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Two studies were carried out in different districts with clinicians who were concerned about the proposed numbers of beds to be provided based on regional targets and assessments. It was found that summary statistics can obscure wide variations over time in the demand for services. Providing beds according to average demand can therefore create a shortage of beds for a large part of the year. It is argued that the norms and targets set by regions should be seen as a starting point for negotiations rather than as the definitive answer for setting the levels of services provided. Because of their particular circumstances certain districts may need to provide more than the levels set by the region, and clinicians and community physicians can work together to provide evidence for this.

The recent media debate about the MRC trial of vitamin supplementation to prevent neural tube defects has tended to draw attention away from the underlying problem of inadequate micronutrient intake in the diet. From a public health perspective a broader approach must be adopted if we wish to significantly reduce the incidence of neural tube defects in the population. The prescription of vitamins can only be considered as a short-term, partial solution, and the long-term goal must be the elimination of the primary causes of micronutrient deficiencies. Particular emphasis must be placed on the nutrient losses and imbalances that arise from current food production and processing techniques.