"I find the term customer offensive"

Explores the tensions between cost and quality, need and market, and the effects on patient care and service providers within today's NHS. Builds on research carried out in two hospitals during 1993 to 1995, focusing on perceptions of quality and its management in the context of the nursing discipline. Indicates a divergence of perspectives on "customer requirements" and the emergence of a cultural divide within the total care process. Identifies and illustrates the significant potential for cost savings in health care, which may be achievable while simultaneously improving quality, and suggests that the "prize" for bridging the cultural divide might include a substantial financial gain as well as improved standards of care. In the context of health care, need, expectation, and finite resources are inextricably linked. A shared understanding of the interdependence between the three, and of the balance to be struck, is essential in health care provision today and into the twenty-first century. Suggests that there is some way to go.