The quadrupling of oil prices by the producers in 1973 plunged the Western economies into crisis, a crisis which affected the welfare state and its funding above all. The post-war consensus round welfare policy was disrupted, and a new Right wing orthodoxy on welfare emerged in the 1970s, finding its political expression in the Thatcher and Major governments of the 1980s and 90s. Much of this panic about public spending was expressed through health and welfare issues, which became increasingly contentious from the mid-1970s. The British health experience is the focus of this book, but to some extent the country was experiencing perceived problems which affected health care systems around the world. Industrialised countries rationalised their fears about public spending through delineation of ‘health problems’ which came to define the policy agendas. The burden of chronic illness, the rise of new infectious diseases, the growing numbers of elderly; questions of the organisation and funding of services, such as the need to control costs, improve accountability and efficiency, monitor effectiveness and establish priorities – in some form, these issues affected most countries. The role of medicine and unquestioned professional dominance in the health arena was under strain. Ever-increasing costs and uncertainties about the relationship between medical care, formal health services and health status brought a more questioning attitude both to the role of medicine and to the relationship between medicine and the role of the state. Health outputs as well as inputs came on to the policy agenda for the first time.