Health Policy under Thatcher and Major

  • Christopher Ham
Part of the Public Policy and Politics book series (PPP)


If health policy between 1948 and 1982 was characterised by successive adjustments to the original design of the NHS and a focus on fine tuning its administrative structure, in the following 15 years events took a different turn. The election of the Conservative government under Margaret Thatcher in 1979, coupled with the emergence of major funding pressures, led to the consideration of more radical alternatives. Of particular importance was the introduction of the reforms set out in the White Paper, Working for Patients, published in 1989 (Secretary of State for Health and others, 1989a). These reforms in turn followed from the introduction of general management and the implementation of a range of efficiency initiatives. The aim of this chapter is to trace the development of health policy from Thatcher to Major, and in the process to examine the various influences on policy-making and implementation.


Health Policy Health Authority Private Insurance White Paper Community Health Service 
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Guide to Further Reading

  1. The background to the Ministerial Review of the NHS is traced in Timmins (1995) and Butler (1992). A summary of the debate which took place during the Review is contained in Ham, Robinson and Benzeval (1990). The government’s proposals were contained in three White Papers, Working for Patients, Caring for People and Promoting Better Health (Secretary of State for Health and others, 1989a, 1989b; Secretary of State for Social Services and others, 1987). Klein’s account of the politics of the NHS (Klein, 1995) contains a useful analysis of the events which led up to the Review and the outcome. Ham (1997a) describes the implementation of the reforms, while Le Grand, Mays and Mulligan (1998) review the evidence on the impact of the internal market.Google Scholar

Copyright information

© Christopher Ham 1999

Authors and Affiliations

  • Christopher Ham

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