Much of the implementation of the CSAG study was devolved to Regions. There were no guidelines on resource implications of service reconfigurations, lack of formal business plans or clear direction and little formal agreement between trusts within a Region; inevitably there has been a considerable delay. The financial intricacies of any reorganisation within the Health Service are always difficult. In the case ofcleft lip and palate services which had been placed in many district general hospitals, it was impossible to recover a single session of speech and language therapy or two sessions of orthodontics. Besides, the new service model intended that these specialties should be provided locally and the bulk of the patients' appointments would not involve undue disruption. There was no clear plan or direction on financial issues other than there as no "new" money. Fortunately, this has been recognised as impossible and those Regions who were able to proceed have been able to make business cases which have dealt,in part, with financial problems. There are of course revenue and capital issues,these are often difficult to achieve in a co-ordinated sequence.