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There is an excess of demand over supply for an ageing population requires ever more sophisticated care.
Medical advances are trumpeted in the media, public expectations are raised and the time interval between discovery and bedside application gets ever shorter.
Costs are high and increase more rapidly than inflation.
Medical care for critically ill people is not without hazard and any treatment will have side effects with significant morbidity and mortality.
Safety, risk and litigation now effect the decisions and working practice of doctors and mangers.
The health professionals make the decisions around treatment and care thus committing the hospital or practice to the cost of that treatment and care. The manager has little or no voice in this clinical decision.
Doctors often resent managers and there may be conflict which interferes with good decision making and team working.