According to the World Health Organisation [Health 21: Health for All in the 21st century, 1998], the 21st century offers a bright vision of better health and social care for all. However, the report Healthcare futures 2010 [Welsh Institute for health and Social Care, Pontypridd, 1998] has suggested that the future is far from straightforward and will be characterised by a series of `paradoxes'. These include: the increased emphasis on health promotion and yet the great demand for cure and treatment of illness; public reliance upon professionalism within nursing and yet greater lay assertiveness; and a greater demand for technical competence and the need for `human' qualities linked to the debate around the issue of competency. It is imperative that we examine some of the possible implications of these paradoxes and explicate their effects on the future development of nursing education. (C) 2003 Elsevier Ltd. All rights reserved.