The National Health Service, now forty years old, remains the most popular public service. Even the Conservative government of Mrs Thatcher has been reluctant, in public at least, to question the basis of the NHS as a universal service funded out of general taxation and still largely free at the point of use, though it has taken many actions to undermine it. There are traditions of public involvement in health services as volunteers, as fund raisers, and even, through lay membership of health authorities, as managers. However, the NHS has been rightly criticized for its failure to take account of the customer or the consumer in the way services are provided (DHSS 1983). People often feel that they are not treated as customers, for whose benefit the service is run. They are often kept in ignorance about their illness and treatment, kept waiting in unfriendly environments, and not given the information they need to make decisions for themselves. Out-patient clinics and hospital routines are organized for the convenience of staff, not customers.