Julian Tudor Hart's book addresses in a scholarly and thoroughly empirical way what has happened to the NHS since its inception. He traces its history, and examines the successive reforms particularly in relation to the management of the NHS and to increased specialisation which threaten the original conception and intentions of its founders.

The recent ‘industrialisation’ of health workers is likened to the processes that occurred in England in the 18th century, whereby the workforce competes in a health market. He concludes that the consumerism affecting the health industry – every man for himself and every woman for herself – stands in opposition to the public belief in the solidarity of health, a belief which remains steadfast today.

His analysis of the reasons why the NHS came into being – in particular the anticipation of major civilian casualties during the Second World War which led to a fundamental re-evaluation of the country's needs – is a fascinating insight into how social, political and military factors interrelated to produce one of our most enduring and much-loved social institutions. It is a book not just about the National Health Service, but also about the conflicting principles and ideals to which the service has been subject over its 60-plus years of existence.