Document:

Exhibit 10.31

To:          Allied Healthcare Group Limited
             as Parent for and on behalf of itself and the other Obligors
             (as defined in the Mezzanine Credit Agreement referred to below)

From:        BNP Paribas
             as Agent for and on behalf of itself and an Instructing Group
             (as defined in the Mezzanine Credit Agreement referred to below)

Date:        1st October 2003

Dear Sirs:

Mezzanine Credit Agreement dated 17 December 1999 between Allied Healthcare
Group Limited (the "Parent"), Transworld Healthcare (UK) Limited (the "Original
Borrower"), BNP Paribas as Agent, Barclays Bank PLC as Security Agent, the Banks
named therein as Banks and others (as amended and restated from time to time)
(the "Mezzanine Credit Agreement")

1.       Terms defined in the Mezzanine Credit Agreement shall have the same
         meaning in this letter and the principles of construction set out in
         the Mezzanine Credit Agreement shall have effect as if set out in this
         letter. References to Clauses in this letter shall be to clauses in the
         Mezzanine Credit Agreement.

2.       With effect from the Effective Date (as defined below):

         Clause 20.32 shall be deleted and replaced as follows:

        "20.32                     Hedging

                                   The Parent shall procure that Allied
                                   Healthcare (UK) Limited maintains the secured
                                   hedging arrangements entered into pursuant to
                                   a Hedging Agreement dated 26 March 2003
                                   between Allied Healthcare (UK) Limited and
                                   Barclays Bank PLC whereby (pound)50,000,000
                                   of the aggregate of, inter alia, the
                                   Outstandings are fixed or capped."

3.       In this letter, the "Effective Date" means the date upon which the
         Agent confirms to the Parent in writing that it has received, in form
         and substance satisfactory to the Agent, each of the following:

3.1      a certificate given by an Authorised Signatory of the Parent,
         certifying that there has been no change to the constitutional
         documents of the Parent since they were last delivered to the Agent;

3.2      a copy, certified by an Authorised Signatory of the Parent, as being
         true, complete and up-to-date, of a board resolution of the Parent
         confirming:

         3.2.1    the approval of the execution, delivery and performance of
                  this letter and the terms and conditions hereof; and

         3.2.2    that the Authorised Signatory that signed this letter was duly
                  authorised; and

3.3      a copy of this letter, duly executed by the Parent.

4.       This letter shall constitute a Finance Document.

5.       Save as expressly provided in paragraph 2 above, the provisions of the
         Finance Documents shall continue in full force and effect and the
         Parent, on behalf of itself and other Obligors, agrees that this letter
         shall not operate as a waiver of any right, power or remedy any Finance
         Party may have under the Finance Documents.

6.       This letter shall be governed by and construed in accordance with the
         laws in England and Wales.

Yours faithfully

/s/ signature illegible
--------------------------------------------
for and on behalf of
BNP Paribas
(as Agent acting with the consent and on the
instructions of an Instructing Group)

We accept and agree to the terms of this letter.

/s/ Charles Murphy                                                   17/10/03
-----------------------------------------------------                --------
for and on behalf of                                                   Date
ALLIED HEALTHCARE GROUP LIMITED
(as Parent for and on behalf of itself and the other Obligors)

                                       2Exhibit 10.32

To:          Allied Healthcare Group Limited
             as Parent for and on behalf of itself and the other Obligors
             (as defined in the Credit Agreement referred to below)

From:        Barclays Bank PLC
             as Agent for and on behalf of itself and the Banks
             (as defined in the Credit Agreement referred to below)

Date: 4th February 2004

Dear Sirs,

Credit Agreement dated 17 December 1999 between Allied Healthcare Group Limited
(the "Parent"), Allied Healthcare Holdings Limited (formerly Transworld
Healthcare (UK) Limited) (the "Original Borrower"), Barclays Bank PLC as Agent
and Security Agent, the Banks named therein as Banks and others (as amended and
restated from time to time, the "Credit Agreement").

1.       Terms deemed in the Credit Agreement shall have the same meaning in
         this Letter and the principles of construction set out in the Credit
         Agreement shall have effect as if set out in this Letter. References to
         clauses in this Letter shall be to clauses in the Credit Agreement.

2.       We refer to your letter dated on or about 18 December 2003, which
         requests the consent of the Agent to the provision of certain
         guarantees (the "Guarantees") by Allied Healthcare Group Limited and
         its subsidiaries (each a "Guarantor") to the social service departments
         of local authorities.

3.       For the purposes of Clause 23.18 (Loans and Guarantees) a Guarantee
         provided to the social services department of a local authority shall
         be deemed to be "in the ordinary course of trading" provided that:

         (a)      the Guarantee is provided in connection with the obligations
                  of a member of the Group to such local authority; and

         (b)      the Guarantee is on terms usual for the trade of such member
                  of the Group.

