The Government have announced that they intend to establish a comprehensive health service for everybody in this country. They want to ensure that every man and woman and child can rely on getting all the advice and treatment and care which they may need in matters of personal health.1

In this statement of the NHS’s founding principle of comprehensiveness, the crucial word is “need.” The new service was set up to satisfy needs (as defined by doctors and other experts) not demands(as defined by patients). This was in keeping with the circumstances of its birth: the NHS was born into a working class society “strong on collectivism, reconciled to scarcity, and with a firm faith in the rationality of planning.”2

This founding principle encountered two problems: one almost immediately and one as the years passed. The first was money; the second was the transition from a postwar to a consumer society, with widely different values.