ABSTRACT
The National Health Service rapidly won the approval and affection of the British people. The reorganization took place at a time when great faith was placed in structural change, but structural change cannot achieve very much if the same processes simply carry over into the new structures. The effects of the 1974 reforms were disappointing, and were soon criticized. In the meantime, however, much deeper changes were developing on the British political scene that would lead to the election of a Conservative Government in 1979 led by Margaret Thatcher. The growth of the internal market led to a change and reduction in the role of the Management Executive and of the Regional Health Authorities, so that their relationship with purchasers and providers became distant. The most ambitious attempts of all came during and the 1980s, with the introduction of general management followed by the internal market, and then, from 1999, an attempt to radically reconfigure the whole health care system.
