By Bill New and Julia Neuberger. King's Fund, 2002, PB £17.00, 230pp. ISBN 1-85717-458-5 All the contributors to this collection of papers are concerned, from widely differing perspectives, with the ways in which the values embodied in a health-care system conflict, and the problems of choice that arise. Most of them focus on the NHS, from a domestic or North American perspective. Only three broaden out the debate. Disappointingly, the individual essays do not add up to a book, although some of them are useful and thought-provoking. Although many of the papers seem to have been produced for seminars, there is no record of any exchange of ideas, no attempt to drive the discussion forward beyond the Tavistock principles, which is more or less where the thinking about values ends up. But these principles, like the statement of values in the NHS Plan, are in the nature of bland rhetorical statements that are themselves conflicting, as Professor Alan Williams comments at the end. If they are to be of help in clarifying what is at issue in an operational context they need to be thought through and applied to real life situations. This is a pity, as several contributors raise questions of great importance, any one of which would have merited fuller exploration. The central assumption throughout is that whatever list of values/principles one starts with, there are inevitable incompatibilities that necessitate difficult choices and decisions. The two keywords are trade-offs and transparency. In one of the most interesting chapters, entitled ‘Managing disappointment in health care’, two Americans, Professors Jim Sabin and Norman Daniels, describe the problems of determining and explaining policy in two very different instances, the availability of Viagra in an HMO and developing a culture of accountability in the purchasing and management of mental health services in Massachusetts (where there is substantial public sector involvement in the provision of services). They also analyse the differing approaches adopted by two large organizations to the funding of ‘last-chance’ treatments, using the child B case as an example. They conclude that what they characterize as ‘accountability for reasonableness’ in determining the best trade-off of competing demands and priorities in a specific situation can help to improve both the quality and the acceptability of the allocation decision that has to be made. Measured against this study of the application of principles in practice the work on organizational values in the NHS sponsored by the King's Fund has not yet got far, being still mainly at the stage of sorting out linguistic confusions and encouraging reflective questioning about organisational principles and objectives among groups of staff in the participating Trusts. This is not a criticism. Building a coherent way of handling choices and dilemmas within an organization takes time. But, and it is a big but, there must be serious doubts as to how far the open, painstaking approach that Sabin and Daniels outline would or indeed could get in the NHS of 2003. To succeed, an organisation seeking to involve the public in making principled management decisions needs autonomy. Unless it can deliver what has been agreed at the end of the day it will increase scepticism and mistrust. In the months since the King's Fund group met to consider the papers published here the scope for professional autonomy in delivering care within the NHS structure has shrunk further, despite the increasing resources being directed at the system. Target-setting, micro-management, NICE and PCTs are all contributing to this state of affairs. Somebody, somewhere, should start to probe the question of what the ‘Hidden Assets’ of the NHS are, and if they are not in danger of being outweighed by its liabilities. At present patients and professionals alike are struggling with a system superimposed on them by a centrally driven bureaucracy, itself governed by short-term politically driven directives, that they have little power to influence. It is time to look at alternative models for securing a socially just health care system, one that puts the power and the onus of making choices in the hands of patients and professionals.