Long Description: In the centre is a smiling boy in a wheelchair, surrounding this image are arrows in a circle with the following text forming a cycle. Most users grateful for a poor quality service Commissioners neglect equipment services Earmarked funding diverted to other priorities Commissioning sustains the status quo Under-managed, under-resourced services delivered Low profit margins for the supply industry Little R&D, few incentives for new market entrants Lack of creative service delivery