The ageing population and the growth in numbers of patients suffering from long-term conditions demands an adequate response from the health service to provide care and support. This is particularly true when individuals experience an acute deterioration in their health: they have a right to expect prompt, effective treatment from competent clinicians who are properly equipped. This pressure on the NHS has been reflected in the increasing numbers of acute admissions to medical beds and the increasing percentage of acute bed days occupied by patients aged over 80 years. Recognizing the need to provide good care at the front door, the NHS looked for solutions and appointed a number of doctors to manage acute medical units. None of these doctors had been trained specifically for this task but, subsequently, training programmes were developed. However, the place of acute medicine remains the subject of debate.