ABSTRACT
The establishment of the National Health Service (NHS) in 1948 was a bold attempt to make health services available to all citizens through a system of public finance and public provision. Responsibility for overseeing the implementation of the reforms was vested in the NHS management executive working on behalf of Ministers. The management executive continued to be located within the Department of Health but increasingly it took on a separate existence from the policy divisions within the Department. In the absence of specific proposals to change the basis of health service financing, Ministers pursued a policy of achieving greater efficiency in the NHS and encouraging the growth of private finance and provision alongside the NHS. The Ministerial Review, initiated by Margaret Thatcher in 1988, offered an opportunity for alternative methods of financing and provision to be re-examined. The reforms to the NHS set out in Working for Patients were a response to acute funding problems that developed during the 1980s.
