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  I suppose it depends on our perception of need. There are many people in hospital or care beds who could be at home, where most people would prefer to be, if given the right amount of targetted support and sufficient safeguards against risk and abuse. This can also work out cheaper than maintaining hospital facilities. But clearly there is also a need for in-patient support near to home - evidence is clear that people - particularly vulnerable people - who are hospitalised near to their circle of support recover quicker and better than those seperated by distance. It is crucial for local communities to get the balance right, and in order to do that it is necessary to tap into local knowledge and expertise - that doesn't mean either allowing local people without expertise in project and healthcare management to run the show or allowing outsiders with that expertise to take over.....it means marrying the two together.

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