Or is the issue how services are delivered?The answer is probably all of the above.
Changes may mean altering how services are delivered, closing buildings and sites totally or in part.
"There is a disincentive on how services are commissioned," she suggests.
Substantial cuts would, she said require "huge rethinking" of how services are provided.
But it may also be down to how services are delivered.
Technology has changed how services are created and delivered so government and community organisation will change too.
And a high degree of practical knowledge is needed as fundamental changes are being implemented to how services are provided.
Labour's election manifesto should outline a new settlement between local and central government containing "an explicit vision of how services are organised and where responsibility lies".
He said the Lib Dems "must remain supporters of the need for reform of the NHS", including more involvement of local people in how services are run.
Ideally, the needs and preferences of the client and the professional judgment of the therapist should drive the decision about how services are offered.
I think the bigger debate has to be about how services are organised across the day/week so that people can stay in their home.
