ABSTRACT
The National Health Service (NHS) presented particular problems for an ideologically driven prime minister. On the one hand, the
administrative structure of the NHS was widely acknowledged to be both inefficient and wasteful. Its ‘national’ status could anyway be questioned since some parts of the country were much better served than others. Its costs were also extremely high, not least because universal provision of quality service since the NHS came into being in 1948 had increased life expectancy. More than twice as many people in the UK (1.6 million) were over 80 years of age in 1981 than in 1951 and the number would increase to 2.2 million by the time Thatcher left office. In 1991, also 16 per cent of the population was over the male pensionable age of 65, compared with 11 per cent when the NHS was founded.1 Inevitably, the very old make heavier demands on resources. Economically, the NHS was the victim of its own success. The prime minister’s think tanks devised numerous schemes for reducing costs and introducing market mechanisms into the service. In the summer of 1982, a Central Policy Review Staff (CPRS or ‘Think Tank’) paper proposing deep cuts in public expenditure urged more vigorous promotion of private health insurance schemes, charging for doctors’ visits and increasing prescription charges. This, it calculated, would save between 10 and 12 per cent of the NHS budget.2
