reinforce changes in society. Reports in the UK news media of the 1990s suggest that although the medical profession still retains huge authority we are more willing to challenge it and make it more accountable. We continue to be optimistic about developments in health care but are more aware than previously of the need to ensure effectiveness and value for money. We know that there are reasonable limits to public spending on the health service, but remain vigilant against examples of unfairness. We are still passionate about the need for a health service that will treat everyone well and fairly according to clinical need and regardless of ability to pay.