He had html twisted and turned for five months to services prevent the implementation of the agreement he had signed in August 1993. en html President Juvenal Habyarimana html services html of Rwanda was no stranger to these people. Hutu html power services was to be re-established by killing all Tutsis and all html moderate political elements in the country. html Their plans were html laid, their weapons were html services html html en html ready, the lists en were drawn up, their propaganda had been spewing en out of html their radio html en html station and newspapers for months The killers needed only a signal to go. At the same time, however, they are encouraging the private sector services to bid to finance and run NHS services and even entire hospitals.

Meanwhile, NHS hospitals are earning record sums from treating private patients.Nicholas Timmins. Ministers find themselves denying the ultimate logic of the NHS reforms - that the service could end up publicly funded but privately provided. Duncan Nichol, the former NHS chief executive, has been replaced by the more pragmatic Alan Langlands.Even under Nichol, however, attempts were made to reinstate planning - not just in London - following fears over just how destructive the market could be to the fabric of the NHS. Without that, London hospital closures would have been even more dramatic. The new community care arrived and Mrs Bottomley has pushed mental health up the agenda.But as some trusts are struggling and fundholding takes on myriad different forms, no one knows whether, three to five years down the road, health authorities or GPs will be buying most care - or which should be.

Early encouragement of more vigorous competition - partly at the instigation of Brian Mawhinney, her health minister - has been followed by much more talk of partnership and co-operation. Peter Griffiths, the deputy chief executive of the NHS, and Eric Caines, its personnel manager, were fiercely pro-market.Under Virginia Bottomley, the pendulum has swung back and forth. But as Major's administration took a softer line, top NHS management took a tougher one. When Kenneth Clarke took over from Moore, he helped Lawson to scupper the plans for alternative financing of the NHS, but bought Thatcher's desire for competition between self-managed hospitals in an internal market - and injected the idea of GP fundholders buying care. Under John Major and William Waldegrave, the language and pace of the reforms were toned down, and Waldegrave put Health of the Nation targets on the agenda. Patient's Charter objectives and centrally funded initiatives to cut waiting lists and improve services took a higher profile.