Saturday, 7 September 2013

Foreign doctors ‘to face language tests before they can work in hospitals’ after complaints about poor care

Powers: The government is seeking for a change to EU law to allow the GMC to test language skills of doctors
New powers to test doctors' language skills could be introduced after a survey showed that patients' lives were being put at risk.

An alarming 66 cases were investigated by senior NHS staff in 2011after patients complained that they had received poor treatment from doctors who had a poor grasp of the English language.
In an attempt to tackle the problem, the Government has proposed introducing language tests specifically for doctors arriving from EU countries in what would amount to a change to EU law.
Powers: The Government is seeking for a change to EU law to allow the GMC to test language skills of doctors

Although the General Medical Council can test the English of doctors from non EU countries, it has been banned from testing the skills of those arriving from member states since 1983.
More than 25,000 doctors from the EU are registered to practice in the UK, none of whom have ever been tested for their English skills.
Health minister Dr Dan Poulter said: 'Overseas doctors make a hugely valuable contribution to the NHS but it is clear that tougher checks are needed.
'We have already strengthened the way doctors' language skills are checked at a local level.
Important step: Health minister Dan Poulter said the change would prevent doctors with limited English from practicing in the UK
Important step: Health minister Dan Poulter said the change would prevent doctors with limited English from practicing in the UK

'These new powers are an important step in making the system even stronger by allowing the GMC to carry out checks on a national level before they start work in the UK and prevent doctors who do not have the necessary knowledge of English from treating patients.'

Roughly half of the 500 senior doctors responsible for investigating complaints took part in a poll, which revealed the scale of the language problem.
In 2008 German Dr Daniel Urbani killed Cambridge patient David Gray when he confused two drugs and gave him 10 times the recommended dose of diamorphine.
Under the Government's plans, the GMC would not be given the right to automatically test all EU doctors, but it would be able to carry out tests if concerns were raised when they registered to work.
Inspectors could be given the right to check competency when looking at qualifications, how long doctors have been registered in other countries and what experience they have.
Red flags might include doctors turning up with interpreters, poor English in interviews or poor written English on application forms.
Any worries could then prompt full testing of the doctor's language skills.
The new plans would also allow the GMC to assess any doctor if language concerns arise during a fitness-to-practise investigation.
At present, the GMC has no powers to carry out such checks during its hearings.
Lethal dose: Dr Daniel Urbani killed a patient after confusing drugs
Lethal dose: Dr Daniel Urbani killed a patient after confusing two different drugs
Chief executive of the GMC Niall Dickson said: 'We are delighted that the Government is consulting on changes to the Medical Act to give us new powers to check the English language skills of all doctors when we have concerns about them.

'This is an important move that will help protect patients and will be welcomed across the country.'
A spokesman for the British Medical Association (BMA) said: 'It is vital for clinical safety that doctors working in the UK have the appropriate English language skills to communicate effectively with colleagues and their patients.
'The BMA believes that it is right that we consider enhancing the GMC's powers to ensure doctors working in the UK can speak English well enough before they treat patients.'
At a local level, staff called responsible officers - appointed senior doctors - already have a legal duty to make sure doctors can speak English to perform their role.
Since April, there has also been one, single national list which every GP has to be on before they can treat NHS patients.
The new changes are expected to come into force next year. A 12-week consultation on the proposals will run until December 2
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Exclusive! Sturridge OUT of England clash with Ukraine leaving Hodgson short on strikers

Blow: Daniel Sturridge has been ruled out of England's qualifier against Ukraine
Daniel Sturridge has been ruled out of England's World Cup qualifier with Ukraine in Kiev on Tuesday.

Sturridge missed Friday night's win over Moldova at Wembley after aggravating a groin injury in Liverpool's triumph over Manchester United last weekend.
It had been hoped the striker would have recovered sufficiently for him to report back for duty this evening.
Blow: Daniel Sturridge has been ruled out of England's qualifier against Ukraine

However, the Football Association has confirmed that will not happen.
'The FA can confirm that Daniel Sturridge will not return to the England squad ahead of the World Cup qualifier with Ukraine on Tuesday," said the FA in a statement.
'Club England medical staff have been in constant contact with their counterparts at Liverpool football club since he returned there on Thursday, his injury has not progressed as had been hoped and it is now clear that Sturridge will not be fit for the match in Kiev on Tuesday evening.'
Out: Sturridge was taken off on a stretcher against Manchester United last weekend
Out: Sturridge was taken off on a stretcher against Manchester United last weekend
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Exclusive! Who's pulling the purse strings at your club? The club-by-club to those really in charge in the Premier League

Ed WoodwardMarouane Fellaini with David Moyes 

 After Manchester United's farcical transfer window, which saw the Old Trafford side reportedly bid for no less than nine midfield players - and recruit just one - Marouane Fellaini - Damien Comolli has led calls for United to appoint a director of football to ease the pressure on manager David Moyes and executive vice-chairman Ed Woodward.


