Teaching hospitals set themselves up as ‘centres of excellence' with staff and patients believing in the power and progressivism of medical science. Public expectations about the healing capacities of hospitals expanded considerably as they filled up with medical students and machinery. During the second half of the 20th century, all western nations experienced an epidemiological transition from acute to chronic disease as life expectancy substantially increased and new procedures were developed to stretch it even further. Most hospitals, particularly the oversubscribed centres of excellence, developed policies of ‘fast tracking' patients through the system so that as many people as possible could benefit from innovative procedures. Aquatint by Julia Midgley, Liverpool.