Imaginative thinking must be the hospital menu planner's bread and butter

To paraphrase Humpty Dumpty, it's always jam yesterday, jam tomorrow, but never jam today - unless you're sick in Leicester, in which case it might be jam every day. The food trolley service at Leicester General Hospital was obviously introduced for all the right reasons.

Patients can pick from a selection of foods. They can choose how much - or little - to eat. And they get hot food, unchilled by the long march from the kitchens. The snag is that bedridden patients, who have to get nurses to queue for them, are being left with the leftovers. Jam sandwiches three days running in the case of one patient who complained to the local paper.

Imaginative management thinking is needed on this one. Menus, perhaps, so nurses only have to queue once. First choice for the bedridden. Bigger nurses with sharper elbows. Marmalade as well as jam. Meanwhile, as the WHO sorts out global healthcare and the UK government reforms the NHS, ponder one of the great truths of existence: it is always the little things that make life really difficult.