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…… 

#justsaying
 http://www.nejm.org/doi/full/10.1056/NEJMp1512297 

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