Viewpoint: Thatcher began Cameron's bid to privatise the NHS

By Dr Kailash Chand, 09 April 2013

The Cameron/Lansley NHS reforms, to privatise the NHS, are the biggest in its history. In terms of scale that may be true, but in terms of their direction of travel, that was set 25 years ago by the NHS review announced by Margaret Thatcher in 1988.

Dr Kailash Chand: 'Cameron is about to fulfil the dream of Thatcher.'

Dr Kailash Chand: 'Cameron is about to fulfil the dream of Thatcher.'

She brought in the concept of the internal market and fundholding in the NHS. This was thanks to the Griffiths report which suggested that the NHS should be run like a supermarket to increase efficiency and effectiveness.

Instead of meeting patient needs, trusts would be run in competition with each other for patients, undermining the very founding principles of the health service.

The central aim of the reforms was to produce a more cost-effective NHS. The National Health Service and Community Act of 1990 was the proposed solution. It reformed both management and patient care by introducing an 'internal market'.

Its big idea was the creation of a market within the NHS so that some parts of the organisation would become providers selling their services to the others, the purchasers. This separation of purchaser from provider - the purchaser/provider split - was the key feature. The result was that the entire NHS started fragmenting, with each hospital in competition with the others. Primary and secondary care were put in an adversarial position.

Under Margaret Thatcher, the government encouraged people to use private medical services (The Health Service Act 1980 being the first step). Her government showed recurrent interest in health insurance but this was played down for electoral reasons.

Tax concessions for private insurance were introduced, there were frequent rises in prescription charges and the contracting out of support services to the private sector was enforced.

Administration costs in the NHS in 1979 were around 6% - after the introduction of the internal market these had doubled to 12%.

Margaret Thatcher, the baroness of spin, conned the electorate by claiming the NHS would be safe in her hands but she left it on its knees by the time she left the office.

There is no denying that Tony Blair and Gordon Brown’s engagement with the private sector exceeded the Thatcher administration.

Market structures, foundation trusts, GP commissioning and the introduction of private corporations into commissioning were all products of the continuation of Thatcher’s vision of public service reform but they still kept saying that the NHS will stay as a preferred provider.

But now Cameron is about to fulfil the dream of Thatcher by starting to complete the process to end the NHS as a publicly provided, publicly financed body. We are moving away from the traditional health service to one ruled by bogus choice, competition, market forces and supplier diversity.

And in this sort of health service the chronically and terminally ill, the mentally ill, those from lower socio-economic groups and the elderly are likely to lose out. The young and able and the privileged who have ease of access to health.com will be the likely winners.

* Dr Kailash Chand, writing a personal view and not in his BMA deputy chairman capacity.

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