The decade was characterised by the growing acknowledgement that clear financial bounds existed within which the NHS operated. It simply could no longer do everything that had become medically possible.

The NHS had become a victim of its own success. New technology was being introduced and more people were being treated in more complex ways. This led to both rising expectations of the health service and an increasingly elderly population with all its attendant health needs.

Advances spanned all fields of NHS activity: primary health care was improving, although less so in the inner cities. Genetic engineering was yielding its first drug successes and magnetic resonance imaging was introduced.

On the surgical side, the decade saw the advent of minimal access techniques, while the number of operations for fractured neck of femur and osteoarthritis of the hip was reaching almost epidemic proportions.

Increasing numbers of heart and liver transplants were being performed and surgical treatment for heart disease was becoming more common by the day.

Beginning in 1978 with what was dubbed by the newspapers as the winter of discontent, the service’s financial problems were worsened by the oil crisis.

NHS management tried to improve efficiency and there were attempts to set priorities in 1979, to restructure the NHS again in 1982 and to introduce a tier of general management between 1983 and 1985.

The 1979 change of government brought little immediate change in health service policy, as attempts to equalise the allocation of resources between different parts of the country continued.

But as time passed, the tension between increasing demand and finite resources prompted experiments in clinical budgeting and a desire for better health service information. Performance indicators were introduced, and the level of acute hospital services likely to be available in London in the future was examined by the London Health Planning Consortium.

Closer examination of what the professionals were doing followed international concern about rising costs. People began to discuss audit of, for example, the results of anaesthesia and surgery.

Clinical advances placed increasing demands on nursing and medical staff, and each profession looked at its education and organisation. One option for the NHS was to move care from a hospital to a community setting. Community nursing was examined and the Government established a review of general practice and primary health care.

Yet by 1987 health authorities throughout the country were in debt, waiting lists were growing and hospital wards were being closed - despite evidence of higher spending, steady increases in staff numbers and the treatment of more patients.

Neither the public nor the health care professions were satisfied and the service was increasingly subjected to scrutiny in the media.

Excerpt taken from From Cradle to Grave by Geoffrey Rivett. Published by the King’s Fund, 1998. (http://www.kingsfund.org.uk/) ISBN: 1-85717-148-9. Price: £25.00. Available from selected bookshops and the King’s Fund bookshop. Tel: 0171 307 2591.