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    A few observations

    1. clearly the issue facing the NHS (per the above table) is poor outcomes - so the focus must be on improving this without changing other things

    2. Throwing money at the problem generally does not work to improve things

    3. Listening to and tailoring services to fit the needs of the local community is important in improving outcomes as this gives a sense of ownership and involvement. There is plenty of evidence that this has a positive impact on outcomes.

    4. Perhaps we should consider an even greater community involvement through moving non core services to social enterprises who are based in local communities, employing locals to deliver services to locals and driven by service needs not profits. (This could/should also includes such things as residential care and some social service provision).

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