This is the review of the full report which analyses the interlocking set of problems posed by health services, medical education and research in London. It warns that health services in the city may become unsustainable unless tehre is the political will to back a strategy of fundamental reform. It examines the demographic, technological and social changes that are combining to forge new patterns of health care and recommends a radical programme of investment and restructuring to reshape services to meet the challenges of the new century.