Comolli told BBC Radio 5 Live: ‘If there was a club in need of a director of football to ease the process for both individuals it was Manchester United. David [Moyes] only joined on 1 July which was quite late.
'The issue for Manchester United is that the two most important people at the club in Sir Alex Ferguson and David Gill left their positions and new people came in for their first transfer window.
Sole signing: Ed Woodward (right) oversaw a summer with Marouane Fellaini Manchester United's only arrival

‘For some reason the club weren’t prepared or they didn’t think it would be that difficult and they ended up in a difficult situation.’
The director of football model has long been popular on the continent, but English football has remained suspicious, anxious that it can compromise the power and responsibility of the manager.
But increasingly, Premier League clubs are beginning to buy into the two-tiered structure, and the model is implemented in some fashion by at least 10 top-flight clubs.
Indeed, the most coherent approaches to the transfer market this summer appear to have come from the likes of Tottenham and Manchester City, with a perfectly balanced and harmonious relationship between a Director of Football, the manager and the money-men.
Busy summer: Daniel Levy has presided over a huge amount of business at Spurs during this window
Busy summer: Daniel Levy has presided over a huge amount of business at Spurs during this window

Then again, don't Newcastle have one of these Director's of Football? Similarly, Everton have no middle man - just a formidable relationship between Chairman Bill Kenwright and manager Roberto Martinez.
So is one way of working really better than the other?
Sportsmail discovers the inside track on how Premier League clubs have managed their dealings this summer, and we reveal who truly holds the purse strings at your club...
 

ARSENAL

Key Individuals: Arsene Wenger, Richard Law, Ivan Gazidis.
Summer Spend: £42.5million.
Who's the boss? Arsene Wenger retains his all-encompassing power at the Emirates. The rhetoric from the board and Chief Executive Ivan Gazidis this summer has been that Arsenal are ready to escalate their spending. That probably didn't help matters at the negotiating table.  
American Dick Law is Arsenal's chief negotiator and helps to facilitate transfers. The trilingual Law - who also speaks Spanish and Portuguese - deals with agents and takes some responsibility for arranging contracts. However, it is understood that Law is hugely reliant on Wenger - he checks every last detail with the manager and has even be known to break off from meetings to clarify certain things with the Frenchman.
Power brokers: Arsene Wenger remains the top dog at Arsenal but Ivan Gazidis (left) and Dick Law are also heavily involved in the negotiation process
Power brokers: Arsene Wenger remains the top dog at Arsenal but Ivan Gazidis (left) and Dick Law are also heavily involved in the negotiation process

Superstar signing: Mesut Ozil joined Arsenal from Real Madrid for £42.5m
Superstar signing: Mesut Ozil joined Arsenal from Real Madrid for £42.5m

Law was on site at Arsenal's London Colney training ground for the final week of the transfer window, which saw Arsenal rubber-stamp the signings of Mathieu Flamini, Mesut Ozil and Emiliano Viviano.
Arsenal supporters will be delighted with the acquisition of Ozil and will be relieved that the club finally spent big on a marquee signing after years of penny-pinching and selling off their finest talents. Yet there will also be some who remain mystified - Ozil, for all his undoubted quality, is a luxury signing for Arsenal.
Of greater immediate importance was the requirement for a world-class striker, another winger and an uncompromising centre-half. The Gunners came close to signing Demba Ba on deadline day, but it should never have been left so late. The first XI is exceptionally strong, we are all enthused by the arrival of the wonderful Ozil but is there the strength in depth to challenge for the Premier League title?

ASTON VILLA

Key individuals: Owner Randy Lerner calls the shots. Chief executive Paul Faulkner makes sure they hit their targets.
Summer spend: £21m.
Who's the boss: Lerner and manager Paul Lambert. The Scot's brutal alienation of several high-earning stars - such as Darren Bent and Shay Given - would not have been possible without his paymaster's backing.
Shot caller: American businessman Randy Lerner has backed Paul Lambert's overhaul of the Villa squad
Shot caller: American businessman Randy Lerner has backed Paul Lambert's overhaul of the Villa squad

Twelve months ago, Villa bought young, mobile English players. During this close-season, the club shifted its' focus to the continent.
However, possibly the biggest coup was re-signing striker Christian Benteke on a four-year deal.
The Belgium striker bagged 19 goals in his first season last time around and was the key to Villa's continued participation in the Premier League.
Secured: Aston Villa's best deal of the summer was to sign Christian Benteke to a new contract
Secured: Aston Villa's best deal of the summer was to sign Christian Benteke to a new contract

