The Darlington Project provides us with a topical example of switching secondary care from hospital to the community. Here we have an initiative whose life straddles the great organisational changes which have occurred in health and social care services in this country in the early 1990s. Although many of the project’s features are specific to its development, the ways in which it was financed and organised, the details of its continuing evolution and the practicalities of moving from a pilot study to a mainstream service provide excellent examples of the cost opportunities and constraints in developing secondary health care in the community.