This title examines the impact of attempts to use rational health economic analyses on local decision-making in the National Health Service. It presents findings from an ethnographic study of one Health Authority and one Primary Care Group to present a picture of the processes and contexts of healthcare resource allocation at local level. co nclusion of the book is that it is extremely difficult to use rational solutions to resource allocation dilemmas at local level in the modern state. The adoption by local decision-makers of what appear to be non-rational coping strategies is essential to the maintenance of service delivery in the context of resource scarcity. Paradoxically, attempts to impose rational decision-making threaten to undermine the precarious stability of the very systems they seek to improve. In this sense, the pursuit of rationality may itself be an irrational act.