treated by a consultant (half of surgery in the NHS is undertaken by non-consultant grades), then you will typically be allocated to the one who will most likely be able to treat you within the 18 week referral to treatment target - there will of course be some exceptions.
Patients who opt to be treated privately are able to choose the consultant of their choice in consultation with their GP.
In answer to your point re full range of diagnostics etc - five of our hospitals have intensive care units (level three) and 30 other Spire hospitals have high dependency units (level two) - the other hospital is co-located with an NHS trust.
Last year our rate of unplanned transfer out to another hospital was only 0.07% - as it was in 2009, and we participate in the critical care network for every region where we operate a hospital. We run 22 MRI scanners and 18 CT scanners etc etc. We undertake complex surgery including neurosurgery (including brain), cardiac surgery, complex bariatric surgery etc.
It is an easy soundbite to suggest private hospitals only undertake easy cases. The truth is that they operate a fully fledged hospitals (albeit with fewer beds that a teaching hospital) with the technology, facilities and capable staffing necessary to make sure they are able to deliver high standards of care. After all, our success depends on it.
2.00pm: Jacky Davis responds directly to Jean-Jacques de Gorter's comment that "I think the proper question that needs to be asked and tackled is whether the NHS is exhausted in its current format". She says:
The NHS is one of the most cost-effective and equitable health services in the world. Others can't believe our politicians are trying to dismantle it. The answer is not to start involving the private sector - when that happens costs go up, quality and equity go down.
Treatments are being delayed or denied. The solution is not to look to the private sector to fill the gap via personal health insurance, which will not help the majority who can't afford to go down this route. We need to see where we can save money within the NHS. The most obvious place to start is with the expensive and unwieldy bureaucracy needed to run the market in healthcare.
Substantial sums of money could be saved by putting an end to the buying and selling of healthcare. In the US, administration accounts for 31% of healthcare costs. In the UK, the bureaucracy involved in buying and selling healthcare is estimated to cost an extra 10% of the NHS budget (2005 estimate) ie over £10bn a year. We could save that every year, which dwarfs the £20bn we'll be struggling to save over the next four years through cuts and closures which damage patients. It makes no sense to throw money away on an idealogical market in healthcare which has no evidence base anyway. Get rid of the market – there's no evidence for it, and the money saved will mean we can avoid the cuts and closures of frontline services that we are currently facing.
It's worth noting that the devolved nations have abandoned the market model, and there's no reason why we can't too.
1.56pm: Jean-Jacques de Gorter responds to the same question from TheNabster (see 1.47pm):
I do not believe this is how the current reforms are envisaged. Remember, GPs are already independent contractors to the NHS and primary care accounts for a substantial proportion of the total NHS spend. In addition, privately funded patients are already treated in public sector hospitals, and some NHS funded patients are treated in a private sector hospitals. You cannot separate the two.
In any event, I believe attempts to compartmentalise the discussion in this way misses the point. Use of the private sector is not a rejection of the NHS. Rather, private provision acts alongside the NHS and complements it.
Being treated privately reduces the overall burden on the NHS and frees up waiting lists. However, privately funded activity accounts for only 1% of total healthcare delivered - hardly market disruption.
I think the proper question that needs to be asked and tackled is whether the NHS is exhausted in its current format. If you were to stand back and take in the symptoms we are currently experiencing, it would suggest that it is. tackling the symptoms one by one will not help deliver a long term and sustainable solution. people are living longer (I read today that one in four 16-year-olds can expect to reach 100 years), people's expectations about the standard and type of healthcare they should receive will only increase, as will the costs of healthcare technologies. Either this has to be funded through tax alone, or we had better start having a rational, unemotional debate about HOW, and not IF, we achieve this.
If you want to see real innovation, then the answer is a) create a level playing field, b) pay a fair price and c) offer patients choice.
Just to make clear, we're is not a funder of healthcare ie we are not an insurer - we are a provider of care.
1.47pm: TheNabster asks:
Do they [the government] have a clear vision as to [what] this refurbished "NHS" will look like? Will it have a private arm and a public arm?
Jacky Davis replies:
As I said above I and many others think the intention is to have the NHS as a funder of but not provider of healthcare. This will come about via mixed funding, with insurance, top-ups and co-payments. Personal budgets are also a move in this direction. The private sector will increasingly provide care under the NHS logo so it will be difficult if not impossible to tell whether your care is being delivered by an NHS organisation or by a private company badged as the NHS.
The distinction between a public arm and a private arm will be lost as private firms are welcomed into the "NHS family". Patients and the public have repeatedly indicated that they do care who provides the service and that they don't want a bigger involvement of the private sector so this loss of transparency is not in their interest.
1.40pm: Jean-Jacques de Gorter replies to Linda Cullen's email. Linda asked what (if any) role will private providers have in training doctors for the future?
Jean-Jacques de Gorter replies:
Hi Linda - training and its funding is very topical right now, and there is a consultation under way looking at this right now ("Developing the Healthcare Workforce"). Around £5bn is spent every year on workforce training in the UK.
We (Spire) currently train nurses and allied health professionals - in 2010 alone: 269 under and postgraduate nurses, 46 pre-registration allied health professionals, a further 177 members of staff took National Vocational Qualifications and 133 completed university degree modules. In addition 5,574 candidates completed critical care courses and staff completed 46,000 e-learning modules using our web-enabled platform. Why does this matter? Because staff frequently move between the private and public healthcare sectors.
However, we are unable to access funding to train undergraduate medical students, since this takes places through universities who are separately funded to deliver this training. There is one private medical school located in Buckinghamshire.
Postgraduate training eg to become a consultant or GP for example, is funded by the Deaneries. Yes of course we would like to participate and contribute to training, and we have tried. However, there are costs to be met, and we have so far been unable to have a sensible conversation about fair reimbursement. Hopefully the outcome of the current consultation will propose a way through to enabling non-public sector providers to deliver medical training. In the meantime, we fund four postgraduate research fellow positions that enable doctors to work alongside recognised experts in their fields for a number of months at a time.
1.17pm: Gwledig and pipesmokingman both ask if the coalition's planned reorganisation is a move to a US-style "no pay, no treatment" system. Jacky Davis replies:
There is no doubt in the minds of those who have been following the debate that the intention is to have the NHS as a kite mark only, with care provided by competing providers. Initially this will be NHS organisations, voluntary organisations and the commercial sector. The private sector is likely to win out in this competition for reasons we can go into if you like.
If you doubt this I strongly recommend a new book, The Plot against the NHS by Colin Leys and Stewart Player. This documents how politicians and the private sector have worked together to get the NHS to the point where this can happen.
At the same time I think we will move towards a system of mixed funding with a three-tier service – those who can only afford the basic NHS service, those who can pay for extra within the NHS through top-ups and co-payments and finally those who can pay to go outside the NHS. These current cuts and closures will accelerate that process as we see in this latest report from Spire.
The private sector recognised this long ago - last August the head of Bupa was quoted as saying: "The UK government [has] started to articulate its plans for reform of its healthcare systems and we believe that this should offer new opportunities for our businesses in the future."
1.12pm: propforward suggests:
Maybe include a desire to include more clinician input (nurses, GPs hospital & community doctors, physios etc) over time within each PCT, but leave the basic structure alone.
Jean-Jacques de Gorter replies:
Anyone who runs an organisation understands the importance of engaging your workforce. And I don't mean "satisfaction" surveys, I mean having people who feel involved in their organisation, who are able to give and receive feedback, who are recognised for their performance and equally see poor performance being addressed, and essentially feel that the organisation's challenges are their own.
Every responsible and smart commercial organisation will recognise this, and pay more than simply lip service to results. They will also engage with their staff and customers when developing their strategy and business plans. For example, we undertake annual staff engagement surveys administrated independently. Every manager will have at least one objective based on the results, and these form an important part of our development plans for the coming year. In terms of developing our annual operating plans, this starts with discussions with clinical teams, managers, and consultants, and concludes when their insights are reconciled with our strategic analysis and conclusions.
Sorry about the wordy answer - the short version is: of course you have to engage your people if you want to be successful.
1.08pm: Jacky Davis writes:
A lot of people are concerned that there might be conflicts of interest when GP commissioning begins eg "Can GPs find themselves commissioning healthcare for patients from providers they might have an interest in? If so what can be done to prevent this conflict of interest?"
Yes, this is likely to be a real problem. First, many GPs (a recent survey suggested as many as 25%) have an interest in the private sector. So if they refer you to a private clinic rather than the NHS you are likely to wonder whether their decision is based on your best clinical interests or their best financial interests. This is likely to damage the patient-doctor relationship unless it is recognised and addressed
But a bigger problem is what will happen when GPs decide that commissioning is too big and time-consuming a job and bring in the private sector to do it for them (the government has already said it wants to see this happening). At the same time you have the policy of "any willing provider" to deliver healthcare.
So what's to stop the private sector (commissioning arm) buying care from the private sector (provider arm)? There will be some weak protection in place no doubt but nothing to stop "I'll scratch your back if you scratch mine". Plus the private sector changes names on a regular basis; it will take a lot of time and money (lost to the NHS) to keep a track of this.
1.05pm: Our experts Jean-Jacques de Gorter, the clinical director of Spire Healthcare, and Jacky Davis, an NHS consultant radiologist, have
begun answering your questions below the line.
Gwledig asks:
The debate seems deceptively complex but is very simple, it's a choice between a state managed, tax funded, at-cost system, run for the national good instead of exploited for profit, or the same system they've had in the USA
Jean-Jacques de Gorter replies:
I don't believe this is as simple a choice as you suggest. It's not a binary decision. There are many different types of healthcare systems across the world, and none that consider themselves to have "cracked it". The challenge faced in funding a satisfactory and sustainable healthcare system is common to every nation.
