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.

(1) Authors may be divided into three classes – shooting stars, planets, and fixed stars. Arthur Schopenhauer: Parerga und Paralipomena, 1851 How brightly should you shine, and for how long? At appointments committees lists of publications are becoming increasingly important as proxy measures of candidates' abilities and potential. As competition for posts becomes fiercer, number and quality of publications are likely to assume even greater importance when similarly qualified individuals are being compared. We may bemoan this trend but in the absence of other more valid indicators of worth and from the point of view of self-interest it would be prudent to acknowledge it and to support it.