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. Some parts of the country were much better served than others. Also, its costs were extremely high, not least because universal provision of high-quality service since the NHS came into being in 1948 had increased life expectancy. More than twice as many people in the United Kingdom (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, 16 per cent of the population was over the male pensionable age of sixty-five, compared with 11 per cent when the NHS was founded.1 Inevitably, the very old make heavy demands on scarce resources. Economically, the NHS was the victim of its own success. The Prime Ministerʼs think tanks devised numerous schemes for reducing costs and introducing more market mechanisms into the service. A Central Policy Review Staff (ʻThink Tankʼ) paper in the early 1980s proposed a package of measures – including the promotion of private health insurance, charging for doctors ʼ visits and increasing prescription charges – designed to save between 10 and 12 per cent of the NHS budget.2
