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A third sector organisation might be the best organisation to deliver the service—the most cost effective, the most inclusive and the most capable of providing the best outcomes—but it will not be on a level playing field for the procurement or commissioning process for that work.
Do you feel that managers, rather than the clinicians, know best about what the budget should be and what would be in the best interests of the patient?
We are intent on solving some of the problems you have just outlined—perennial problems that have dogged this debate for a very long time and which have led to older people not getting the best care that they can get.I want to solve those problems.
All we can do is, as Harry McGuigan said, gear up to provide the best advice and try quickly to pick up and counsel people who have fallen into arrears.