The excitement over the top up fees vote waned throughout Tuesday as there were last minute changes of mind among Labour rebels. When the vote came, and the result was announced I was surprised the majority was only five votes. I voted with the rebels and the Opposition as I cannot accept that there are no other ways of providing more money for the universities. However, I admired at least one Tory rebel who voted on his conscience with the Government. I continue to have a great respect for Labour rebels who withstand the enormous pressure from their Whips. The feeling in the rebel lobby was not as electric as after the Iraq war division. Perhaps that was an even more difficult rebellion for them or is it just that with a dictatorial style of government rebellion is becoming commonplace?

I was disappointed yesterday as I was unable to attend Prime Minister’s Questions on the day of the release of the Hutton Report because of a long arranged engagement to talk to a conference of Health Service Managers about hospital reconfigurations. Everyone is highly aware that centralisation of hospital services is a political matter since Wyre Forest people’s political actions.

An excellent article on hospital reconfiguration in last week’s British Medical Journal (Black A. BMJ 2004;328:178-9) states in its title that centralisation of services is politically impossible. It refers to our downgrading as "the Kidderminster debacle", and emphasises the need for the clinical professions to connect with the public and to give more thought to the concept of managed clinical networks so that local emergency units can function effectively in partnership with nearby full accident and emergency departments.

The author accurately sums up the problems that have surfaced: "If the price of moving the complex emergency to an appropriate centre of expertise is that this patient is accompanied by another nine or 10 patients who are not complex acute cases, then another set of problems is launched".

This gives us real support for our need of a local emergency centre to receive the majority of patients who are not complex acute cases that do not need to move out of the area. In our case this would be an enhanced Minor Injuries Unit in combination with the Primary Care Centre so conveniently united in the new Treatment Centre.

I visited the Ambulance Trust Headquarters last week and was impressed with their up-to-date command and control centre. Operators can check instantly on screen where ambulances are to the nearest post code. The number of ambulances waiting to unload patients at A&E Departments can be seen. I understand that the service is working to its full capacity and there is no more scope for expansion. Surely further evidence, if it was needed, for avoiding unnecessary transfers from Kidderminster to Worcester.