CARDIFF CITY

Key individuals: Vincent Tan, Malky Mackay, Iain Moody.
Summer spend: £34m.
Who is the boss? Mackay is old school and likes full control off the football operation. Head of recruitment Iain Moody is his main sounding board, though owner Vincent Tan is far from a silent presence at the club.
A good summer, in which they achieved the spine they needed with record purchaes for Andreas Cornelius, Steven Caulker and Gary Medel. Tan has stated he now expects results.
Old school: Malky Mackay likes to take full control of his signings
Old school: Malky Mackay likes to take full control of his signings

Backing: Owner Vincent Tan broke Cardiff City's record transfer three times this summer
Backing: Owner Vincent Tan broke Cardiff City's record transfer three times this summer

CHELSEA

Key individuals: Jose Mourinho, Michael Emenalo, Roman Abramovich.
Summer spend: £65.5million.
Who's the boss? Nine managers in nine years leave little doubt as to who rules the roost. Mourinho may strut about with an arrogance but Abramovich is THE boss at Stamford Bridge.
Ruling the roost: Nine managers in nine years shows who's boss at Stamford Bridge
Ruling the roost: Nine managers in nine years shows who's boss at Stamford Bridge

Director of Football Michael Emenalo offered to resign to help facilitate Mourinho's return to Chelsea but Abramovich was keen for the Nigerian to remain.
Andre Schurrle had been on Chelsea's radar for over two years - suggesting he was a recruit chosen by Emenalo. Similarly, Marco van Ginkel met with Emenalo at Chelsea's Cobham training base towards the end of May. Then again, Samuel Eto'o was very much a Jose choice, after the forward previously flourished under Mourinho at Inter.
Back at the Bridge: But Jose Mourinho is very much his own man when it comes to transfers
Back at the Bridge: But Jose Mourinho is very much his own man when it comes to transfers

And let's not forget that Abramovich doesn't mind getting involved every so often - Andriy Shevchenko, anyone? But so far, the second coming has led the Special One to develop a Special Relationship with his superiors and all is well in the land of Mourinho. He could have done with a an established, world-class striker, mind. Chelsea's title chances may well rest with the form of Eto'o - unless Mourinho has a cunning plan to resuscitate Fernando Torres.

CRYSTAL PALACE

Key individuals: Jeremy Hosking, Martin Long, Steve Parish, Stephen Browett, Ian Holloway
Summer Spend: £18million
Who's the boss? There's four of them - and none of them are named Ian Holloway. Parish, Long, Browett and Hosking all own a 25% stake in CPFC 2010, which owns the club after negotiating a takeover in 2010 following the club falling into administration.
In the shade: Steve parish is one of four co-owners of CPFC 2010 - the company that owns Palace
In the shade: Steve parish is one of four co-owners of CPFC 2010 - the company that owns Palace

Parish and Browett have been the most vocal in the media with Parish recently expressing his frustration in the transfer window, which saw the club spend reasonable fees on Dwight Gayle and Adlene Guedioura.
Holloway, meanwhile, has already heard questions circling over his future at Selhurst Park, and the charasmatic boss must keep a side light on Premier League quality battling above water if those rumours are not to become more concrete.
Celebration: But Ian Holloway will ahve to keep Palace's heads above water if he is to stay at Selhurst Park
Celebration: But Ian Holloway will ahve to keep Palace's heads above water if he is to stay at Selhurst Park

EVERTON

Key Individuals: Bill Kenwright, Roberto Martinez.
Summer Spend: £21million.
Who's the boss? Wonderfully old-fashioned, it is all about the relationship between chairman Bill Kenwright and the manager Roberto Martinez at Everton. Kenwright, who adores the Merseyside club, has the final say on financial matters while the manager identifies his targets. Easy-peasy.
Old-fashioned: Roberto Martinez and Bill Kenwright still use an old style of identifying and adding players
Old-fashioned: Roberto Martinez and Bill Kenwright still use an old style of identifying and adding players


The simplest possible approach led Everton to enjoy an excellent window, losing Marouane Fellaini to Manchester United but replacing the Belgian with the highly-talented James McCarthy for half the price at £13million. Everton were sharp movers on deadline day, and brought in the powerful Romelu Lukaku and the experienced Gareth Barry on loan. Gerard Delofeu also seems a shrewd loan move by Martinez.
Is it mere coincidence that Everton had their best summer for a long time without Moyes, while United suffered their worst in recent memory with the Glaswegian? Probably, but Bill Kenwright will be delighted with his club's signings - and they kept Leighton Baines.
Replacements: James McCarthy and Gareth Barry have been brought in to replace Marouane Fellaini
Replacements: James McCarthy and Gareth Barry have been brought in to replace Marouane Fellaini

