ABSTRACT
Introduction If the establishment of the NHS in 1948 was cause for selfcongratulation, it was not long before clouds began to gather. Within five years the Guillebaud Committee had been set up to examine the dilemma of continuing to provide an adequate level of health care without, at the same time, condemning the Treasury to having to meet ever-rising costs. Over the following decades the problem refused to go away. Responses were sometimes piecemeal, aimed at a particular problem such as the need for investment in hospital building. At other times attempts were made at more fundamental remedies, either by changing structures or, particularly after 1982, by changing what went on inside the structures.
