This paper is divided into four parts. The first part describes the dramatic changes which are currently being made to the National Health Service in the UK. Many of these changes affect the hospital service with the formation of an internal market of managed competition. Local Health Authorities are being divided into purchaser and provider functions: the purchaser aims to become the champion of the patient by buying and monitoring services on his behalf. Every household in the UK has been issued with a copy of the Patients Charter, which gives details of people's rights. The second part of the paper describes the methodology used to conduct a major study of levels of patient satisfaction in three District Health Authorities located in East Sussex. The methodology was specifically tailored to allow for analysis both at the most general and at detailed levels. After an extensive development phase, a total of over 6000 postal questionnaires were despatched to patients who had recently left the hospital: a response rate of 71% was achieved. The survey is helping the process of change within the health service, by focusing on the needs and views of patients, and by helping the Authorities to move towards the Charter's objective, which is always to put patients first, providing services that meet clearly defined national and local standards, in ways responsive to people's views and needs. The final part of the paper looks at the future, the possibility of a repeat survey in 1993 and the encouragement which the three pioneering Districts are giving to other Districts to follow suit.