ABSTRACT
Introduction Since its inception in 1948, healthcare in the NHS has been influenced heavily by the interests of powerful professional groups and individuals' interests, with service development skewed by politico-vocal pressures. Older people, and those with dementia and their carers, were not strong voices. Old age psychiatry only started to emerge as a specialty in the 1970s onwards, and the Alzheimer's Society as a national organization in 1980. In health policy terms, the 1980s saw an experiment with competitive forces in a managed market as a way of ensuring that the 'consumer' got the best out of services. This was seen to shift the focus of service development from a top-down provider perspective to more patient-centred services. However, it did little for equity of access to services, and there were what was seen as unacceptable variations in service levels and standards across the UK.