Australia and New Zealand - both places that I have worked as a doctor - used elements of both UK and US systems effectively (to my way of thinking). Both were fair, provided universal coverage, but also included elements of competition and choice.
I also have experience of the US system - my family resides in the US. Personally, it is not a model I favour and would not expect the UK to follow suit. That does not mean I disagree with the ability of individuals to take more responsibility for their own health, the importance of some competition, and the ability for people to exercise choice.
12.53pm: David Worskett of the NHS Confederation, the body that represents almost all senior managers in the health service, sends the following:
Yes, there is plenty of evidence of private providers doing a good job – most powerfully from patient surveys, which show 97% of patients rating their NHS care delivered by an independent sector provider as "excellent" or "very good". It's also important to note that independent providers now operate at NHS standard tariffs, so the cost to the taxpayer is no different.
And although with less than 5% of all NHS work being done by independent providers (excluding GP practices, of course), the scope to become involved in education and training is small, it is now possible and many independent providers would love to do so to a greater extent: But the "system" itself seems to get in the way.
12.03pm: At 1pm today there we will be holding a live Q&A session on Spire Healthcare's new survey, which shows waiting times creeping upwards for a number of procedures. Online debating the pros and cons of turning to private providers for the answer will be:
• Dr Jean-Jacques de Gorter, clinical director, Spire.
• Jacky Davis, NHS consultant radiologist.
We want the questions to come from you in the comments below, but here are a few suggestions:
• Can private providers help reduce waiting times?
• Do private providers save money? There's evidence they cost more.
• What are the risks of using private providers?
• Do we have any examples of private providers working well and working badly? Why?
• If we do use taxpayers' money to fund private contracts, how can we get the most out of them?
• Can GPs find themselves commissioning healthcare for patients from providers they might have an interest in? If so what can be done to prevent this conflict of interest?
• If private providers take all of the work out of hospitals, what will this mean for the training of junior doctors?
Photograph: Dan Kitwood/Getty Images
11.51am: My colleague Hélène Mulholland has filed a story on David Cameron's comments that "changes need to be made" to the NHS reforms (see 10.03am). Here are the key quotes from the prime minister (left):
Yes, I think they do need to change. We need to get this right. But I don't think it was wrong to get started rapidly on a process of change. While it's an option to stick with the status quo, I don't think it's a sensible option. So I think it was right to get moving.
But we have a moment now where the legislation is almost finished in the Commons, where I think it is right to stop and to pause, to rethink and improve because I think we can make further improvements to our policy. I think that is a different thing for the government to do.
Normally governments just plough ahead regardless, but I think it's important to see if we can further improve those policies and, at the same time, make sure we have more full-throated support from people working in the NHS, most of whom know change is necessary. I want to get them on board for the changes we are considering and see if they have ideas for further improvement.
11.33am: Sunny Hundal (left) at the left-liberal blog Liberal Conspiracy has just written this post criticising the NHS reforms. He says the government is confused and points to a recent YouGov poll for the Sunday Times showing that the public remains unconvinced.
Response? Total support 27%, Total oppose: 52%, Don't know: 21%. That's a big thumbs-up from the public then.
11.23am: Peter Ward Booth, who describes himself as a partially retired NHS consultant and who followed the blog yesterday, sent this email to Rowenna this morning saying that practitioners and patients need more information about the reasons about the government's reforms. Ward Booth tackles the important point about whether GPs are really in a position to cut the cash flowing into highly specialised hospital specialities.
Of course we all know it's about saving money - specifically targeting secondary specialist or hospital care - however you want to describe it. Yes, it is expensive, because it is super-specialised, with beds and highly trained healthcare workers.
Yes, if GPs hold the funds, they will restrict referrals to save money, just as PCTs restrict referrals by declaring certain procedures "low priority" - euphemism for not treating a condition. Either way the quality of care will go down, unless you can afford private care.
In the past governments tried to reduce the cost of secondary care by trying to have managers micromanage the running of the hospitals; the price was we have statistically a manager for every hospital bed. Managers are, however bright or motivated, driven by their political masters, not by patient or doctor needs. They are also very expensive.
So let's be honest and recognise we need secondary/specialist care, but address the costs issue separately. Let's give the power to the consultants to run their own departments and have "costs" league tables as well as "outcome" league tables. Have teams of peers to review the failing units with the power to hire and fire.
Above all the "reforms" should not be allowed to reduce specialist care to only those who can afford it. Yes, GPs are specialists, but not in surgery (or) cardiology.
10.37am: The health secretary got a boost today with a sympathetic and pithy portrait from the Independent's health editor Jeremy Laurance. Laurance gets the health secretary's deadpan humour to a tee, recalling his funniest personal anecdote about suffering a stroke while playing cricket.
"People imagine politicians are a bit brain dead," [Lansley] would say. "Well I am – and I have the MRI scan to prove it."
On a less humorous note, in the Guardian former Labour chair of the health select committee David Hinchliffe attacks the government for its pro-market tilt.
The same market philosophy which impacted upon my constituents 20 years ago is at the heart of the health and social care bill. Its proposals are driven by an ideology totally alien to a health service whose success has been rooted in co-operation and collectivism.
In the FT there's more bad news for the government as one of four NHS trusts chosen to be early adopters of the electronic patient records pulled out – plunging the health service's £12.7bn programme to create a vast patient database into "yet another crisis".
Also in an ominous sign of things to come, news that Trafford General Hospital is in a financial mess. It's an iconic place in NHS history - treating the first ever state-funded patient when the health service was inaugurated in 1948. The Manchester Evening News says "the hospital where the NHS was founded could find itself £75m in debt by 2015".
And trust the Daily Mail to come up with a holiday story in health. The tabloid claims that a hospital is considering flying foreign patients overseas rather than fund their long-term care. One way to beat the Easter traffic.
10.32am: Rowenna points out a political spat in Scotland where Labour claimed that knife injuries cost the NHS in Scotland £500m a year – almost 5% of Scotland's £11bn NHS budget.
Nigel Hawkes on Straight Statistics has an interesting take on how politicians are using stats on the health costs of knife crime to score political points.
He says the Scottish Labour party has promised a mandatory prison sentence for anyone found in possession of a knife outside their home. To justify the policy, they say knife injuries cost Scotland's NHS £500m a year, or 4.5% of the health budget.
But after some digging, Nigel says that even with the "best will in the world" it's hard to see the total cost of knife crime exceeding £10m a year – or 50 times less than the Scottish Labour party is claiming.
Scottish Labour's policy doesn't make much sense, Nigel argues, given that they are setting aside an extra £20m to provide the extra prison places that will be needed if more people are sent to jail as a result of their policy."
(Disclaimer: Rowenna is standing as a candidate in local elections next month in England for the Labour party.)
10.03am: Hello. I am Randeep Ramesh, the Guardian's social affairs editor, and my colleague Rowenna Davis and I will be liveblogging the government's radical NHS reforms all day. Today there will be a question and answer session on Spire Healthcare's new survey, which sees waiting times creeping upwards in a number of procedures. No surprise perhaps that families are not getting fertility treatments at a time of cuts, but worryingly patients are facing long waits for hip replacements and hernia repairs. Online debating the issues will be Spire's clinical director, Dr Jean-Jacques de Gorter, and NHS consultant radiologist Jacky Davis.
Also Rowenna will be at a conference on looking how to close hospitals painlessly. Earlier this month welfare secretary Iain Duncan Smith marched to save his local hospital; while his cabinet colleague Andrew Lansley has to marshal insufficient resources to meet rising demand, this is one of the most vexing political issues of the day.
For those who missed it Andrew Sparrow has already caught up with David Cameron's interview on the Today programme. The main take away is that there will be changes to the NHS reforms. Interestingly Cameron made a point of saying hospital doctors would have a say in how GPs commission services for their patients. The prime minister's brother in law, Carl Brookes, works as a cardiologist in Basingstoke for the North Hampshire NHS trust and memorably told him he was concerned that family doctors would become too powerful under Andrew Lansley's plans.
You can email me at randeep.ramesh@guardian.co.uk or tweet at tianran. Rowenna's email is rowenna.davis@guardian.co.uk and her Twitter name is rowenna_davis.
Wales election: different language but the same issues – coalitions and cuts
Welsh assembly's four-party politics creates air of uncertainty as voters decide whether to punish Cardiff or London
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Michael White
guardian.co.uk, Tuesday 19 April 2011 18.28 BST
Article history
Facing a Labour resurgence at the Welsh election? Plaid Cymru figures, from left, MP Elfyn Llwyd, Iwan Huws, candidate for Aberconwy, heritage minister Alun Ffred Jones, and former party leader Dafydd. Photograph: Steve Peake for the Guardian
Patriotic yellow-and-orange flags festoon Conwy's narrow high street in honour of the legendary Owain Glyndwyr. It is more than 600 years since Owain, Shakespeare's Owen Glendower, briefly captured Edward I's intimidating frontier fortress - just down the hill - during the long Welsh revolt against Henry IV.
"Who'd have thought it? Glyndwyr's flag flying in an old garrison town like this," whispers a Plaid Cymru politician canvassing for votes in the 5 May elections to the fourth Welsh assembly to sit in distant Cardiff Bay.
Even if few nationalists still pay lip-service to the revolt-and-independence agenda, Wales still nurses resentments against its large neighbour. But Wales is changing too, more cosmopolitan and outward-looking, its spruced-up capital competing for business with English cities like Leeds and Manchester.
Nowadays non-Welsh speakers and English incomers can see the point of preserving what its adherents proclaim is Europe's oldest living language - spoken today by 600,000 Welsh people, one in five and rising. If saving the language is no longer the primary issue (coalition cuts to S4C, the Welsh TV channel, certainly are), there are plenty of others to fill the gap.
