The NHS

• Thatcher would have loved to slash the cost of inefficiency of the NHS in the same way she did with the civil service
• Her preferred solution to the spiralling cost of the NHS would have been to abolish tax funding entirely and enforce private health insurance
• However, while the public did not notice the 'revolution' in government bureaucracy, they would certainly have noticed cuts or 'contracting out' in healthcare
• The vast majority of the British public approved of the NHS's provision of free, expert care to those in need regardless of wealth or income
• Thatcher had to tread far more cautiously than she would have instinctively liked
• Between 1980-87, spending on the NHS rose 60%: as a percentage of total government spending, the NHS's share rose from 12 to 15% between 1979 and 1996
• Her third election victory in 1987 gave Thatcher the confidence to back more radical proposals for NHS reform
• The 1989 White Paper 'Working for Patients' called for the creation of an internal market where health authorities would purchase healthcare services from hospital trusts
• Professional managers rather than doctors would run the hospital trusts to ensure performance targets were hit and waste reduced
• The idea of hospital trusts was that better providers would attract more demand from GPs and so success would be rewarded with higher funding
• Although the internal market was not introduced until after Thatcher fell from power in 1990, the introduction of free-market elements into the NHS was very much in line with her overall aims
• The reforms proved to be highly unpopular with doctors and did not deliver cost casings in the way that Thatcher had anticipated; while the overall cost of the NHS rose by almost 25% between 1985 and 1991, the money spent on NHS managers increased from £25.7 million to £383.8 million
• By 1996, 34 NHS trusts were in debt; attempts to cut costs impacted upon the quality of care for non-emergency patients
• The requirement to 'meet targets' led to demoralization among doctors and nurses who felt they spend less time caring for patients to satisfy managers without medical training
• Although spending on the NHS rose at a slower rate than under previous governments, Thatcher was unable to roll back government to roll back government provision of healthcare
• The number of people with private health insurance grew from around 500,000 in 1955 to 6.6 million in 1990. only 1% of manual workers had private cover, and the vast majority of the British people continued to depend on the state-provided healthcare that they regarded as the 'jewel in the crown' of welfare provision