Every day, NHS managers face difficult choices about funding patient care. Decisions about whether to fund expensive drugs or treatment can be fraught with difficulty for everyone concerned. This publication uses five real-life case studies to draw out the implications of these difficult decisions for patients, doctors and managers. It argues that conflicting interests are inevitable at times, and suggests ways in which doctors and managers can handle these. By using good communication, involving independent experts and drawing on peer support, doctors and managers can help everyone involved feel that the situation has been satisfactorily resolved. The publication is a sequel to Tragic Choices in Health Care: The case of child B.