Unlike Scotland, Wales after devolution in 1999 did not fully share the British boom. Income per head remains about 75% of the UK average. Alone in Britain, Welsh unemployment rose in the last quarter, by 3,000 to 8.6%, higher than in Scotland, Northern Ireland, let alone England's 7.8%. Alarming new data shows Wales falling behind England in GCSE and A-level results - a first.
Are these figures all the fault of Labour as the historically dominant party of Wales, champions of newly expanded legislative powers for Wales, but also in power in London and Cardiff Bay for most of the past 15 years? Its three rivals, Tory, Lib Dem and Plaid Cymru, certainly want voters to conclude as much on 5 May. In 2007 the three parties even discussed a "rainbow" coalition until Labour wooed Plaid into a red-green coalition. Plaid's leader, Ieuan Wyn Jones, served as economics minister to Labour's Rhodri Morgan and his successor as first minister, Carwyn Jones (no relation).
There have been few public coalition bust-ups and all four parties united to back expanded powers in last month's referendum. It carried in all counties except (by 51% to 49%) semi-English Monmouth, last survivor of the sharp east-west split which ensured only a narrow yes to devolution in 1997.
Combined with coalitions - past, present and future - such proximity gives a slightly unreal quality to their manifesto offers and petty jibes against each other in this campaign. Everyone knows that economic growth is central and all have some sensible ideas – and daft ones.
But the Lib Dems are accused of backtracking on free NHS prescriptions and of manifesto spelling errors. Labour has what Plaid calls " a tragic lack of ambition" for Wales but counters that Plaid is a "passenger" on economic policy, drifting back to small-c conservatism.
As for Labour's schools policy, it is as elitist as the Tories who are blamed for the cuts. The funding gap with England favours Wales on the NHS (by £106 per head), but not education (-£600). Both are falling behind. Yet the most dramatic Welsh election event so far has been on the lunatic fringe, when a BNP assembly candidate burned the Qur'an in his garden. "More Muslims in Britain than Welsh people" is a BNP campaign theme.
The result is that in the volatile, uncertain public mood of 2011 no one seems confident of the outcome. In a country where "keep the Tories out" is both a rallying cry and a strategy, no coalition options are quite off the table and no UK party can have policies too different from London.
Welsh Labour is hoping voters will decide to blame the other coalition, the Tory-Lib Dem one cutting Welsh budgets from London. Fingers firmly crossed, voter anger just might deliver Labour a working majority of 31 in the 60-seat assembly, the first ever.
Even in all-conquering 1999 Labour got only 28 seats to Plaid's 19, still Plaid's highpoint. In 2007 the result was 26 Labour, 15 Plaid, 12 to the recovering Tories and just six to the Lib Dems, whose position has since weakened further. This month polls giving Labour 50% of the vote (Cons 20.3%; Plaid 16.7%; Lib Dems 7.6%) suggest outright victory is possible, especially if 5 May vindicates the theory advanced by some Welsh academics that the junior partner in most coalitions is the one voters punish. That would hammer Plaid locally and the Lib Dems - their poll share sharply down - for the Clegg factor.
"I can't remember a Welsh election so dominated by UK economic issues," avows a Welsh Labour MP.
"He would say that, wouldn't he?" reply Labour's many critics who suspect that, as in Scotland, 2011 may prove too soon to forgive disappointments of the Blair-Brown era.
What's the difference between Tory and Labour policies on cuts, education or health, Plaid candidates craftily ask voters. "Who will be the chief beneficiary of the Lib Dem collapse, that's the big question?" asks Elfyn Llwyd MP, Plaid's leader at Westminster.
Few sound sure and in Wales's four-party politics, where some assembly members (AMs) are elected on the additional member (AMS) regional list, the maths are tricky. The decision of north Wales's returning officer, Dr Mohammed Mehmet, to postpone counting until Friday 6 May will enhance the weekend drama.
In Conwy's picturesque high street voters still seem immune to any prospective drama, despite assurances from the political class and Welsh blogging wonks that this is the most interesting contest for years. Most passers-by are English tourists with no local vote anyway.
In the Welsh-speaking Conwy valley farming is central (and coalition policy unpopular), but along the sandy, history-laden coast east of Caernarfon - so close to Liverpool and Lancashire - tourism is king in sepia-tinted Victorian resorts.
In a back room of Conwy's Castle hotel Plaid's ex-MP-now-Lord Dafydd Wigley, nearby MP, Elfyn Llwyd, and the assembly's culture minister, Alun Ffred Jones, discuss the industry with local businessmen. They have brought along their local candidate for AM, Iwan Jones, a first-time political wannabe who just happens to be the former head of the Snowdonia national park, a heritage specialist.
All are keen to get help from London and Cardiff but fear that Cardiff - they really mean Labour politicians in south Wales - still don't regard tourism as a proper industry. Historically difficult road, rail and air links between north and south Wales are improved, even the bendy A470, but old tensions resurface.
More important than north-south or east-west today is a problem that all parties complain about, that most of Wales is dominated by English media that take little interest in Wales or its political agenda. Yet any mention of 5 May's all-Britain referendum on the alternative vote (AV) for Westminster and an air of uncertainty descends on north and south, tourist and locals alike.
"That's the new voting system, is it? I like the idea that all votes count, but I need to study it a bit," admits a politically engaged Conwy railworker on his way to the station.
As elsewhere Welsh parties are divided on the merits of AV and the likely referendum result, though Plaid politicians in north Wales hope it may help them in a string of local seats. The railworker's vote in the three-way marginal of Aberconwy migrates between Labour, Green and Plaid Cymru (his wife votes Plaid) and will probably return to Labour in the hope that Welsh leaders in Cardiff Bay may be more radical than Labour in Westminster.
Plaid won Aberconwy with 38.6% in 2007's assembly election, but the Tories won the Westminster seat last May on 35.8% of the vote, Wigley tells voters. Under AV they would probably have lost to second preferences of the other voters.
There is a similar three-way race next door in Clwyd West and in distant Carmarthen West.
But Welsh politics are run on the AMS version of PR, designed to make it hard to win a majority, so a constituency seat won on a strong swing may mean a seat lost to the same party when the region's top-up seats are allocated to be fairer to also-rans.
So Lib Dem assembly leader, the well-regarded Kirsty Williams, may hold the fate of Tory leader, Nick Bourne, in her hands. She is expected to hold her rural Brecon and Radnor constituency. But if she falters and the Tories surge then Bourne, who currently holds top place on the Mid and West Wales regional list may end the night without a seat.
As with much else in PR- and coalition-driven politics no one can be sure. England may soon have to get used to it too.
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Michael White
guardian.co.uk, Tuesday 19 April 2011 18.28 BST
Article history
Facing a Labour resurgence at the Welsh election? Plaid Cymru figures, from left, MP Elfyn Llwyd, Iwan Huws, candidate for Aberconwy, heritage minister Alun Ffred Jones, and former party leader Dafydd. Photograph: Steve Peake for the Guardian
Patriotic yellow-and-orange flags festoon Conwy's narrow high street in honour of the legendary Owain Glyndwyr. It is more than 600 years since Owain, Shakespeare's Owen Glendower, briefly captured Edward I's intimidating frontier fortress - just down the hill - during the long Welsh revolt against Henry IV.
"Who'd have thought it? Glyndwyr's flag flying in an old garrison town like this," whispers a Plaid Cymru politician canvassing for votes in the 5 May elections to the fourth Welsh assembly to sit in distant Cardiff Bay.
Even if few nationalists still pay lip-service to the revolt-and-independence agenda, Wales still nurses resentments against its large neighbour. But Wales is changing too, more cosmopolitan and outward-looking, its spruced-up capital competing for business with English cities like Leeds and Manchester.
Nowadays non-Welsh speakers and English incomers can see the point of preserving what its adherents proclaim is Europe's oldest living language - spoken today by 600,000 Welsh people, one in five and rising. If saving the language is no longer the primary issue (coalition cuts to S4C, the Welsh TV channel, certainly are), there are plenty of others to fill the gap.
Unlike Scotland, Wales after devolution in 1999 did not fully share the British boom. Income per head remains about 75% of the UK average. Alone in Britain, Welsh unemployment rose in the last quarter, by 3,000 to 8.6%, higher than in Scotland, Northern Ireland, let alone England's 7.8%. Alarming new data shows Wales falling behind England in GCSE and A-level results - a first.
Are these figures all the fault of Labour as the historically dominant party of Wales, champions of newly expanded legislative powers for Wales, but also in power in London and Cardiff Bay for most of the past 15 years? Its three rivals, Tory, Lib Dem and Plaid Cymru, certainly want voters to conclude as much on 5 May. In 2007 the three parties even discussed a "rainbow" coalition until Labour wooed Plaid into a red-green coalition. Plaid's leader, Ieuan Wyn Jones, served as economics minister to Labour's Rhodri Morgan and his successor as first minister, Carwyn Jones (no relation).
There have been few public coalition bust-ups and all four parties united to back expanded powers in last month's referendum. It carried in all counties except (by 51% to 49%) semi-English Monmouth, last survivor of the sharp east-west split which ensured only a narrow yes to devolution in 1997.
Combined with coalitions - past, present and future - such proximity gives a slightly unreal quality to their manifesto offers and petty jibes against each other in this campaign. Everyone knows that economic growth is central and all have some sensible ideas – and daft ones.
But the Lib Dems are accused of backtracking on free NHS prescriptions and of manifesto spelling errors. Labour has what Plaid calls " a tragic lack of ambition" for Wales but counters that Plaid is a "passenger" on economic policy, drifting back to small-c conservatism.
