Good afternoon. Apologies for a day or two of radio silence, but to paraphrase John Lennon, life has been happening to us while we were busy making other plans.

The latest instalment of The Maynard Doctrine has arrived for your edification (www.healthpolicyinsight.com/?q=node/123). This touches on the vital issue of incentives, which will be addressed in our latest 'Colloquia', which should be up by this evening.

by Andy Cowper

Some concluding thoughts from Confed

1. Every big conference has an atmosphere: a reflection of the mood across the service. This year the atmosphere has been elusive. Conference chair David Walker, editor of Guardian Public characterised it as “calm”. Calm was a symptom, but the cause was waiting. We are all waiting for Darzi.

Is David Nicholson still gunning for Monitor?

No matter how bad your day is, Joe Simpson has had a worse one. The climber and inadvertent bestselling author gave a thoroughly moving and harrowing speech today to Confed. His recounting of the physical ordeal was harrowing just to hear. Simpson niftily avoided the potential pitfalls of emotionalism, drawing instead a deeply touching and personal message that feeling totally alone and beyond contact or human touch is the worst kind of pain.

Andy Cowper
The Day Today: Wednesday 18 June 2008 - Day One NHS Confederation conference
And so to Manchester for the NHS Confederation conference, via Heathrow Terminal Five - not so much an airport, more a shopping opportunity. Blimey, what a decade you’ve just had if you love shopping. Now credit is crunchy and there’s a real risk of 70s-style stagflation, things look different.

by Andy Cowper

Welcome to Health Policy Insight, a new online health policy information and analysis service.

New on the site today is Nick Timmins’ first HPI column, which considers the impact of ‘top-ups’ to NHS care. The Government is due to announce today or tomorrow that it will change policy. The level of detail to be announced, however, is uncertain.

The abstract principle of payment for healthcare was breached with prescription charges in the NHS’s earliest days. In the English NHS today, dentistry and audiology show us a residualist NHS service for much of the country, while access to physiotherapy and various mental health services in psychotherapy can be deeply patchy. And then there’s car parking charges …