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I think the strongest defence against the cry of "postcode lottery" is to flip it on its head - get patients and public excited about the prospect of their area developing the best services for X or Y in the country.

Risk-taking can be addictive, and cloud judgement. There's an enormous difference between a trust getting together with patients and developing a proposal, and a few influential individuals becoming enamoured of an idea and plotting their place in history. Getting patients involved right at the beginning is vital, before time and ego has been invested in an initiative.