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This chapter considers the various reasons which help to determine whether the record of the Health Service is one of progress and success. Some of the more important ones become explicable only when it is understood how far reaching the effects of the Second World War on the British economy were. The whole fabric of organized medical care, public and private, suffered particularly. Inevitably, the highest priorities in medicine were reserved for the military and civil defence forces. Even as early as June 1943, the standard of medical care available for the civilian population was, in the judgment of the War Cabinet, dangerously low.

This concluding chapter reviews how, during the past decade, there has been an increasing volume of studies and reports on general practice in Britain, the United States, and other countries. No doubt much of this interest has been provoked by the growing impact of scientific developments on medicine over the same period. These have raised many questions about the present state of general practice, its historical evolution, and its future place in medical care. The chapter discusses the association of these developments with the changing character of demand for medical care and its effects on the doctor–patient relationship. It also looks at the questions of science and specialism in a broader historical context.

This chapter discusses the application of the values of the marketplace to human blood. American and British economists are making an economic case against a monopoly of altruism in blood and other human tissues. They wish to set people free from the conscience of obligation. Although their arguments are couched in the language of price elasticity and profit-maximisation, they have far-reaching implications for human values and all ‘social service’ institutions. However, the moral issues that are raised extend far beyond theories of pricing and the operations of the marketplace. They involve the foundations of professional freedom in medical care and other service relationships with people; the concept of the hospital and the university as non-profit-making institutions; and the legal doctrine in the United States of charitable immunity.

This chapter addresses the quality of the gift of blood. The transfusion and use of whole blood and certain blood products carries with it the risk of transmitting disease, particularly serum hepatitis, malaria, syphilis, and brucellosis. Not only are there risks in infected blood and plasma, but there are also risks in the use of contaminated needles and apparatus in the collection and transfusion processes. The absence of a scientific check on quality and safety means that the subsequent biological condition of those who receive blood constitutes the ultimate test of whether the virus was present in the donation. However, few patients know that their bodies perform this role. In these situations of consumer ignorance and uncertainty, as in many others in the whole field of medical care, the patient has to trust the medical profession and the organised system of medical care.