I certainly don't share your opinions Don; the acute care depletion (spreading the contents of one hospital about instead of improving all and preparing them for increasing populations) is causing fury. There is little improvement in social care and spending on the horizon although interesting ideas on integration which I welcome. The clinical basis as evidence that I've seen is poor, tends to be written by academics in health research in institutes or universities, or economists, rather than coming from consultants on the job. For example look at the Morris paper used locally as evidence for stroke centralisation of services. It really only shows that there was some long term benefit from actually getting treatment within 4hrs. The selling of the STPs is a repetition of presentations when in fact people ask 'why would anyone think this is a good idea?'...at a time when either the country is broke or the politicians refuse to tax more (for NHS) or spend more. At the same time we see this creeping privatisation and more staff weariness. Opinion is now hardening on what appears to be a political problem served against an unwilling public.