The great debate about the NHS is not whether it is getting better - it clearly is - but whether the improvement is commensurate with the huge extra sums that have been invested.

The great debate about the NHS is not whether it is getting better - it clearly is - but whether the improvement is commensurate with the huge extra sums that have been invested.

For an indication of how much worse things could have been, take a look at the other countries in the union. In Wales, Scotland and northern Ireland, waiting times have risen - not fallen, as in England. More than one in 10 patients in Wales and Scotland, and more than one in five in Northern Ireland, is waiting longer than 12 months, compared with none in England. Yet funding in the three countries is up to 30 per cent higher per head than in England. That's an extra £300 for every man woman and child.

Paediatricians have a cruel sense of humour. As the president of their royal college, Sir Alan Craft, put it at the annual dinner last week, they like to play games.

Sir Alan's idea of a jolly jape on this occasion was to seat me next to the president of the General Medical Council, Sir Graeme Catto. A couple of weeks ago I wrote a piece asking why Sir Graeme had not fallen on his sword following the drubbing the GMC got in Dame Janet Smith's fifth report from the Shipman inquiry.

However, Sir Graeme was his usual charming self and gave me a full and frank account of his views on revalidation - the "MOT for doctors" that Dame Janet wants to see toughened - and explained under what circumstances he would resign (if it ends in a fudge).

There are some tricky negotiations ahead and no one is predicting what form the new check on doctors' competence will take, how the profession will react or even if self-regulation will survive. But whatever the outcome, it will not eliminate risk.

Safe doctors are essential, but they are only part of a wider picture. Safe systems are what count, for identifying patients, administering drugs, matching blood and ensuring surgeons don't lop off the wrong limb. If only the Department of Health understood. Another guest at the dinner told me how an inquiry he chaired into the introduction of a new treatment that was linked with a series of patient deaths was held up for almost a year because ministers insisted that someone be blamed.

One method of assessing competence, for surgeons, is to check their individual death rates. But this may be bad news for sicker patients. In New York, a survey of 120 cardiologists found 80 per cent admitted they had avoided performing an angioplasty - threading a wire up to the heart and inflating a balloon to widen a blocked artery - on a patient they considered too risky. They were worried how it might affect their ranking in the league table.

As the authors from the University of Rochester commented, an attempt to provide the public with information has ended by creating a conflict for the doctor which may actually worsen patient care.

John Reid's future as a well-informed health secretary only narrowly survived the tsunami that swept through South East Asia. Both his special advisers were caught up in the disaster - and one was lucky to escape with his life.

Paul Corrigan, who has been beavering away on the NHS reforms, was stretched out on a sun lounger in the Maldives with his wife, Hilary Armstrong, when the wave swept underneath the raised platform outside their hotel.

Steve Bates, Mr Reid's youthful apparatchik, had a nastier experience. He and his girlfriend were on a bus following a coastal road in Thailand when they saw a wall of water and debris sweeping towards them. They escaped, and managed to grab hold of palm trees and hang on till the water receded.A few days later, Bates developed pneumonia. He is now back at his desk, shaken but undeterred.

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