ABSTRACT
The Bill which created the National Health Service received the Royal Assent in November 1946. It formed the centrepiece of the great reforming programme of the post-war Labour administration and one of the main pillars of the new Welfare State. Any attempt to consider the changes introduced to the National Health Service during the 1980s and 1990s needs to begin with an understanding of the principles upon which the service was originally founded. From the perspective of those who believed that the 1946 settlement represented a basic miscalculation between the relative merits of public and private provision, the problems which faced the Health Service were not so much the accidental or unforeseeable by-product of a heroic experiment, as inevitable and intrinsic to the whole venture. The health service, in many ways, represented the greatest challenge for the free-marketeers who were progressively to dominate the Thatcher administrations of the 1980s.
