The climate in 1969, in which the HAS was created, was one of increasing anxiety and embarrassment about the quality of long term care being offered to elderly, mentally ill and mentally handicapped patients in England and Wales. The need for a body to advise the Secretary of State, independently of the Department of Health and Social Security, was recognised and, with the wise guidance of Dr Alex Baker, the concept of multidisciplinary review by professional colleagues was established. Both these important principles have been maintained and stoutly defended by subsequent Directors, including myself.