4.       The Parent undertakes that it shall deliver to the Agent, prior to
         entering into any Guarantees, a copy of this Letter duly executed by
         the Parent.

5.       Save as expressly provided in paragraph 3 above, the provisions of the
         Finance Documents shall continue in full force and effect and the
         Parent, on behalf of itself and the other Obligors, agrees that this
         letter shall not operate as a waiver of any right, power or remedy any
         Bank may have under the Finance Documents.

6.       On the date that the Parent duly executes this Letter, the Parent
         confirms, in relation to each Obligor, that the Repeated
         Representations shall be deemed to be repeated.

7.       The Parent shall reimburse the Agent for all legal costs and expenses
         incurred by it together with any VAT thereon incurred by it in
         connection with the negotiation, preparation and execution of this
         letter and any other document referred to or contemplated by this
         letter.

8.       This Letter is designated a Finance Document.

9.       This Letter may be executed in any number of counterparts, all of which
         taken together constitute one and the same instrument.

10.      This Letter shall be governed by and construed in accordance with
         English law.

Yours faithfully

/s/ signature illegible
-----------------------------------------
for and on behalf of
BARCLAYS BANK PLC
(as Agent)

We accept and agree to the terms of this letter.

/s/ Charles Murphy                                                     9/2/04
-----------------------------------------------------                  ------
for and on behalf of                                                    Date
ALLIED HEALTHCARE GROUP LIMITED
(as Parent for and on behalf of itself and the other Obligors)

                                       2Exhibit 10.33

To:        Allied Healthcare Group Limited
           as Parent for and on behalf of itself and the other Obligors
           (as defined in the Mezzanine Credit Agreement referred to below)

From:      BNP Paribas
           as Agent for and on behalf of itself and the Banks
           (as defined in the Mezzanine Credit Agreement referred to below)

                                                         Date: 4 February 2004

Dear Sirs,

Mezzanine Credit Agreement dated 17 December 1999 between Allied Healthcare
Group Limited (the "Parent"), Allied Healthcare Holdings Limited (formerly
Transworld Healthcare (UK) Limited) (the "Original Borrower"), BNP Paribas as
Agent, Barclays Bank PLC as Security Agent, the Banks named therein as Banks and
others (as amended and restated from time to time, the "Mezzanine Credit
Agreement").

1.       Terms defined in the Mezzanine Credit Agreement shall have the same
         meaning in this Letter and the principles of construction set out in
         the Mezzanine Credit Agreement shall have effect as if set out in this
         Letter. References to clauses in this Letter shall be to clauses in the
         Mezzanine Credit Agreement.

2.       We refer to your letter dated on or about 18 December 2003, which
         requests the consent of the Agent to the provision of certain
         guarantees (the "Guarantees") by Allied Healthcare Group Limited and
         its subsidiaries (each a "Guarantor") to the social service departments
         of local authorities.

3.       For the purposes of Clause 20.17 (Loans and Guarantees) a Guarantee
         provided to the social services department of a local authority stall
         be deemed to be "in the ordinary course of trading" provided that:

         (a)      the Guarantee is provided in connection with the obligations
                  of a member of the Group to such local authority; and

         (b)      the Guarantee is on temps usual for the trade of such member
                  of the Group.

4.       The Parent undertakes that it shall deliver to the Agent, prior to
         entering into any Guarantees, a copy of this Letter duly executed by
         the Parent.

5.       Save as expressly provided in paragraph 3 above, the provisions of the
         Finance Documents shall continue in full force and effect and the
         Parent, an behalf of itself and the other Obligors, agrees that this
         letter shall not operate as a waiver of any right, power or remedy any
         Bank may have under the Finance Documents.

6.       On the date that the Parent duly executes this Letter, the Parent
         confirms, in relation to each Obligor, that the Repeated
         Representations shall be deemed to be repeated.

7.       The Parent shall reimburse the Agent for all legal costs and expanses
         incurred by it together with any VAT thereon incurred by it in
         connection with the negotiation, preparation and execution of this
         letter and any other document referred to or contemplated by this
         letter.

8.       This Letter is designated a Finance Document.

9.       This Letter may be executed in any number of counterparts, all of which
         taken together constitute one and the same instrument.

10.      This Letter shall be governed by and construed in accordance with
         English law.

Yours faithfully

/s/ signature illegible
--------------------------------------------
for and on behalf of
BNP Paribas
(as Agent)

We accept and agree to the terms of this letter.

/s/ Charles Murphy                                                     9/02/04
-----------------------------------------------------                  -------
for and on behalf of                                                     Date
ALLIED HEALTHCARE GROUP LIMITED
(as Parent for and on behalf of itself and the other Obligors)

                                       2

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