the study did not however look at system cost and the authors do not speculate on whether they believe that the interventions saved money overall the incremental cost per qualityadjusted life year gained was gdp between domiciliary care and stroke unit care leading the authors to conclude that cost perspectives are important when stroke services are evaluated and that the improved health outcomes in the stroke unit come at a higher cost currently in excess of the usual threshold for accepting new technologies in england this outcome is particularly likely to arise in systems where hospital and social care are delivered by separate agencies in england and wales the health services have the power to fine local governments a daily tariff for delays in discharge caused by local social care failures an alternative model was that local hospital and social care services were encouraged to work collaboratively by applying for special grants to improve community services