At the risk of appearing vulgar, we feel we have to point out that getting their OATs looks like becoming a preoccupation for NHS managers. The government's plans for replacing extra-contractual referrals with retrospective payments for 'out of area treatments' may resurrect some of the problems associated with funding cross-boundary flows before 1991. Any major shifts in commissioning part way through the year could cause severe financial hardship for the affected health authority. These proposals ought to generate much debate; unfortunately, consultation is timed to last only five and a half weeks.

The National Reference Cost Index, which will replace the reviled Purchaser Efficiency Index, has aroused understandable fears about ill-informed comparisons and confusion between cheapness and cost-effectiveness.

If a glimmer of hope exists that ministers share these concerns, it can be found in health secretary Frank Dobson's other momentous announcement of the past 10 days - on clinical performance information. Any published figures 'must be a fair and accurate reflection of clinical quality', he said. They must compare like with like and highlight genuine problems rather than penalise good doctors dealing with desperately ill patients.

Let's hope managers will encounter a similarly enlightened approach.