In this episode of Modern Veterinary Practice, Jack Peploe is joined by Dr. Paul Manktelow , Chief Vet at Blue Cross, and Dr. Alison Thomas, Head of Veterinary Standards at Blue Cross, to explore what veterinary care looks like when it is designed around purpose, pragmatism, and accessibility rather than profit. Together, they discuss the belief that “more” isn’t always better, and how evidence-based guidelines can give vets the confidence to deliver pragmatic care without compromising welfare. Paul shares insights into the financial realities of the charity sector, from managing rising costs to understanding true service delivery, while Alison reflects on the ethical challenges of balancing owner expectations with patient needs. The conversation also tackles difficult topics such as euthanasia, pricing transparency, and the future of health plans, offering practical lessons for the wider profession. A thought-provoking episode on how values-led care can shape a more sustainable future.