FULHAM

Key individuals: Chief executive Alistair Mackintosh and new owner Shahid Khan.
Summer spend: £9million.
Who’s the boss? In the past there has been tension between manager Martin Jol's desire to spend big and Fulham's natural propensity for caution - if not always in terms of transfer fees (£11.5million for Bryan Ruiz, anyone?), then certainly with regard to wages.
New boss: Shahid Khan's reign at Fulham should signal an increase in spending in both fees and wages
New boss: Shahid Khan's reign at Fulham should signal an increase in spending in both fees and wages

Mohamed Al Fayed's decision to sell up after 16 years earlier this summer suggested a raft of changes at Craven Cottage, but their transfer policy has stayed pretty constant, with prudent permanent deals for the likes of Sascha Riether, Maarten Stekelenburg, Scott Parker and Elsad Zverotic and the capture of free agents and loan signings, including Adel Taarabt and Darren Bent.
Parker and Bent are exceptions to the rule, however: Fulham rarely buy English players, preferring to use Jol's contacts in Europe to bring in foreign players whose wages match their own payment structure. The club's highly-acclaimed Under-21 squad and Academy are also dominated by players from abroad.
This, though, finally feels like Jol's team with a raft of exciting, if temperamental, flair players, after a summer that has seen stalwarts of the Roy Hodgson era such as Chris Baird, Simon Davies and, most importantly, Mark Schwarzer released or leave on free transfers.
New boys: Darren Bent and Adel Taraabt have joined Fulham while stalwarts such as Chris Baird, Simon Davies and Mark Schwarzer have left
New boys: Darren Bent and Adel Taraabt have joined Fulham while stalwarts such as Chris Baird, Simon Davies and Mark Schwarzer have left

HULL CITY

Key Individuals: Ehab Allam, Assem Allam, Nick Thompson, Steve Bruce.
Summer Spend: £14.5million.
Who's the boss? The club's rebranded name aside, Hull fans can't have too much to complain about. Ehab Allam, the club's owner (and chairman) and his son Assem (the vice-chairman) have backed Steve Bruce in the transfer market, with MD Nick Thompson assisting with the negotiations.
Backing: Hull City owner Assem Allam has given Steve Bruce money to spend
Backing: Hull City owner Assem Allam has given Steve Bruce money to spend


There seems to have been little intrusion into Bruce's transfer policy, with British players generally the order of the day. It may not be the easiest thing to convince foreigners to live in Hull.
Though then again, the Egyptians seem to like it....anyway, the signings of Allan McGregor, Curtis Davies, Tom Huddlestone, Jake Livermore and George Boyd appear to be smart business. British talent - with a point to prove. Strong showings in the Premier League - even in away defeats to Chelsea and Manchester City - suggest that Hull may be here to stay.
Little intrusion: Steve Bruce has been allowed to get on with signing who he wants, and Hull have been rewarded with strong performances in their opening matches
Little intrusion: Steve Bruce has been allowed to get on with signing who he wants, and Hull have been rewarded with strong performances in their opening matches

LIVERPOOL

Key Individuals: Brendan Rodgers, Dave Fallows, Barry Hunter, Michael Edwards, Ian Ayre.
Summer Spend: £48.3million.
Who's the boss? After an ill-fated splurge on the hottest English properties under Director of Football Damien Comolli and former manager Kenny Dalglish - think £35million for Andy Carroll, £20million for Stewart Downing et al - Liverpool have changed tact, instead opting for a transfer committee.
New look: Brendad Rodgers' new look Liverpool team have started the season with three wins from three
New look: Brendad Rodgers' new look Liverpool team have started the season with three wins from three

Dave Fallows has joined as the club's head of recruitment while Barry Hunter stepped into the position of chief scout from Manchester City, while Michael Edwards is head of analysis. Along with Brendan Rodgers, who is keen to steer away from the Director of Football model, this group monitor and weight up targets for the club's Fenway owners. Ian Ayre, the club's MD, is also involved.
It is a traditional set-up, with scouts and the manger taking the lead, but combined with global statistical analysis. It is a collective effort that has paid off this summer.
Eight players have been signed and they will all contribute to the first-team squad. Mamadou Sakho, Tiago Ilori and Kolo Toure add genuine competition to the centre of the defence and should tackle the problem of replacing Jame Carragher, with Daniel Agger and Martin Skrtel also remaining at Anfield, while Simon Mignolet has kept three clean sheets in his opening three Premier League games in goal. Victor Moses offers Liverpool a directness and pace from the wing that has sometimes been missing while recruits from the Spanish league - Luis Alberto and Iago Aspas may take time to settle but offer Liverpool further strength in depth.
With Daniel Sturridge sparkling, Luis Suarez soon to return and Liverpool free of any Europa League commitments, Brendan Rodgers will privately feel that has a squad capable of breaking back into the top four - at the very least.
Revamp: Ian Ayre has been behind the signing of eight new players
Revamp: Ian Ayre has been behind the signing of eight new players

