We are living in an increasingly consumerist culture. Public sector services are often being run like private companies, alongside privatisation the profit motive is more and more central to how services are being planned and delivered. For those of us working in such services one loss is that we must increasingly turn people away on cost grounds, and sometimes even cherry-pick ‘profitable’ work. In addition colleagues in nearby organisations, with whom mutual learning and the exchange of ideas was once possible, are now competitors in a dog eat dog world, and so opportunities for helping each other in delivering the best health or other services are threatened. Another other central agenda is that of personal choice, and public servants are frequently expected to think of those we work with as customers.