Abstract The National Health Service was conceived on the basis that, with the eradication of infection and deprivation, disease would become less common. This has not happened. Experience in a Liverpool hospital reveals that over the years, the less affluent have continued to constitute a hospital class; but their disease pattern has changed. They have taken on those diseases which result from personal mismanagement —by smoking, drinking, overeating. The situation can only be improved by education of the potential patient.