The Liberal Democrats in their election manifesto wanted local authorities to do the purchasing of NHS care. Even now, during Cameron, Clegg and Lansley’s “pause” in their NHS reforms, their activists are pushing hard for councillors to be given a much bigger role in commissioning.

This is a really bad idea. And Enfield council, in the first test of what the Liberal Democrats would like to be the new regime, have just demonstrated why.

The reason council commissioning of care is a not a good idea is that it mixes representation without taxation. Councillors have democratic legitimacy. But they don’t raise the money for the NHS.

So over the long term, giving them responsibility for commissioning is simply a recipe for councils to say there is not enough money in the system and to blame central government for the NHS’s deficiencies, rather than take hard decisions – hard in the sense that they are always locally unpopular – over how services need to be reshaped as medicine changes.

That was what almost invariably happened when councillors sat on health authorities back in the seventies and eighties. Today, Enfield has just made the point again.

Chase Farm Hospital in the borough has both accident and emergency, and maternity and paediatric services, that hospital clinicians locally believe are no longer safe. Indeed, it is 17 years since the closure of Chase Farm’s “blue light” A&E was first proposed and 15 years since the same case was made – again on clinical grounds – over the maternity care.

Enfield is bitterly opposed to the plans to transfer both these services to the nearby North Middlesex Hospital – a proposal that would leave Chase Farm doing more non-emergency surgery than at present, and still with an urgent care centre.

Despite endless rounds of consultation which have shown clear majority support among hospital clinicians and GPs across Barnet, Enfield and Haringey – all three boroughs and parts of Hertfordshire are affected by this change – Andrew Lansley, the health secretary, recently gave the council a chance to come up with an alternative strategy.

Today it has done so. Boiled down, its conclusion is “give us more money and keep everything open”. Point made.

David Cameron this morning sought to scupper Gordon Brown’s potential appointment to head the International Monetary Fund.

The job is expected to come up within months if and when Dominique Strauss Kahn tilts for the French presidency ahead of next year’s elections. (Although Chris Giles, our economics editor, has dismissed the idea that Brown is a front-runner). Cameron, interviewed on the Today programme, was cattily dismissive:

“I haven’t spent a huge amount of time thinking about this, but it does seem to me that if you have someone who didn’t think we had a debt problem in the UK, when we self-evidently do have a debt problem, then they might not be the most appropriate person to work out whether other countries around the world have debt and deficit problems….

“What matters is the person running the IMF is someone who understands the danger of excessive debt, excessive deficit, and it really must be someone who gets that rather than someone who says that they don’t see a problem.”

It is not clear if Cameron is talking about Britain’s debt issues pre-crash or post-crash.

It is true that Gordon Brown had his head in the sand during the build-up to the financial crisis, refusing to accept that systemic risk was building up in the system. Even when the house of cards started to fall he was still in a state of disbelief. (On a return flight from New York in the autumn of 2008 he became apoplectic when I questioned his belief that Britain had not experienced any ‘subprime’ lending).

But for Cameron to pretend that the Tories were any more concerned about the situation, pre-crunch, show a degree of chutzpah. Not only did the Conservatives agree to match Labour’s spending promises right up until the crash – which they would not have done if they predicted the meltdown. They also wanted even lighter regulation on the banks.

Where the Tories outmanouvred Labour post-credit crunch was in recognising that an enormous deficit had opened up; one that could not simply be ignored. (We described Brown’s attempts to dismiss this in June 2009 as “fundamentally

You’ll find better coverage of this on FT Alphaville.

But today’s warning about the US economy from Standard & Poor’s will be closely watched in Britain today and beyond. (Bear in mind the old expression that when the US economy sneezes, the rest of the world catches a cold).

You can read our main story at ft.com through this link. Shares have fallen sharply, Treasury yields are up and gold has hit a new record price.

Here is one of the key passages from the ratings agency:

Because the U.S. has, relative to its ‘AAA’ peers, what we consider to be very large budget deficits and rising government indebtedness and the path to addressing these is not clear to us, we have revised our outlook on the long-term rating to negative from stable.

No doubt the coalition will argue that Britain is a different case because the UK deficit reduction path is relatively clear.

Ipsos Mori has published an interesting survey today suggesting that three quarters (75 per cent) of Britons believe that immigration is currently a problem.

There is also strong support for the government’s plan to introduce an annual cap on the on the number of workers coming into Britain from countries outside the European Union. More than half (57 per cent) support the cap and only 15 per cent (one in seven) oppose it.

To quote from the pollster:

The main cause of concern about immigration is the perceived burden it has on public services and the pressure it places on jobs. Indeed, lower skilled workers are the most likely to say immigration is a problem.

With youth unemployment reaching record highs, concern amongst those aged 16 to 24 has seen a big increase (this group is usually least negative about immigration). Almost half (49 per cent) of them believe that immigration to Britain will damage the economic recovery by taking away jobs from people already living here.

The West Midlands has the highest level of concern, with 88 per cent perceiving immigration as an issue. Despite a very high number of immigrants, London is the region with the least anxiety but the numbers are still high at 61 per cent.

While less than ten per cent of people want to see an end to all immigration into Britain, there is strong support for tougher laws.