Bristol Specialist Drug Service has experienced a steeply incremental increase in demand against afixed, finite resource from the Health Commissioners. This paper examines accurate costing of therapeutic interventions and the restructure of an open-ended to a time limited intervention service driven by financial and not clinical imperatives. It specifically examines such issues at the active management of waiting lists, outcomes and activity data collection requirements and the management of existing patients during a period of change. The author further explores the issues that have arisen as a result of such restructure in the following areas:-

• The multidisciplinary team

(a) Expectations
(b) Change
(c) Skills base
(d) Supervision

• Patients

(a) Expectations
(b) Change
(c) Potential of dangerous behaviour

• Data collection

(a) Activity data
(b) Clinicaloutcomesdata

• Cost

(a) Prescribing
(b) Urinalysis
(c) Staff
(d) New developments in treatment

• Information

(a) Primary health care
(b) Mental health colleagues
(c) Voluntary sector
(d) Social services

The dilemma for clinicians in the drug field is explored in this paper. In particular, should fewer patients be treated for as long as is clinically indicated or should clinical interventions be time-limited to allow a critical examination of clinical outcomes when changes in service provision are externally imposed?