The state of UK health services in 1997 was characterised as one of crisis. Famously its future leader and the nation lived through ‘twenty-four hours to save the NHS’. In 1997 the crisis was seen mainly in terms of long waiting times. Later came assessment in terms of under-funding, low levels of spending in relation to the European average, and poor outcomes in terms of key disease areas such as cancer and heart disease. Later still came a different assessment in terms of poor value for money and lack of incentive. Thus within the Blair premiership there were three different policy phases which we will note as Blair (1997) Blair (2000) and Blair (2003).

These policy changes were heading into a health environment which was showing much more rapid change across all developed countries than in the previous four decades. A new wave of high-benefit programmes was bringing benefits to patients but stretching funding in all systems. There were moves worldwide towards a greater focus on prevention and away from hospital treatment. Survival was improving but bringing a new challenge of reducing disability and improving quality of life.

Blair (1997) was mainly set by the priority for containment of public spending. The decision was taken to stick with the previous government's plans for public expenditure, both for the total and for detailed allocations. However, within this constraint some initiatives were taken. There were the National Service Frameworks starting with that for coronary heart disease.