MANCHESTER CITY

Key Individuals: Manuel Pellegrini, Txiki Begiristain, Ferran Soriano.
Summer Spend: £95million.
Who's the boss? Sporting director Txiki Begiristain is the man responsible for player recruitment and has the absolute trust of Chief Executive Ferran Soriano and the club's Abu-Dhabi based owners. He has overhauled the club's scouting system and personally put together a list of targets - graded from letter A to D - for every position in the team at the start of the summer. Roberto Mancini was keen to recruit category A players (world-class, game-changing players like Edinson Cavani, per say) but Manuel Pellegrini has pursued category B players (the best available to City this summer, like Alvaro Negredo and Jesus Navas).
Responsible: Txiki Begiristain is the mastermind behind nearly £100m worth of spending at the Etihad
Responsible: Txiki Begiristain is the mastermind behind nearly £100m worth of spending at the Etihad

The new Chilean boss will unquestionably have had a major say in the players signed - centre-back Martin Demichelis played under Pellegrini twice before at Malaga and River Plate - but the summer business has been conducted under the watchful eye of Begiristain.
It is Soriano and Begiristain - who have previously worked together at Barcelona - that are directing the club's long term policy, favouring the oft-quoted 'holisitic' approach that will aim to finally produce a City team with at least half the players homegrown. This is the classic continental format with a sporting director in it for the long haul - but managers can often come and go.
City will be pleased with their summer business - they have eliminated the melodrama of Carlos Tevez and Mario Balotelli - and Carrington is an increasingly crisis-free arena these days. They have also bought wisely.
Jesus Navas offers something City had been lacking - genuine pace and width - while Alvaro Negredo and Stevan Jovetic are exciting recruits up front. Nonetheless, Fernandinho will have to prove that he is worthy of his £30million price tag while it is also a little bit surprising that City left it so late in the window to sign a defender. Demichelis is 32 and has already been ruled out for six weeks. A younger centre-half at the peak of his powers is what City really needed to partner Vincent Kompany.
Big fee: Fernandinho was signed for £30m and will have to prove his worth
Big fee: Fernandinho was signed for £30m and will have to prove his worth

MANCHESTER UNITED

Key Individuals: David Moyes, Ed Woodward, the Glazer family.
Summer Spend: £30million.
Who's the boss? Both David Moyes and executive vice-chairman Ed Woodward have insisted all summer long that there is no limit to United's spending power and that the club will always be interested in the best players. Unfortunately, it didn't work out too well, with Marouane Fellaini the only significant addition. United tried - and failed - to recruit Thiago Alcantara, Cesc Fabregas, Luka Modric, Daniele De Rossi, Leighton Baines, Sami Khedira, Ander Herrera and Wesley Sneijder this summer.
Missing out: Manchester United have failed in their bid to land a number of top targets, including Cesc Fabregas and Thiago Alcantara (below)
Missing out: Manchester United have failed in their bid to land a number of top targets, including Cesc Fabregas and Thiago Alcantara (below)

United had planned that the Moyes/Woodward relationship would mirror that of David Gill and Sir Alex Ferguson. Ferguson and his scouting team would identify targets and Gill would go out and sign them. Simples. But the new duo have suffered serious teething problems, with the club unable to secure any major business early on in the window, before the approach became increasingly scattergun as deadline day loomed.
Damien Comolli reckons United should appoint a Director of Football and it would probably be in the club's interests. But don't bank on it happening any time soon. United view themselves as the last of the traditional clubs, where the manager manages and they are trying to afford David Moyes the same level of control enjoyed by Sir Alex Ferguson. Woodward was out of his depth this summer but David Gill was not without his flaws, too. He must do better in January but he deserves that second chance.
And what of the Glazer family? United are to announce record-breaking revenue in the coming weeks, they continue to unveil multi-million pound sponsorship deals and they have the extra cash from a television deal worth billions. So why couldn't they compete for Gareth Bale? Why wouldn't they meet Everton's asking price of £18-20million for Leighton Baines? Moyes, like Ferguson before him, maintains that the Glazers place no restrictions on United's budget. It is becoming an increasingly suspect soundbite.
Thiago Alcantara

NEWCASTLE UNITED

Key individuals: Alan Pardew, Joe Kinnear, Mike Ashley, Graham Carr.
Summer Spend: £250,000.
Who's the boss? Who knows? Pardew is the manager but he has been severely hamstrung by the incompetence of Director of Football Joe Kinnear this summer. Maybe Kinnear just went for all the wrong players in this window. As in, he just got their names wrong. Sorry, cheap shot. But what a mess.
Frustrated: Alan Pardew and the Newcastle fans have been left annoyed by the lack of players brought in to St James' Park
Frustrated: Alan Pardew and the Newcastle fans have been left annoyed by the lack of players brought in to St James' Park

