The task of examining just how the concept of 'organisations' has fared in Sociology of Health and Illness in its first 25 years is in some ways unrewarding. The answer has to be -'not at all well'. But why is this and does it matter? Part one of this paper considers what research on health care organisations was being conducted in the early years of the Journal and why that work was not viewed with favour by sociologists. Part two examines the growing gulf between those who saw themselves principally as responding to the call for a sociology of health and illness informed by broader sociological theory, and those who regarded themselves more as analysts of health policy and practice. Postmodernism, curiously, has begun to open up something of a route back. Just what might be done to create a closer rapprochement between those calling for theory and those wanting to address some of the day to day challenges of the delivery and experience of health care in the 21 st century are topics for the final section.