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Commissioning is integral to the Government's change agenda for public services with its crosscutting aims of keeping people well, improving overall health and reducing inequalities. Commissioning for mental health ‐ rather than merely for the treatment of people with mental health problems ‐ should be a defined and clear‐cut aspect of health and social care planning and investment. However, it remains a significant challenge for a number of reasons.

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Historically, Panama has always been “a place of transit.” While technically the isthmus formed part of Colombia in the nineteenth century, it was linked geopolitically to the United States soon after the California gold rush, beginning in the late 1840s. The first attempt at building a canal ended in failure in 1893 when disease and poor management forced Ferdinand de Lesseps to abandon the project. The U.S. undertaking to build the canal could only begin after Panama declared itself free and broke away from Colombia in 1903, with the support of the United States.

Discusses the long existing and confusing problems of establishing the relationship of who is, and who if not, a dependent worker. Reflects developments which have occurred in British law as it affects the employment field, plus an evaluation and analysis of some of the different types of employment relationships which have evolved by examining, where possible, the status of each of these relationships. Concludes that the typical worker nowadays finds himself in a vulnerable position both economically and psychologically owing to the insecurity which exists.

The Falls Exercise Prevention Programme for older people was introduced as a new project for North Bradford Primary Care Trust in 2002. The introduction of this new service was in response to an identified need to help reduce the incidence of falls, reduce serious injuries as a result of falling, and help improve and maintain the quality of life for those older people who had been identified as having had a fall or being at high risk of falling. The service was not established to be a front line service but to be incorporated into the falls referral pathway. The exercises undertaken are all evidence based and proven to be effective with this population. However, the Group promotes other aspects of quality of life for older people and promotes a holistic approach including health promotion and education. The group has now expanded to incorporate a ‘Walking for Health’ project; a ‘Walk From Home’ project and a ‘Buddy‐Up’ system. The Group is continually growing and future plans are to incorporate ‘Walks for Fallers’. Evaluation of the service provides information to continually improve and extend the services on offer.

A total of 63 parents whose children underwent urological surgery at a tertiary referral specialist paediatric hospital were surveyed at three times points: immediately after signing consent; two to three days after surgery (at discharge); and by telephone two to three weeks after discharge. The survey was to assess parents’ perceptions of the consent process and parental recall of information given about the surgical procedure and risks. Results demonstrated that despite the majority of parents being satisfied with the consent process, operation, aftercare and the subsequent health of their child, their recall of risk information was poor, with 60 per cent of parents unable to recall any explained risks of the operation. This study pre‐dated the introduction of the national consent policies and forms, but provides evidence which supports the need for this consistent approach across the NHS which emphasises the effective communication of risks and benefits in relation to proposed treatment.