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The main task of NHS purchasers should be to reshape services to achieve the greatest possible improvements in their population's health. The obstacles to that endeavour are many. They include the scientific problems of measuring the effectiveness of, and hence need for, clinical interventions*RF 1-3* and the political problems of bringing about changes in the teeth of fiercely held interests. As relatively small organisations, purchasers need all the help they can get with the sheer complexity of altering so many interlocking aspects of provision of the health services while meeting the many other demands of their new role.
Coming to their rescue is the Welsh Health Planning Forum's recently completed series of protocols for investment in health gain,*RF 4-17* which summarises the science and mobilises the political will. The series highlights both the advantages and the pitfalls of such
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