Kinnear arrived in July, promised the world and delivered nothing. The only addition - Loic Remy on loan - was a target for Newcastle and their superbly informed scout Graham Carr long before Kinnear.
The Director of Football model can be hugely successful - but the candidate has to be credible. It can't just be an owner offering a job to his best pal over a Sunday lunch in a London pub.
Kinnear claimed he can pick up the phone to any manager in the world. He might be telling the truth. That's all well and good - but it's not the way that the transfer market operates anymore. You need to be more streetwise, in line with the agents and cutting deals with the intermediaries.
It should be pointed out that Newcastle deserve some credit for retaining their best players - Tim Krul, Fabriccio Coloccini, Cheik Tiote, Yohan Cabaye, Hatem Ben Arfa and Papiss Cisse is a damned good spine and Newcastle should improve without the extra burden of Europa League football.
Solitary: Joe Kinnear's only piece of business for the first team was the loan signing of Loic Remy
Solitary: Joe Kinnear's only piece of business for the first team was the loan signing of Loic Remy

But the atmosphere is toxic on Tyneside. Pardew is walking on eggshells, refusing to publicly criticise Kinnear even if he must feel privately humiliated. Carr is understood to have come closing to walking out on the club after Kinnear blocked a move for central defender Douglas earlier in the summer. the scout had been working on the deal for over a year.
And then there is that inescapable fear that Kinnear is Newcastle's manager in waiting.

NORWICH CITY

Key Individuals: Chris Hughton, Ewan Chester, David McNally, Delia Smith, Michael Wynn-Jones.
Summer Spend: £25million.
Who's the boss? Ewan Chester, previously the club's Chief Scout for one year between 2010 and 2011 has joined Norwich for a second time, in the role of Director of Football Recruitment. He enjoys a healthy relationship with gaffer Chris Hughton, with the pair having also worked together at Birmingham City.
Strengthened: Norwich have spent a large sum of money to try and propel themselves up the Premier League table
Strengthened: Norwich have spent a large sum of money to try and propel themselves up the Premier League table

David McNally heads up the Norwich board as Chief Executive he has the unequivocal trust of owner Delia Smith and her hubby Michael Wynn-Jones.
The Canaries have been bold this summer, breaking the club's transfer record for Ricky van Wolsfwinkel and also seeing off strong competition to sign Gary Hooper, Leroy Fer and Martin Olsson. Impressive business from Norwich, who should hope to avoid a relegation struggle with their new and improved squad.
New boy: Ricky van Wolfswinkel was signed for £8.5m and scored a goal on his debut
New boy: Ricky van Wolfswinkel was signed for £8.5m and scored a goal on his debut

SOUTHAMPTON

Key Individuals: Nicola Cortese, Mauricio Pochettino, Liebherr Trust.
Summer Spend: £35.5million.
Who's the boss? The new television deal, allayed with the club's improved financial position, has allowed Southampton to spend in excess of £35million on just three players. Pochettino has added Champions League and international experience to his squad, with Dejan Lovren arriving from Lyon, Vincent Wanyama from Celtic and Daniel Osvaldo from Roma.
Nicola Cortese
Mauricio Pochettino
Big money: Nicola Cortese has allowed Mauricio Pochettino to spend £35m on just three players

Alongside a raft of homegrown (and recruited) young English players - Nathaniel Clyne, Jay Rodriguez, Luke Shaw, Adam Lallana and Callum Chambers are particularly gifted - the added quality should provide a promising balance for the Saints. Cortese is the Chairman and the boss, a ruthless operator who was left in sole charge at the club following the sudden death of Markus Liebherr.
The players and manager have complete respect for the Italian. But despite the bravado, do not be fooled that into thinking that Cortese holds all the aces at Southampton. The club is now in the hands of the Liebherr Trust, run by Katharina Liebherr, and she has - so far - allowed Cortese to continue with a high budget.
That may not last forever. Indeed, towards the end of last season, Cortese threatened to walk because Mrs. Liebherr did not share his desire to spend mega-bucks this summer. The manager and players said they would walk if Cortese walked  We are not quite sure where they were all planning on walking too, but walking they were. The fans, of course, desperate to see money spent, backed Cortese. So Liebherr backed down - for now. Watch this space.
Record breaker: Pablo Osvaldo was bought for £15m
Record breaker: Pablo Osvaldo was bought for £15m