As for Labour's schools policy, it is as elitist as the Tories who are blamed for the cuts. The funding gap with England favours Wales on the NHS (by £106 per head), but not education (-£600). Both are falling behind. Yet the most dramatic Welsh election event so far has been on the lunatic fringe, when a BNP assembly candidate burned the Qur'an in his garden. "More Muslims in Britain than Welsh people" is a BNP campaign theme.
The result is that in the volatile, uncertain public mood of 2011 no one seems confident of the outcome. In a country where "keep the Tories out" is both a rallying cry and a strategy, no coalition options are quite off the table and no UK party can have policies too different from London.
Welsh Labour is hoping voters will decide to blame the other coalition, the Tory-Lib Dem one cutting Welsh budgets from London. Fingers firmly crossed, voter anger just might deliver Labour a working majority of 31 in the 60-seat assembly, the first ever.
Even in all-conquering 1999 Labour got only 28 seats to Plaid's 19, still Plaid's highpoint. In 2007 the result was 26 Labour, 15 Plaid, 12 to the recovering Tories and just six to the Lib Dems, whose position has since weakened further. This month polls giving Labour 50% of the vote (Cons 20.3%; Plaid 16.7%; Lib Dems 7.6%) suggest outright victory is possible, especially if 5 May vindicates the theory advanced by some Welsh academics that the junior partner in most coalitions is the one voters punish. That would hammer Plaid locally and the Lib Dems - their poll share sharply down - for the Clegg factor.
"I can't remember a Welsh election so dominated by UK economic issues," avows a Welsh Labour MP.
"He would say that, wouldn't he?" reply Labour's many critics who suspect that, as in Scotland, 2011 may prove too soon to forgive disappointments of the Blair-Brown era.
What's the difference between Tory and Labour policies on cuts, education or health, Plaid candidates craftily ask voters. "Who will be the chief beneficiary of the Lib Dem collapse, that's the big question?" asks Elfyn Llwyd MP, Plaid's leader at Westminster.
Few sound sure and in Wales's four-party politics, where some assembly members (AMs) are elected on the additional member (AMS) regional list, the maths are tricky. The decision of north Wales's returning officer, Dr Mohammed Mehmet, to postpone counting until Friday 6 May will enhance the weekend drama.
In Conwy's picturesque high street voters still seem immune to any prospective drama, despite assurances from the political class and Welsh blogging wonks that this is the most interesting contest for years. Most passers-by are English tourists with no local vote anyway.
In the Welsh-speaking Conwy valley farming is central (and coalition policy unpopular), but along the sandy, history-laden coast east of Caernarfon - so close to Liverpool and Lancashire - tourism is king in sepia-tinted Victorian resorts.
In a back room of Conwy's Castle hotel Plaid's ex-MP-now-Lord Dafydd Wigley, nearby MP, Elfyn Llwyd, and the assembly's culture minister, Alun Ffred Jones, discuss the industry with local businessmen. They have brought along their local candidate for AM, Iwan Jones, a first-time political wannabe who just happens to be the former head of the Snowdonia national park, a heritage specialist.
All are keen to get help from London and Cardiff but fear that Cardiff - they really mean Labour politicians in south Wales - still don't regard tourism as a proper industry. Historically difficult road, rail and air links between north and south Wales are improved, even the bendy A470, but old tensions resurface.
More important than north-south or east-west today is a problem that all parties complain about, that most of Wales is dominated by English media that take little interest in Wales or its political agenda. Yet any mention of 5 May's all-Britain referendum on the alternative vote (AV) for Westminster and an air of uncertainty descends on north and south, tourist and locals alike.
"That's the new voting system, is it? I like the idea that all votes count, but I need to study it a bit," admits a politically engaged Conwy railworker on his way to the station.
As elsewhere Welsh parties are divided on the merits of AV and the likely referendum result, though Plaid politicians in north Wales hope it may help them in a string of local seats. The railworker's vote in the three-way marginal of Aberconwy migrates between Labour, Green and Plaid Cymru (his wife votes Plaid) and will probably return to Labour in the hope that Welsh leaders in Cardiff Bay may be more radical than Labour in Westminster.
Plaid won Aberconwy with 38.6% in 2007's assembly election, but the Tories won the Westminster seat last May on 35.8% of the vote, Wigley tells voters. Under AV they would probably have lost to second preferences of the other voters.
There is a similar three-way race next door in Clwyd West and in distant Carmarthen West.
But Welsh politics are run on the AMS version of PR, designed to make it hard to win a majority, so a constituency seat won on a strong swing may mean a seat lost to the same party when the region's top-up seats are allocated to be fairer to also-rans.
So Lib Dem assembly leader, the well-regarded Kirsty Williams, may hold the fate of Tory leader, Nick Bourne, in her hands. She is expected to hold her rural Brecon and Radnor constituency. But if she falters and the Tories surge then Bourne, who currently holds top place on the Mid and West Wales regional list may end the night without a seat.
As with much else in PR- and coalition-driven politics no one can be sure. England may soon have to get used to it too.
Malawi threatens to expel British high commissioner over leaked remarks
Memo from Fergus Cochrane-Dyet refers to President Bingu wa Mutharika as 'ever more autocratic and intolerant of criticism'
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Godfrey Mapondera in Blantyre and David Smith in Accra
guardian.co.uk, Tuesday 19 April 2011 17.45 BST
Article history
The foreign secretary, William Hague, was said to be strongly concerned at suggestions the high commissioner could be expelled from Malawi. Photograph: KeystoneUSA-ZUMA/Rex Features
In days gone by, British ambassadors would wait until they were leaving before firing off a valedictory despatch that revealed what they really thought about their foreign hosts. Not Fergus Cochrane-Dyet, the high commissioner to Malawi, whose use of undiplomatic language while still in the post may now hasten his exit.
Cochrane-Dyet was quoted in a leaked cable to London describing Malawi's president Bingu wa Mutharika as "ever more autocratic and intolerant of criticism".
As if to prove the point, Malawi's foreign ministry in Lilongwe summoned him on Monday and ordered him to leave the country this week.
There was a sharp response from Britain, where the Foreign Office insisted that declaring its man "persona non grata" would be unacceptable. Any such action would have "consequences", it warned.
In the leaked memo to the foreign secretary, William Hague, Cochrane-Dyet said that in Malawi the "governance situation continues to deteriorate in terms of media freedom, freedom of speech and minority rights".
According to the Nation newspaper, which published the correspondence, he said rights activists had reported a campaign of intimidation through threatening anonymous phone calls.
"They seem genuinely afraid," Cochrane-Dyet wrote. "The office of one high-profile activist has allegedly been raided and his house broken into. There are unsubstantiated rumours that the ruling party is forming a youth wing modeled on the Young Pioneers used as a tool of repression during the country's three-decade dictatorship."
Britain, Malawi's main bilateral donor, cut aid by £3m last year after the purchase of a presidential jet at a cost of more than £8m. British officials said they were concerned about the purchase in the impoverished nation that relies on donor support for up to 40% of its development budget and the salaries of its 169,000 civil servants. Mutharika defended the new jet, saying it was cheaper to run it than hire an aircraft each time he wanted to travel abroad.
The British diplomat was quoted as saying that "for donors, the local political relationship has definitely got worse [although working relations with most key ministries remain good].
"Some ambassadors have been summoned by the foreign minister for a dressing down, others [including me] have been summoned by the president's brother [Peter] for gentler delivery of the same message: stop supporting civil society to destabilise the government."
Cochrane-Dyet said donors had responded robustly. "We deny the accusation, our development goals require more stability not less, far more of our assistance goes through government than through NGOs."
Cochrane-Dyet said that given "our huge investment in Malawi development, the UK interest is for these tensions to be defused.
"Our leverage is limited and must be used carefully with this combative president. We want the government to reverse its two-year slide on governance issues, mend fences with faith groups and civil society and adopt a more open approach to dissenting views."
On the other hand, he wrote that "we want civil society to be less confrontational".
He warned there was "no reason for optimism as the political temperature is likely to rise further ahead of elections in 2014 when Mutharika steps down", but added that "the effect of a serious cut in overseas aid for the fragile Malawian economy and for development would be serious ... the 75% of Malawians who live on less than $1 per day would suffer most."
In London, the acting permanent under secretary, Sir Geoffrey Adams, summoned Malawi's charge d'affaires to the Foreign Office on Tuesday to convey the foreign secretary's strong concern at suggestions that Cochrane-Dyet could be expelled.
"Sir Geoffrey made clear to the charge d'affaires that such an action would be unacceptable," the Foreign Office said. "Mr Cochrane-Dyet is an able and effective high commissioner, who retains the full confidence of the British government.
"Sir Geoffrey added that if the government of Malawi pursued such action there were likely to be consequences affecting the full range of issues in the bilateral relationship. He urged the Malawian authorities, through the charge d'affaires, not to proceed down such a road."
Malawi has recently drawn criticism from donor countries, including Britain, over "certain negative trends" including a new law that allows publications to be banned if deemed contrary to the public interest.
Mutharika, who ends his two terms as president in 2014 and is likely to hand over power to his brother Peter, often accuses local independent newspapers of negative reporting about Malawi.
In 2009, he threatened to shut down newspapers he accused of lying when the weekly Malawi News, owned by the family of the late dictator Kamuzu Banda, reported that up to a million people would need food aid.
Mutharika, who has made the country self-sufficient in food through the $180m subsidy fertiliser programme given to more than a million peasant farmers, demands that he be given kudos because half Malawi's 12 million citizens previously faced starvation.
