I think that the entire problem with management (at least when being done by mid-level government lackeys) is summed up in your first paragraph. The whole point of AAC is to improve the public perception of the service? Won't the public percieve the service as good when everyone's still alive after their heart attacks and road accidents? This is not to say that perception isn't important, but it should at least be secondary to actually helping people. In my opinion, it should be secondary to not wasting money as well, but I don't pay taxes in the UK. I like being an Expat.