STOKE CITY

Key Individuals: Mark Hughes, Mark Cartright, Peter Coates, Tony Scholes.
Summer Spend: £7million.
Who's the boss? Peter Coates is the club's owner. Also the man behind Bet365, he would appear to be 'rolling in it' but the owners has been surprisingly frugal in Mark Hughes' first summer in charge.
Frugal: Pete Coates hasn't given new manager Mark Hughes as much financial backing as may have been expected
Frugal: Pete Coates hasn't given new manager Mark Hughes as much financial backing as may have been expected


Was it a simple decision to tighten the belt after allowing Tony Pulis to spend big in recent seasons? Were the club wary of allowing Sparky access to a deep pot of cash after his QPR disaster? Possibly.
Transfer targets were identified by Hughes and the club's technical director Mark Cartwright, who was talent-spotting at the UEFA under-21 Championships earlier this summer. Both Erik Pieters - a £3.1million signing from PSV - and Marc Muniesa - a free signing from Barcelona - were brought in on the advice of Cartwright and his extensive scouting network.
The aim now is increasingly younger players, after the club became concerned by Tony Pulis signed too many ageing Premier League players with little to no resale value. It is Chief Executive Peter Coates who looks to pull off the deals.
New target: Hughes is expected to look to younger players after Tony Pulis signed older players with little to no resale value
New target: Hughes is expected to look to younger players after Tony Pulis signed older players with little to no resale value

SUNDERLAND

Key Individuals: Paulo Di Canio, Roberto Di Fanti, Valentino Angeloni, Margaret Byrne, Ellis Short.
Summer Spend: £19.1million.
Who's the boss? Sunderland have scoured the Italian market this summer, with manager Paulo Di Canio being joined this by compatriots Roberto Di Fanti - in the role of Director of Football - and Valentino Angeloni - in the position of chief scout. Although the latter pair only parked up at the Stadium of Light in June, their impact appears to have been immediate, with a remarkable fourteen signings having been made.
Paolo Di Canio
Ellis Short
Remarkable: Paolo DI Canio and Sunderland owner Ellis Short have brought 14 players to Wearside

Four Italians have been signed - Vito Mannone, Emanuele Giaccherini, Fabio Borini and Andrea Dossena - while Modibo Diakite was purchased from Lazio. It will take the signings - thirteen of them from overseas - considerable time to settle. And time is one thing Sunderland do not have, with just one point from the club's opening three Premier League games.
Sunderland have gone for bulk over quality, with a low-budget approach and a nominal net spend of after selling Stephane Sessengon, Simon Mignolet, James McClean and Ahmed Elmohamady for a total of £19million. Ellis Short is the club's owner and has evidently decided to tighten the pursestrings after splurges under Steve Bruce and Martin O'Neil.
Margaret Byrne is the chief executive and has revealed that Di Fanti and Angeloni, who previously worked together at Inter Milan and Udinese, are on Wearside for the long haul and are assessing global targets for seasons to come.
But if there is one thing Paolo Di Canio is unlikely to bring, it is stability. There is a fear that his tantrums (and bad results) could see him gone sooner rather than later. And will a new manager want the Italian system in place?
Taking time: Emanuele Giaccherini and his new team-mates will take time to gel
Taking time: Emanuele Giaccherini and his new team-mates will take time to gel

SWANSEA CITY

Key Individuals: Huw Jenkins, Michael Laudrup, David Leadbeater, Tim Henderson, Erik Larsen.
Summer Spend: £21million.
Who's the boss? Tension was brewing at the Liberty earlier this summer. The talk was that manager Michael Laudrup was ready to resign, after the Swansea board failed to back the Dane in his pursuit of forwards Iago Aspas and Pierre-Emerick Aubameyang.
Tension: It was reported that Swansea manager Michael Laudrup was ready to resign amid differences over transfer targets
Tension: It was reported that Swansea manager Michael Laudrup was ready to resign amid differences over transfer targets

Instead, it was suggested to Laudrup that he sign British-based players, such as Kenwynne Jones or Marvin Emnes. You can understand the frustration.
The issues stemmed from a complicated set-up at the Liberty, under which British-based players are monitored by the club's network (with David Leadbeater as Head of Recruitment and Tim Henderson as Technical Recruitment Scout), while the continent's finest talent is assessed by Laudrup's own team, headed up by Erik Larsen. Huw Jenkins is the Chairman, and was understood to be favouring the British approach at the start of the summer. The evidence suggests he has since relented, with Laudrup remaining at the club and eight of Swansea's ten recruits being signed from abroad.
Relented: Huw Jenkins eventually came round to Laudrup's way of thinking, and 10 new players were signed
Relented: Huw Jenkins eventually came round to Laudrup's way of thinking, and 10 new players were signed