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Godfrey Mapondera in Blantyre and David Smith in Accra
guardian.co.uk, Tuesday 19 April 2011 17.45 BST
Article history
The foreign secretary, William Hague, was said to be strongly concerned at suggestions the high commissioner could be expelled from Malawi. Photograph: KeystoneUSA-ZUMA/Rex Features
In days gone by, British ambassadors would wait until they were leaving before firing off a valedictory despatch that revealed what they really thought about their foreign hosts. Not Fergus Cochrane-Dyet, the high commissioner to Malawi, whose use of undiplomatic language while still in the post may now hasten his exit.
Cochrane-Dyet was quoted in a leaked cable to London describing Malawi's president Bingu wa Mutharika as "ever more autocratic and intolerant of criticism".
As if to prove the point, Malawi's foreign ministry in Lilongwe summoned him on Monday and ordered him to leave the country this week.
There was a sharp response from Britain, where the Foreign Office insisted that declaring its man "persona non grata" would be unacceptable. Any such action would have "consequences", it warned.
In the leaked memo to the foreign secretary, William Hague, Cochrane-Dyet said that in Malawi the "governance situation continues to deteriorate in terms of media freedom, freedom of speech and minority rights".
According to the Nation newspaper, which published the correspondence, he said rights activists had reported a campaign of intimidation through threatening anonymous phone calls.
"They seem genuinely afraid," Cochrane-Dyet wrote. "The office of one high-profile activist has allegedly been raided and his house broken into. There are unsubstantiated rumours that the ruling party is forming a youth wing modeled on the Young Pioneers used as a tool of repression during the country's three-decade dictatorship."
Britain, Malawi's main bilateral donor, cut aid by £3m last year after the purchase of a presidential jet at a cost of more than £8m. British officials said they were concerned about the purchase in the impoverished nation that relies on donor support for up to 40% of its development budget and the salaries of its 169,000 civil servants. Mutharika defended the new jet, saying it was cheaper to run it than hire an aircraft each time he wanted to travel abroad.
The British diplomat was quoted as saying that "for donors, the local political relationship has definitely got worse [although working relations with most key ministries remain good].
"Some ambassadors have been summoned by the foreign minister for a dressing down, others [including me] have been summoned by the president's brother [Peter] for gentler delivery of the same message: stop supporting civil society to destabilise the government."
Cochrane-Dyet said donors had responded robustly. "We deny the accusation, our development goals require more stability not less, far more of our assistance goes through government than through NGOs."
Cochrane-Dyet said that given "our huge investment in Malawi development, the UK interest is for these tensions to be defused.
"Our leverage is limited and must be used carefully with this combative president. We want the government to reverse its two-year slide on governance issues, mend fences with faith groups and civil society and adopt a more open approach to dissenting views."
On the other hand, he wrote that "we want civil society to be less confrontational".
He warned there was "no reason for optimism as the political temperature is likely to rise further ahead of elections in 2014 when Mutharika steps down", but added that "the effect of a serious cut in overseas aid for the fragile Malawian economy and for development would be serious ... the 75% of Malawians who live on less than $1 per day would suffer most."
In London, the acting permanent under secretary, Sir Geoffrey Adams, summoned Malawi's charge d'affaires to the Foreign Office on Tuesday to convey the foreign secretary's strong concern at suggestions that Cochrane-Dyet could be expelled.
"Sir Geoffrey made clear to the charge d'affaires that such an action would be unacceptable," the Foreign Office said. "Mr Cochrane-Dyet is an able and effective high commissioner, who retains the full confidence of the British government.
"Sir Geoffrey added that if the government of Malawi pursued such action there were likely to be consequences affecting the full range of issues in the bilateral relationship. He urged the Malawian authorities, through the charge d'affaires, not to proceed down such a road."
Malawi has recently drawn criticism from donor countries, including Britain, over "certain negative trends" including a new law that allows publications to be banned if deemed contrary to the public interest.
Mutharika, who ends his two terms as president in 2014 and is likely to hand over power to his brother Peter, often accuses local independent newspapers of negative reporting about Malawi.
In 2009, he threatened to shut down newspapers he accused of lying when the weekly Malawi News, owned by the family of the late dictator Kamuzu Banda, reported that up to a million people would need food aid.
Mutharika, who has made the country self-sufficient in food through the $180m subsidy fertiliser programme given to more than a million peasant farmers, demands that he be given kudos because half Malawi's 12 million citizens previously faced starvation.
Royal wedding: two protests planned as police consider pre-emptive arrests
Scotland Yard to mount one of its biggest ever operations on the day of the wedding amid fears of disruption by activists
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Sandra Laville, crime correspondent
guardian.co.uk, Tuesday 19 April 2011 21.52 BST
Article history
Police officers at the university fees protest. Scotland Yard fear that activists will disrupt the royal wedding. Photograph: Fernanda Nalin
Police across the country could make pre-emptive strikes in the coming days to arrest activists intent on causing trouble during the royal wedding, Scotland Yard has revealed.
The Metropolitan police are working with other forces across England and Wales and using local intelligence to identify activists and anarchists who they believe are committed to carrying out criminal activity on 29 April.
"We will attempt to prevent people coming to London to carry out criminal activity," said assistant commissioner Lynne Owens, head of central operations at Scotland Yard, adding there would be police activity in the days ahead of the event to "disrupt any criminal behaviour that may be anticipated".
But the tactic of making pre-emptive arrests of groups or individuals planning demonstrations is controversial. Police have to prove that a criminal plot has taken place before moving in, or that a breach of the peace is imminent, for example seconds, minutes or possibly hours away, according to legal experts.
Scotland Yard has also said that two groups have applied for permission to protest in the immediate area of the wedding on the day. Muslims Against Crusades, an offshoot of the outlawed group al-Muhajiroun, is in ongoing discussions with the police. The Yard has refused them permission to demonstrate outside Westminster Abbey but cannot stop them mounting a static protest elsewhere. In response, the English Defence League has indicated they will mount a counter-demonstration, raising fears of a flashpoint on the day.
Anjem Choudary, spokesman for Muslims Against Crusades, said the group believed the royal wedding was the perfect time to mount a demonstration. "The timing on the royal wedding is absolutely spot on because it will raise awareness among the masses here and around the world that the Muslims will never remain silent," he said.
In the past, members of the group have burned poppies on the anniversary of Armistice Day and carried out demonstrations in east London against troops returning from Afghanistan.
Scotland Yard will mount one of the biggest operations in its history on the day of the wedding. Just under 5,000 officers will be deployed. Police are likely to use section 60 of the Criminal Justice Act 1996 to impose zones where officers can stop and search individuals, regardless of suspicion.
Owens said: "If anyone comes to London on the day of the royal wedding intending to commit criminal acts, we will act quickly, robustly and decisively so it is a safe and happy environment for everyone else who wishes to be here and celebrate."
She said it was a security operation and, as such, might not be compatible with the wishes of any protesters.
The police said they were getting daily intelligence updates from both covert and open sources, such as social media sites. But they admitted the tactic adopted by anarchists of creating a "black bloc", where individuals turn up at an event, cover their heads and put on black clothing to appear as a solid mass and remain anonymous, was difficult to anticipate.
The Yard said those who had committed criminal acts at previous demonstrations, including the TUC march and the anti-fees protest last year, came from all over the country.
Sixty people who have been arrested at previous demonstrations have bail conditions which ban them from entering the City of Westminster. They would be arrested if they were seen in the area on the day, the police said.
Pre-emptive action could include moving in to break up squats in London or elsewere where individuals are gathering. They could also carry out arrests under conspiracy laws if they had enough evidence that a criminal plot or conspiracy had taken place.
But Mike Schwarz, of Bindmans solicitors, said: "Both of these tactics would be very controversial, particularly with protesters, because they have rights of expression under Article 10 of the European convention on human rights and under Article 11 of assembly, and the police have an obligation to facilitate that.
"The police would have to show that what was planned was not just a demonstration but an unlawful act and that could be problematic for them."
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Sandra Laville, crime correspondent
guardian.co.uk, Tuesday 19 April 2011 21.52 BST
Article history
Police officers at the university fees protest. Scotland Yard fear that activists will disrupt the royal wedding. Photograph: Fernanda Nalin
Police across the country could make pre-emptive strikes in the coming days to arrest activists intent on causing trouble during the royal wedding, Scotland Yard has revealed.
The Metropolitan police are working with other forces across England and Wales and using local intelligence to identify activists and anarchists who they believe are committed to carrying out criminal activity on 29 April.
"We will attempt to prevent people coming to London to carry out criminal activity," said assistant commissioner Lynne Owens, head of central operations at Scotland Yard, adding there would be police activity in the days ahead of the event to "disrupt any criminal behaviour that may be anticipated".
But the tactic of making pre-emptive arrests of groups or individuals planning demonstrations is controversial. Police have to prove that a criminal plot has taken place before moving in, or that a breach of the peace is imminent, for example seconds, minutes or possibly hours away, according to legal experts.
Scotland Yard has also said that two groups have applied for permission to protest in the immediate area of the wedding on the day. Muslims Against Crusades, an offshoot of the outlawed group al-Muhajiroun, is in ongoing discussions with the police. The Yard has refused them permission to demonstrate outside Westminster Abbey but cannot stop them mounting a static protest elsewhere. In response, the English Defence League has indicated they will mount a counter-demonstration, raising fears of a flashpoint on the day.
Anjem Choudary, spokesman for Muslims Against Crusades, said the group believed the royal wedding was the perfect time to mount a demonstration. "The timing on the royal wedding is absolutely spot on because it will raise awareness among the masses here and around the world that the Muslims will never remain silent," he said.
In the past, members of the group have burned poppies on the anniversary of Armistice Day and carried out demonstrations in east London against troops returning from Afghanistan.
