Published: 14/03/2002, Volume II2, No. 5796 Page 23

What a depressing week. It ended with bad news on the waiting-list front: they're getting worse again, at least in England. But that followed ill-tempered exchanges between senior ministers and the unions over what are known as 'two-tier workforces'.

It is a terribly important issue for public sector employees and managers, especially those trying to manage the public sector from the private sector, opinion-formers whom Number 10 seeks to reassure. Yet none of it shed much light that I could detect.

Tony Blair told MPs that pay and conditions of staff transferred to private sector management - in the NHS, for instance - must be protected, but also that managers must be allowed to manage. They are still trying to find a way to square the circle. So That is all right, then.

Thanks, Tony.

In the circumstances, I rummaged through my ideas file to find something cheerful to write about for a change. It wasn't easy, but I stumbled on a recent speech by Dr Howard Stoate, Labour MP for Dartford since 1997 and possibly the only MP still committing medicine on a regular basis.

Dr Stoate is a cheerful chap and, sure enough, he was praising a useful initiative at Darent Valley Hospital, one of the early private finance initiative schemes, opened by Alan Milburn in December 2000. It replaced three very old hospitals on his patch, albeit amid instant claims that it was too small.

As HSJ readers know, the Darent Valley's managers have also taken a pasting - zerorated and going out to franchise, currently headed in the interim by Sue Jennings.

But Dr Stoate had found a silver lining: the six-bed 23-hour unit for routine operations - hernias, varicose veins and urological procedures - which he called 'an example of innovative thinking that needs to be more widely replicated in the NHS'.

The unit is ring-fenced, just the sort of diagnostic and treatment centre (DTC) that Mr Milburn is looking to France, Germany and the US to replicate here. Indeed, German health teams are already sniffing around Dartford. The local MP proudly called it 'the first dedicated stand-alone unit for intermediate and elective surgery' in Kent.

That may not be saying quite as much as it might in some counties, Kent being something of an NHS battleground.Dr Stoate's Canterbury and Whitstable neighbour, Tory Julian Brazier, recently staged his umpteenth debate on East Kent's hospital problems. He reported that ITN's Colin Baker had likened Kent and Canterbury Hospital's A&E department - 50 trolleys some nights - to a Balkan war zone. 'He should know, he was wounded there.'

But I digress.Dr Stoate's problem is that his pioneering new unit, which is proving effective in cutting back outpatient waits, and its dedicated nursing staff are being funded by the winter service emergency team.

They will deal with 30 patients a week - 1,380 a year from a waiting list currently 3,500, the minister, Yvette Cooper, confirmed.But the cash is only guaranteed for a year. Dr Stoate, who notes disapprovingly 'the low priority [still] given to routine cases', wants to find more cash - possibly from the DTC money Mr Milburn promised last year to finance 26 such centres.

When I caught up with the MP on Sunday night - he was watching what Mrs Stoate called 'an unsuitable film on Channel 5' - he said that Darent Valley had indeed suffered too many operations cancelled at the last minute.People do not complain about emergency treatment, but about elective surgery.

'That is the biggest problem the NHS faces.'

So the new unit is the way to go.

Unfortunately, the MP told me, the management difficulties the hospital has faced mean it has not been best placed to trouser some ofMr Milburn's DTC funds.

Ms Cooper drew attention to the wider needs ofNorth West Kent, but was vague - as junior ministers clutching tightly to their brief tend to be.The secret of DTCs is four-fold: separation of elective from emergency care; maximum efficiency in work processes; inter-disciplinary coordination among doctors; a patientfocused system which concentrates on 'prompt and convenient access and reliably booked appointments'.

Dr Stoate would have little quarrel with that. As for his robust views on how to reorganise Mr Brazier's hospital problems next door, we will draw a veil over them. Let's keep the column cheerful for once.