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Community services have experienced decades of being used as piggy bank to bail out massive overspends in acute trusts, so there may be less 'inefficiency' than you think, anon 1.08pm. More needs to be specified, but the biggest problem is the silo/single mind set of those running the acutes, who assume a one-size-fits all for the community, instead of having the vision and ability to understand the difference between the two forms of service provision. If more services are to be delivered in the community in future, which we keep being told is the way forward, then a bit more humility and insight from big-bully hospitals would be in order. Hissy fit over (and I'm not even a lib-dem!)