TOTTENHAM HOTSPUR

Key individuals: Andre Villas-Boas, Franco Baldini and Daniel Levy.
Summer spend: £107million.
Who’s the boss? The drawn-out summer saga surrounding Gareth Bale’s record £86million transfer to Real Madrid was softened by the arrival of no less than seven new players. The continental structure, with Franco Baldini taking up the position of Director of Football, appears to be working after previous experiments with Frank Arnesen and Damien Comolli.
The transfer policy has clearly been well co-ordinated, with Baldini using an unrivalled contact book to attract seven players of seven different nationalities to Spurs. Is it not a little bit of a shame, though, that four midfield players were signed while bright young talent Tom Carroll - who was training with the England senior team earlier this week - is forced to play Championship football with QPR?
Busiest ever: Tottenham Hotpsur were the summers biggest spenders, totalling £107m, but recouped most of that with the sale of Gareth Bale
Busiest ever: Tottenham Hotpsur were the summers biggest spenders, totalling £107m, but recouped most of that with the sale of Gareth Bale

There has clearly been a huge amount of faith placed in the relationship between chairman Daniel Levy, manager Andre Villas-Boas and Baldini, with money-man Levy spending the entirety of the Bale transfer fee - with interest. Spurs fans are generally pleased with their acquisitions - Roberto Soldado appears a sharp-shooter up front, while there is excitement surrounding the signings of creative midfield players Christian Eriksen and Erik Lamela.
There are, however, some grounds for caution. Spurs have secured six points from their opening three games but the two victories were 1-0 wins courtesy of penalty-kicks. AVB's side are yet to score in the Premier League from open play and were particularly toothless against Arsenal. Lamela and Eriksen are yet to start a game but they will need to settle quickly.
The general consensus is that Spurs have done good business, but their wage bill will have grown exponentially this summer - the longevity of the Levy-Baldini-AVB relationship may depend on whether the club secure qualification for next season's Champions League.
Saga: Gareth Bale was finally sold for a world record fee to Real Madrid
Saga: Gareth Bale was finally sold for a world record fee to Real Madrid

Good business: As well as Daniel Levy, Franco Baldini has been behind Spurs' excellent dealings
Good business: As well as Daniel Levy, Franco Baldini has been behind Spurs' excellent dealings

WEST BROMWICH ALBION

Key individuals: Steve Clarke, Jeremy Peace, Richard Garlick.
Summer Spend: £12million.
Who's the boss? Chairman Jeremy Peace is widely acclaimed as one of the shrewdest operators in top-flight, ensuring that Albion remain in the black and the Baggies seem to have finally established themselves as a Premier League side.
Jeremy Peace
Steve Clarke
Shrewd: Jeremy Peace is acclaimed as one of the best operators in the division, but West Brom have started the season poorly, and are bottom of the league after three games

But bottom of the league after three games, manager Steve Clarke went public with his concerns, warning Peace and Garlick that additions were required following the 2-0 defeat at home to Swansea.
The pair answered their manager's calls, bringing in Stephane Sessegnon and Victor Anichebe on deadline day, but they were unable to force through another loan for Romelu Lukaku, who instead headed to Everton. Clarke may have been allowed some extra leeway after an encouraging first season in charge.
The Clarke/Garlick partnership does not seem to be as efficient as the one enjoyed by Roy Hodgson and Dan Ashworth previously at the Hawthorns.
Late deal: Stephane Sessegnon was brought in from Sunderland on deadline day
Late deal: Stephane Sessegnon was brought in from Sunderland on deadline day

WEST HAM UNITED

Key individuals: David Sullivan, David Gold and Karen Brady.
Summer spend: £21.5m.
Who’s the boss? The club's transfer record was broken for the second season in a row with the £15.5m purchase of Andy Carroll while Stewart Downing arrived for £6m. Razvan Rat and Adrian came in for free and youth player Danny Whitehead cost a minimal fee.
Experienced trio: David Gold, David Sullivan and Karen Brady over see transfers at an ever-improving West Ham
Experienced trio: David Gold, David Sullivan and Karen Brady over see transfers at an ever-improving West Ham

Co-chairman Sullivan has the biggest say on expenditure, having become the majority stakeholder by acquiring an additional 25 per cent of shares this summer to take his total past the 50 per cent mark. Gold, also co-chairman, had previously owned an equal amount of the club.
Sullivan, who has good knowledge of the South American market, is hands on and works closely with Sam Allardyce on transfers. He has publicly spoken of the limits to West Ham's spending power by citing the club's annual £52m wage cap, which was all but used up with the signing of Downing.
That led to a deadline day scramble for the required extra striker ending without success. Carlton Cole's proposed return failed over fitness issues but other free agents are being looked at.
Vice-chariman Brady also works proactively on players' contracts.

Coup: West Ham secured the services of Andy Carroll after a successful season-long loan last year
Coup: West Ham secured the services of Andy Carroll after a successful season-long loan last year
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