What are the political forces which drive the process of change in the health service? How do these forces impact on existing structures of power, policy and organisation? In addressing these questions, Brian Salter applies an original theory of political change to key areas of NHS activity. He shows how the escalating demand for health care combined with recent radical policy initiatives has posed different problems for politicians, doctors, bureaucrats and managers. Out of the accommodations reached, a new shape has emerged for the NHS.