We must all be aware that there are certain practices in our health service which are neither user-friendly or administratively acceptable. We also know that it will be very difficult to change those practices. We will be up against the habits of a lifetime, the perception of rights built up throughout a career and the possibility of interfering with fee structures or earnings which are both out of date and inappropriate to the climate and system in which we now operate. In short, we must eliminate bad practice and vested interests, maximise the resources available and examine every euro being spent to extract full value from it.