Scotland Yard will mount one of the biggest operations in its history on the day of the wedding. Just under 5,000 officers will be deployed. Police are likely to use section 60 of the Criminal Justice Act 1996 to impose zones where officers can stop and search individuals, regardless of suspicion.
Owens said: "If anyone comes to London on the day of the royal wedding intending to commit criminal acts, we will act quickly, robustly and decisively so it is a safe and happy environment for everyone else who wishes to be here and celebrate."
She said it was a security operation and, as such, might not be compatible with the wishes of any protesters.
The police said they were getting daily intelligence updates from both covert and open sources, such as social media sites. But they admitted the tactic adopted by anarchists of creating a "black bloc", where individuals turn up at an event, cover their heads and put on black clothing to appear as a solid mass and remain anonymous, was difficult to anticipate.
The Yard said those who had committed criminal acts at previous demonstrations, including the TUC march and the anti-fees protest last year, came from all over the country.
Sixty people who have been arrested at previous demonstrations have bail conditions which ban them from entering the City of Westminster. They would be arrested if they were seen in the area on the day, the police said.
Pre-emptive action could include moving in to break up squats in London or elsewere where individuals are gathering. They could also carry out arrests under conspiracy laws if they had enough evidence that a criminal plot or conspiracy had taken place.
But Mike Schwarz, of Bindmans solicitors, said: "Both of these tactics would be very controversial, particularly with protesters, because they have rights of expression under Article 10 of the European convention on human rights and under Article 11 of assembly, and the police have an obligation to facilitate that.
"The police would have to show that what was planned was not just a demonstration but an unlawful act and that could be problematic for them."
Plans for tough European rules on oil spills come under attack
UK and other governments oppose EU regulations aimed at preventing oil leaks at deepwater drilling operations
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Comments (15)
Fiona Harvey, environment correspondent
guardian.co.uk, Tuesday 19 April 2011 21.04 BST
Article history
European measures aimed at preventing a spill in EU waters are under attack. Photograph: Gerald Herbert/AP
European plans to crack down hard on oil companies with a series of measures to prevent a spill in EU waters like that of BP's Gulf of Mexico disaster, are under attack from the UK and other national governments, the Guardian has learned.
The measures, backed by the EU's energy chief Günter Oettinger, require companies to use a higher standard of equipment, pay for damage for which they are not liable now, and prove they have enough funds to clear up after any accident, before they can be licensed to drill.
The rules will be brought forward in July, and would apply to new and controversial deepwater drilling operations being embarked upon by several firms, such as Chevron at its site west of Shetland, and Cairn Energy in Greenland.
A year ago on Wednesday, an explosion at BP's Deepwater Horizon drilling rig in the Gulf of Mexico killed 11 people and caused the biggest offshore oil spill in US history, wreaking devastation in the Gulf.
Green campaigners welcomed the tougher stance from the European commission, but warned that the proposals were under attack. Richard George, an oil campaigner for Greenpeace, said: "If these regulations pass they'll be a good first step towards ensuring that oil companies are held responsible for their spills. The concern right now is that national governments, with the UK at the forefront, are working hard to water down these proposals at the behest of the oil companies. David Cameron needs to get behind efforts to prevent a Deepwater Horizon-style disaster in European waters."
One proposal, which would extend the EU regulations to the overseas operations of European offshore oil firms, is the subject of a sustained attack. If this rule had been in place last year BP's Deepwater Horizon drilling would have been subject to EU safety standards. Greenpeace said it was vital that this was retained.
A European commission source said that at first officials tried to involve oil executives in talks on the proposals but had been rebuffed by the companies, which insisted the Deepwater Horizon spill was solely due to shoddy practices. The commission has now decided to go ahead with the crackdown without input from the industry.
The oil industry is mounting a rearguard action, to get the rules changed before they can be brought into effect.
The planned rules must be approved by member states and the European parliament before they can come into operation, a process likely to take at least two years. But lobbying from the energy industry has been intense even before the proposals are scheduled to be formally brought forward, in July.
Under the commission plans, tough rules would apply to all drilling sites within 200 miles of the coast. Previous piecemeal EU attempts to regulate oil drilling extended only to wells within 12 miles of shore, a limit that would have exempted BP's Deepwater Horizon operation. The rules would cover the boundary with international waters where the legal standing of wells is unclear, and mean virtually all offshore oil drilling operations within the EU being covered.
Oil companies would have to prove they could pay for any damage caused, either through an obligation to buy sufficient insurance, or by paying into a fund. They would also have to submit detailed plans on dealing deal with any accident.
Mobile oil rigs, like BP's Deepwater Horizon floating platform, would also be covered, with new tough rules on the kind of equipment to be used, such as blowout preventers, the failure of which was a key factor in the BP catastrophe. At present, laws requiring a high standard of safety equipment are limited to fixed rigs.
Companies would have to record any incidents, however minor, and notify the EU, with a description of the problem and and what was done to solve it. At present, companies can conceal such incidents.
The disclosure rules will help regulators gain an early insight – for instance, if there is a pattern of incidents across a company's sites, that could indicate problems with that firm's practices.
Share
Comments (15)
Fiona Harvey, environment correspondent
guardian.co.uk, Tuesday 19 April 2011 21.04 BST
Article history
European measures aimed at preventing a spill in EU waters are under attack. Photograph: Gerald Herbert/AP
European plans to crack down hard on oil companies with a series of measures to prevent a spill in EU waters like that of BP's Gulf of Mexico disaster, are under attack from the UK and other national governments, the Guardian has learned.
The measures, backed by the EU's energy chief Günter Oettinger, require companies to use a higher standard of equipment, pay for damage for which they are not liable now, and prove they have enough funds to clear up after any accident, before they can be licensed to drill.
The rules will be brought forward in July, and would apply to new and controversial deepwater drilling operations being embarked upon by several firms, such as Chevron at its site west of Shetland, and Cairn Energy in Greenland.
A year ago on Wednesday, an explosion at BP's Deepwater Horizon drilling rig in the Gulf of Mexico killed 11 people and caused the biggest offshore oil spill in US history, wreaking devastation in the Gulf.
Green campaigners welcomed the tougher stance from the European commission, but warned that the proposals were under attack. Richard George, an oil campaigner for Greenpeace, said: "If these regulations pass they'll be a good first step towards ensuring that oil companies are held responsible for their spills. The concern right now is that national governments, with the UK at the forefront, are working hard to water down these proposals at the behest of the oil companies. David Cameron needs to get behind efforts to prevent a Deepwater Horizon-style disaster in European waters."
One proposal, which would extend the EU regulations to the overseas operations of European offshore oil firms, is the subject of a sustained attack. If this rule had been in place last year BP's Deepwater Horizon drilling would have been subject to EU safety standards. Greenpeace said it was vital that this was retained.
A European commission source said that at first officials tried to involve oil executives in talks on the proposals but had been rebuffed by the companies, which insisted the Deepwater Horizon spill was solely due to shoddy practices. The commission has now decided to go ahead with the crackdown without input from the industry.
The oil industry is mounting a rearguard action, to get the rules changed before they can be brought into effect.
The planned rules must be approved by member states and the European parliament before they can come into operation, a process likely to take at least two years. But lobbying from the energy industry has been intense even before the proposals are scheduled to be formally brought forward, in July.
Under the commission plans, tough rules would apply to all drilling sites within 200 miles of the coast. Previous piecemeal EU attempts to regulate oil drilling extended only to wells within 12 miles of shore, a limit that would have exempted BP's Deepwater Horizon operation. The rules would cover the boundary with international waters where the legal standing of wells is unclear, and mean virtually all offshore oil drilling operations within the EU being covered.
Oil companies would have to prove they could pay for any damage caused, either through an obligation to buy sufficient insurance, or by paying into a fund. They would also have to submit detailed plans on dealing deal with any accident.
Mobile oil rigs, like BP's Deepwater Horizon floating platform, would also be covered, with new tough rules on the kind of equipment to be used, such as blowout preventers, the failure of which was a key factor in the BP catastrophe. At present, laws requiring a high standard of safety equipment are limited to fixed rigs.
Companies would have to record any incidents, however minor, and notify the EU, with a description of the problem and and what was done to solve it. At present, companies can conceal such incidents.
The disclosure rules will help regulators gain an early insight – for instance, if there is a pattern of incidents across a company's sites, that could indicate problems with that firm's practices.
Fish worth £4m seized in EU crackdown on illegal fishing
Catches of octopus, squid, sole, shrimp and grouper, allegedly caught using child labour, impounded in Canary Islands
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Robert Booth
guardian.co.uk, Tuesday 19 April 2011 19.46 BST
Article history
The fish were seized after a fleet of canoes were spotted fishing around the Marcia 707, which is thought to have fed its catch to the Seta No 73. Photograph: EJF
European authorities have impounded 5m portions of fish destined for tables across the continent following allegations they were caught by illegal "pirate fishing" off west Africa using child labour.
The block on catches of octopus, squid, sole, shrimp and grouper landed in the Spanish port of Las Palmas in the Canary Islands represents the biggest action yet against the landing of illegally caught fish in the European Union following the introduction of new Brussels regulations last year that ban the practice.
The catches weighed a combined 1,100 tonnes and were worth around £4m. They were found on three refrigeration vessels owned and flagged to South Korea, Panama and China.
The boats were heading to processing plants from where their catch was to be distributed to fish counters in Spain and the rest of Europe in time for Holy Week, when fish sales typically double in Spain.
But the EU is pursuing allegations the catch was taken from waters protected for use by local fishermen and that some of the crew were 14-year-old Senegalese boys who had been at sea for three months. Local fishermen's nets had allegedly been slashed by the foreign crews and one was allegedly assaulted with a metal bar when trying to retrieve his nets from entanglement with the industrial ship.
