Explores the issues of health gain and the importance of rigorous assessment of existing services in terms of true health gain before instituting change. Notes that much health gain has already been achieved and that this must be recognized before overzealous and enthusiastic action is instituted to create untested change. Health gain has not arison de novo from the latest reforms but may be being used as a means of justifying rationing. The key problem is that what is technically possible exceeds what is economically affordable. The only way of tackling the enormity of the existing problem is to address the agenda in a co‐ordinated fashion and to avoid prejudicing positive change through a process of rigorous assessment.
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