Proposes the MILTON model of health care policy and management as a framework within which debates about the future reform of the UK National Health Service may be conducted. Reviews the economic, political, social and technological forces which have shaped health care policy and management. Suggests that, at the macrolevel, the paradigm has changed from one based on assessment of needs to one based on securing value for money. At the microlevel, there have been equally profound changes in the nature and availability of work. A theme common to both levels is that of rapid and continuous change. Claims the MILTON model offers a way for the protagonists in the health care debate to locate their arguments about policies of health care provision and the implications for the management of work in a changing world in four planes of the model. The benefits are that the differing positions may be seen more clearly and, arguably more important, that a wider range of options is appreciated when, all too often in the past, arguments have become polarized on a single plane.