"Those vessels could be totally frozen out of trade with the EU," Maria Damanaki, commissioner for maritime affairs and fisheries told the Guardian last night. "Illegal fishing is a nightmare. A lot of countries are losing money from it and while we talk a lot about aid to the third world, if we stop illegal fishing a lot of local citizens in poorer countries will benefit."
She said illegal fishing damaged the sustainabilty of fish stocks and went hand-in-hand with criminality on a wider scale. It is estimated Sierra Leone loses up to $29m a year from pirate fishing. The new EU regulations aim "to prevent, deter and eliminate illegal, unreported and unregulated fishing".
Spanish officials seized a 500-tonne cargo on the South Korean-owned Seta No 73, which European Commission investigators believe was packed with fish illegally caught off Sierra Leone. Spain has also blocked the catch from the Chinese-flagged Haifeng 823 and Chinese-owned but Panama-flagged Lian Run, which together had nearly 600 tonnes on board. They await explanations from the flag states about where the fish came from.
Processing plants in Gran Canaria have been becalmed by the sanctions and, with Easter looming, parts of the Spanish fish industry have complained the timing of the seizures is political.
The moves are the start of a crackdown on pirate fishing planned by Brussels which could see dozens of industrial fishing ships banned from landing their catch in Europe, the world's biggest market for fish. In a planned "second strike" the EU is investigating the activities of 70 vessels from 11 non-EU countries and five member states which it suspects of fishing illegally, Damanaki said.
Alarm over Seta No 73's activities was raised by a fisherman from Mania village in Sierra Leone, who reported the destruction of 250 yards of nets to the Environmental Justice Foundation, a British charity which runs a community surveillance programme in the area.
The fisherman had spotted a fleet of canoes fishing around a trawler, the South Korea-flagged Marcia 707, in an inshore exclusion zone reserved for "artisanal" fishermen. Buoys had been cut from many of the local fishermen's nets, causing them to sink. Some of the canoe crews gave their age as 14 and said they had been picked up in Senegal before spending three months at sea, EJF reported.
When the local fishermen and EJF officials boarded the rusty trawler they saw two men who they believed to be South Korean sitting on the dirty and waterlogged deck. Up to 120 fishermen slept in a block of makeshift rooms on deck in cramped and very basic conditions with latrines which dumped directly over the side of the ship. The boat is thought to have fed its catch to the Seta No 73.
The crew of another vessel which provided part of the seized catch are alleged to have attacked a local fisherman who tried to retrieve his net when it became entangled with its fishing gear. He was allegedly hit on the head with a metal bar, opening a large gash, when he clashed with the crew in the exclusion zone.
"This investigation has exposed the highly organised theft of natural resources from some of the world's poorest people – communities dependent on fish for food security and employment," said Steve Trent, executive director of EJF. "Without flag states better regulating the activities of their vessels and coastal countries taking responsibility for monitoring their waters, this theft will continue."
In the case of the Seta No 73, the European Commission is demanding answers from the Panamanian authorities who provided certificates the catches were legal and within international fishing agreements, which protect certain waters for local fishermen.
"The most likely outcome is that a large part of the catch will be illegal," said Oliver Drewes, a spokesman for the commission. "The ultimate sanction is they could lose their licence to land fish at EU ports."
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Robert Booth
guardian.co.uk, Tuesday 19 April 2011 19.46 BST
Article history
The fish were seized after a fleet of canoes were spotted fishing around the Marcia 707, which is thought to have fed its catch to the Seta No 73. Photograph: EJF
European authorities have impounded 5m portions of fish destined for tables across the continent following allegations they were caught by illegal "pirate fishing" off west Africa using child labour.
The block on catches of octopus, squid, sole, shrimp and grouper landed in the Spanish port of Las Palmas in the Canary Islands represents the biggest action yet against the landing of illegally caught fish in the European Union following the introduction of new Brussels regulations last year that ban the practice.
The catches weighed a combined 1,100 tonnes and were worth around £4m. They were found on three refrigeration vessels owned and flagged to South Korea, Panama and China.
The boats were heading to processing plants from where their catch was to be distributed to fish counters in Spain and the rest of Europe in time for Holy Week, when fish sales typically double in Spain.
But the EU is pursuing allegations the catch was taken from waters protected for use by local fishermen and that some of the crew were 14-year-old Senegalese boys who had been at sea for three months. Local fishermen's nets had allegedly been slashed by the foreign crews and one was allegedly assaulted with a metal bar when trying to retrieve his nets from entanglement with the industrial ship.
"Those vessels could be totally frozen out of trade with the EU," Maria Damanaki, commissioner for maritime affairs and fisheries told the Guardian last night. "Illegal fishing is a nightmare. A lot of countries are losing money from it and while we talk a lot about aid to the third world, if we stop illegal fishing a lot of local citizens in poorer countries will benefit."
She said illegal fishing damaged the sustainabilty of fish stocks and went hand-in-hand with criminality on a wider scale. It is estimated Sierra Leone loses up to $29m a year from pirate fishing. The new EU regulations aim "to prevent, deter and eliminate illegal, unreported and unregulated fishing".
Spanish officials seized a 500-tonne cargo on the South Korean-owned Seta No 73, which European Commission investigators believe was packed with fish illegally caught off Sierra Leone. Spain has also blocked the catch from the Chinese-flagged Haifeng 823 and Chinese-owned but Panama-flagged Lian Run, which together had nearly 600 tonnes on board. They await explanations from the flag states about where the fish came from.
Processing plants in Gran Canaria have been becalmed by the sanctions and, with Easter looming, parts of the Spanish fish industry have complained the timing of the seizures is political.
The moves are the start of a crackdown on pirate fishing planned by Brussels which could see dozens of industrial fishing ships banned from landing their catch in Europe, the world's biggest market for fish. In a planned "second strike" the EU is investigating the activities of 70 vessels from 11 non-EU countries and five member states which it suspects of fishing illegally, Damanaki said.
Alarm over Seta No 73's activities was raised by a fisherman from Mania village in Sierra Leone, who reported the destruction of 250 yards of nets to the Environmental Justice Foundation, a British charity which runs a community surveillance programme in the area.
The fisherman had spotted a fleet of canoes fishing around a trawler, the South Korea-flagged Marcia 707, in an inshore exclusion zone reserved for "artisanal" fishermen. Buoys had been cut from many of the local fishermen's nets, causing them to sink. Some of the canoe crews gave their age as 14 and said they had been picked up in Senegal before spending three months at sea, EJF reported.
When the local fishermen and EJF officials boarded the rusty trawler they saw two men who they believed to be South Korean sitting on the dirty and waterlogged deck. Up to 120 fishermen slept in a block of makeshift rooms on deck in cramped and very basic conditions with latrines which dumped directly over the side of the ship. The boat is thought to have fed its catch to the Seta No 73.
The crew of another vessel which provided part of the seized catch are alleged to have attacked a local fisherman who tried to retrieve his net when it became entangled with its fishing gear. He was allegedly hit on the head with a metal bar, opening a large gash, when he clashed with the crew in the exclusion zone.
"This investigation has exposed the highly organised theft of natural resources from some of the world's poorest people – communities dependent on fish for food security and employment," said Steve Trent, executive director of EJF. "Without flag states better regulating the activities of their vessels and coastal countries taking responsibility for monitoring their waters, this theft will continue."
In the case of the Seta No 73, the European Commission is demanding answers from the Panamanian authorities who provided certificates the catches were legal and within international fishing agreements, which protect certain waters for local fishermen.
"The most likely outcome is that a large part of the catch will be illegal," said Oliver Drewes, a spokesman for the commission. "The ultimate sanction is they could lose their licence to land fish at EU ports."
Florida police release images of shot Britons' last hours
US detectives anxious to speak to women in video to help fill in 'lost hour' between closing time and discovery of bodies
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Richard Luscombe in Miami
The Guardian, Wednesday 20 April 2011
Article history
CCTV still released by police showing James Cooper and James Kouzaris in a bar just after midnight on the morning they were killed. Photograph: Sarasota Police/PA
Detectives have released video images showing British holidaymakers James Kouzaris and James Cooper enjoying their final night out in a Florida bar less than three hours before the friends were found shot dead in a crime-plagued neighbourhood.
The series of grainy stills shows the pair drinking and talking to several women, who police want to interview to help fill in the crucial "lost hour" between closing time in downtown Sarasota in the early hours of Saturday and the discovery of their bodies with multiple gunshot wounds on a street in Newtown several miles away.
"None of these women are suspects but we'd like to see if they know what the victims were talking about shortly before their deaths," said Captain Paul Sutton of the Sarasota police department.
"The bars are open until 2am and at 2.56am we got the call. Assuming they stayed until closing time, it would be a very narrow time frame. We'd like to know if they were talking about their plans for the evening, anyone they were going to meet up with, where they might be going."
Assistant state attorney Karen Fraivillig said that Shawn Tyson, 16, will be tried as an adult on first-degree murder charges following his arrest on Monday.
A grand jury will hear allegations within two weeks that he shot and killed Cooper, 25, from Warwick, and Kouzaris, 24, of Northampton, during their three-week holiday with relatives on the exclusive west coast barrier island of Longboat Key.
"Despite the fact that he's being tried as an adult, the death penalty simply doesn't apply in Florida to anyone who's under 18 years old," she said.
Sutton said that although police were "very happy" to have a suspect in custody, much work needed to be done.
Detectives have visited several bars along Sarasota's Main Street, where the friends, who met as students at the University of Sheffield, were drinking. The images were recorded at a popular hangout called Smokin' Joe's.
"We're going all out on that. We've looked at video and interviewed employees and we're trying to piece together the events of Friday night and Saturday morning for our two victims," Sutton said.
