The asymmetric approach we have to expecting cashable returns on investment

There is a legitimate question of aysmetric apptroaches to ROI.

We don’t expect NHS to be perpetual motion machine, why public health, prevention, VCS work?

One of my standard lines is that we question a VCS contract (or PH intervention) worth £4.78 and make them fill in a form that you weigh rather than read….and then performance manage to within an inch of it’s life questioning value for money all the while…..

But meanwhile pour tens of millions of area xxxxx it yyyyyy but don’t question value of it etc etc……

See this NEJM article

There is a need to expose this, and address some of the issues that may help. For example:

  • Expose the asymmetrical nature openly and debate it
  • Monitoring requirements – which vary widely between different funder
  • Contract length
  • Expectation that the sector will generate visible and cashable downstream savings – we don’t have same expectations re say dermatology or diabetes medicine



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