Throughout the 1980s concern mounted over the provision of health and personal social services. As a result of inflation, an expansion in demand and technical advances, the increasingly expensive hospital services became more and more obviously threadbare, while the perceived failures of the community care movement were widely canvassed. As the decade ended the Government embarked on two bold initiatives aimed at increasing the efficiency, effectiveness and accountability of health and social care. These proposals, set out in the White Papers Caring for People (HMSO, 1989a) and Working for Patients (HMSO, 1989b), have now become law in the National Health Service and Community Care Act 1990. Another paper (pp. 641–645) somewhat critically reviews Caring for People from a psychiatric perspective (Holloway, 1990). At the heart of the ‘reforms’ is an attempt to create the conditions of a market. To achieve this a sharp distinction is to be drawn between the purchasers of care (Health Authorities, Local Social Services Authorities and Family Health Services Authorities) and service providers, with whom the purchasers will let contracts. It is envisaged that eventually a plethora of providers will compete within a “mixed economy of care”, becoming ever more efficient.