Investigators believe Tyson did not have access to a car and that he was already waiting in Newtown when an unknown third party arrived with the pair shortly before 3am.
Police also believe the two were there of their own volition. "It's plausible they were taken there and confronted by at least one individual," Sutton said. "We're continuing to investigate the possibility that others were involved."
Family members attacked suggestions that Cooper was buying marijuana. "He never did drugs. He did not even smoke. He was a professional tennis coach. Taking drugs would be the last thing on his mind," Desmond Walton, Cooper's grandfather, told reporters.
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Richard Luscombe in Miami
The Guardian, Wednesday 20 April 2011
Article history
CCTV still released by police showing James Cooper and James Kouzaris in a bar just after midnight on the morning they were killed. Photograph: Sarasota Police/PA
Detectives have released video images showing British holidaymakers James Kouzaris and James Cooper enjoying their final night out in a Florida bar less than three hours before the friends were found shot dead in a crime-plagued neighbourhood.
The series of grainy stills shows the pair drinking and talking to several women, who police want to interview to help fill in the crucial "lost hour" between closing time in downtown Sarasota in the early hours of Saturday and the discovery of their bodies with multiple gunshot wounds on a street in Newtown several miles away.
"None of these women are suspects but we'd like to see if they know what the victims were talking about shortly before their deaths," said Captain Paul Sutton of the Sarasota police department.
"The bars are open until 2am and at 2.56am we got the call. Assuming they stayed until closing time, it would be a very narrow time frame. We'd like to know if they were talking about their plans for the evening, anyone they were going to meet up with, where they might be going."
Assistant state attorney Karen Fraivillig said that Shawn Tyson, 16, will be tried as an adult on first-degree murder charges following his arrest on Monday.
A grand jury will hear allegations within two weeks that he shot and killed Cooper, 25, from Warwick, and Kouzaris, 24, of Northampton, during their three-week holiday with relatives on the exclusive west coast barrier island of Longboat Key.
"Despite the fact that he's being tried as an adult, the death penalty simply doesn't apply in Florida to anyone who's under 18 years old," she said.
Sutton said that although police were "very happy" to have a suspect in custody, much work needed to be done.
Detectives have visited several bars along Sarasota's Main Street, where the friends, who met as students at the University of Sheffield, were drinking. The images were recorded at a popular hangout called Smokin' Joe's.
"We're going all out on that. We've looked at video and interviewed employees and we're trying to piece together the events of Friday night and Saturday morning for our two victims," Sutton said.
Investigators believe Tyson did not have access to a car and that he was already waiting in Newtown when an unknown third party arrived with the pair shortly before 3am.
Police also believe the two were there of their own volition. "It's plausible they were taken there and confronted by at least one individual," Sutton said. "We're continuing to investigate the possibility that others were involved."
Family members attacked suggestions that Cooper was buying marijuana. "He never did drugs. He did not even smoke. He was a professional tennis coach. Taking drugs would be the last thing on his mind," Desmond Walton, Cooper's grandfather, told reporters.
Michelle Obama's plane forced to abort landing
The plane carrying Michelle Obama was too close to a military jet, an incident that has put the FAA in the spotlight again
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Associated Press
guardian.co.uk, Wednesday 20 April 2011 04.04 BST
Article history
Air traffic controllers directed a plane carrying first lady Michelle Obama to abort a landing because it was too close to a military cargo jet (AP Photo/Pablo Martinez Monsivais)
Air traffic controllers directed a plane carrying first lady Michelle Obama to abort a landing at Andrews Air Force Base because it was too close to a military cargo jet, officials said, in yet another embarrassment for the Federal Aviation Administration.
The episode puts the FAA back into the spotlight as officials struggle to calm public jitters about flying that have been raised by nine suspensions of air traffic controllers and supervisors around the country in recent weeks, including five for sleeping on the job.
This latest incident occurred at about 5pm (2100 GMT) on Monday when a Boeing 737 belonging to the Air National Guard, one of several guard planes used by the White House, came within about three miles of a massive C-17 as the planes were approaching Andrews to land, according to the FAA and Major Michelle Lai, a spokeswoman for Andrews.
The FAA requires a minimum separation of five miles between two planes when the plane in the lead is as large as the 200-ton cargo jet, in order to avoid dangerous wake turbulence that can severely affect the trailing aircraft.
The FAA is investigating the incident as a possible error by controllers at a regional radar facility in Warrenton, Virginia, that handles approaches and departures for several airports, including Andrews, where the president's aircraft, Air Force One, is maintained.
The C-17 and Mrs Obama's plane didn't have the proper separation when controllers in Warrenton handed them off to the Andrews controllers, a source familiar with the incident said.
Andrews air traffic controllers initially ordered the plane to conduct a series of turns to bring it farther from the military jet. When that didn't provide enough distance, controllers realised that there might not be enough time for the cargo plane to clear the Andrews runway before Mrs Obama's plane landed.
Controllers then directed the pilot of Mrs Obama's plane to execute a "go-around" to stop descending and start climbing and circle the airport, located in a Maryland suburb of Washington. A go-around is considered a type of aborted landing.
"The aircraft were never in any danger," the FAA said in a statement.
Jill Biden, wife of Vice President Joe Biden, was also on the plane with Mrs Obama. The first lady and Mrs Biden had been in New York earlier in the day for a joint TV interview.
The first lady's office declined to comment and referred all questions to officials at the FAA and Andrews. The president's West Wing press office did likewise.
The National Transportation Safety Board is gathering information about the incident but hasn't yet decided whether it will open a formal investigation, board spokeswoman Kelly Nantel said.
The controllers in Warrenton and at Andrews work for the FAA, and it is their job to keep planes separated. When aircraft get too close, the FAA counts that as an operation error. Over the past several years, errors by controllers have increased substantially.
The first disclosed case of a controller falling asleep on duty occurred March 23 at Washington's Reagan National airport, not far from Andrews. The most recent was this week when a controller at a regional radar facility near Cleveland was suspended for watching a movie on a DVD player when he was supposed to be monitoring air traffic. The head of the US air traffic system resigned last week.
FAA Administrator Randy Babbitt has said the higher number of known errors is due to better reporting and technology that can determine more precisely how close planes are in the air.
Bill Voss, president of the Flight Safety Foundation of Alexandria, Virginia, said the kind of spacing error that occurred in the handling of Mrs Obama's plane happens every day.
"It was more an embarrassment than a danger," said Voss, a former controller.
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Associated Press
guardian.co.uk, Wednesday 20 April 2011 04.04 BST
Article history
Air traffic controllers directed a plane carrying first lady Michelle Obama to abort a landing because it was too close to a military cargo jet (AP Photo/Pablo Martinez Monsivais)
Air traffic controllers directed a plane carrying first lady Michelle Obama to abort a landing at Andrews Air Force Base because it was too close to a military cargo jet, officials said, in yet another embarrassment for the Federal Aviation Administration.
The episode puts the FAA back into the spotlight as officials struggle to calm public jitters about flying that have been raised by nine suspensions of air traffic controllers and supervisors around the country in recent weeks, including five for sleeping on the job.
This latest incident occurred at about 5pm (2100 GMT) on Monday when a Boeing 737 belonging to the Air National Guard, one of several guard planes used by the White House, came within about three miles of a massive C-17 as the planes were approaching Andrews to land, according to the FAA and Major Michelle Lai, a spokeswoman for Andrews.
The FAA requires a minimum separation of five miles between two planes when the plane in the lead is as large as the 200-ton cargo jet, in order to avoid dangerous wake turbulence that can severely affect the trailing aircraft.
The FAA is investigating the incident as a possible error by controllers at a regional radar facility in Warrenton, Virginia, that handles approaches and departures for several airports, including Andrews, where the president's aircraft, Air Force One, is maintained.
The C-17 and Mrs Obama's plane didn't have the proper separation when controllers in Warrenton handed them off to the Andrews controllers, a source familiar with the incident said.
Andrews air traffic controllers initially ordered the plane to conduct a series of turns to bring it farther from the military jet. When that didn't provide enough distance, controllers realised that there might not be enough time for the cargo plane to clear the Andrews runway before Mrs Obama's plane landed.
Controllers then directed the pilot of Mrs Obama's plane to execute a "go-around" to stop descending and start climbing and circle the airport, located in a Maryland suburb of Washington. A go-around is considered a type of aborted landing.
"The aircraft were never in any danger," the FAA said in a statement.
Jill Biden, wife of Vice President Joe Biden, was also on the plane with Mrs Obama. The first lady and Mrs Biden had been in New York earlier in the day for a joint TV interview.
The first lady's office declined to comment and referred all questions to officials at the FAA and Andrews. The president's West Wing press office did likewise.
The National Transportation Safety Board is gathering information about the incident but hasn't yet decided whether it will open a formal investigation, board spokeswoman Kelly Nantel said.
The controllers in Warrenton and at Andrews work for the FAA, and it is their job to keep planes separated. When aircraft get too close, the FAA counts that as an operation error. Over the past several years, errors by controllers have increased substantially.
The first disclosed case of a controller falling asleep on duty occurred March 23 at Washington's Reagan National airport, not far from Andrews. The most recent was this week when a controller at a regional radar facility near Cleveland was suspended for watching a movie on a DVD player when he was supposed to be monitoring air traffic. The head of the US air traffic system resigned last week.
FAA Administrator Randy Babbitt has said the higher number of known errors is due to better reporting and technology that can determine more precisely how close planes are in the air.
Bill Voss, president of the Flight Safety Foundation of Alexandria, Virginia, said the kind of spacing error that occurred in the handling of Mrs Obama's plane happens every day.
"It was more an embarrassment than a danger," said Voss, a former controller.
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