Cook's warning. . . Conservative voters unhappy. . . Heckler interrupts Clarke. . . Pressure on doctors. . . Pharmacists snub offer. . .

At the Labour Party conference in Brighton, shadow health secretary Robin Cook told HSJ that 'managers have got to make up their minds whether they are political appointments or running the administration of the NHS'. He urged them to 'sort out' the Institute of Health Services Management so it was not 'dragged along with the government's coat tails'. A motion that 'senior managers who have aided and abetted Tory attempts to destroy the NHS should be replaced' when Labour took office was withdrawn before being put to a vote.

Up to 12 per cent of Conservative voters may switch their allegiance if the government continues with the NHS reforms, according to a MORI poll. In total, 62 per cent - not all Tory voters - felt the plans would damage healthcare.

Health secretary Kenneth Clarke's speech to the Society of Family Practitioner Committees was interrupted by an elderly heckler who shouted that the NHS was underfunded, ambulance crews were underpaid and too many local hospitals had been closed.

Hospital pharmacists have rejected a 6.5 per cent pay offer but voted against industrial action. Their move is being portrayed as a contrast to the ambulance staff unions' action in response to a similar offer.

Pressure on doctors to support the reforms was jeopardising the success of the resource management initiative, consultants' leaders warned. Applications for trust status were generating 'mistrust' between doctors and managers, they said.

Ambulance responses to emergency calls in London averaged ha lf an hour at the weekend, according to the crews' union, NUPE. The figure, more than double the recommended standard, is worse than previous weeks, after 3,500 ambulance officers and controllers joined the four week-old overtime ban.