It is clear that to achieve sustainable prudent health and healthcare in Wales, immediate change is urgently needed. The problem lies in making this happen. Similar messages have been made before (Wanless 2003) and many of the barriers identified in this paper have been long recognised and articulated. These are not new, yet NHS Wales continues to perpetuate largely the same practices, roles and responsibilities, making minor modifications, sometimes with the things known not to work or which shouldn’t be in place.
