ABSTRACT
At its inception in 1948 there were high hopes that the National Health Service would eliminate the inequalities in health that had scarred Britain in the 1920s and 1930s. No longer would inability to pay be a barrier to sick people receiving good quality medical care. Nor would living in a deprived area carry the additional burden of lack of access to health care. Planning would ensure that a comprehensive health service was available to residents of all parts of the country and this would be free at the point of delivery. The NHS inherited a motley collection of existing health services and buildings. Some of these were the product of charity, some were municipal services which were often direct descendants of nineteenth century workhouses and others were the product of market forces. What the NHS had to work with was a collection of hospitals and activities, not a rationally planned health service. Inevitably, this meant that in many cases the wrong services were being provided for the wrong people in the wrong places. Tudor Hart (1971) summed up the situation in terms of what he called an inverse care law: that the availability of good medical care tends to vary inversely with the need of the population served. More than 40 years on it is possible to examine whether the NHS has been able to move towards a more equitable pattern of health care.
