Markets and Choice

Abstract

As Chapter 1 showed, central to the New Right health policy agenda during the first two Thatcher governments was a belief that private sector disciplines needed to be imposed on the NHS. Health was not alone in being a target for this neo-liberal prescription: other ‘public’ sector services received similar attention. Nor did health receive particularly intensive attention, perhaps as a consequence of the considerable public attachment to the service. The net consequence was, however, twofold. First, by the end of the 1980s, health policy had been affected by creeping privatisation (Haywood and Ranade, 1989): contracting had been introduced for some ancillary services and charges for some activities. Second, the basis for these developments had been located in a general concern for a version of efficiency in which the commonplace term ‘value-for-money’ had assumed centre stage. This second tendency had led, inter alia, to the introduction of general management, the abolition of area health authorities and the notion of the ‘cost-improvement programme’. The two tendencies were, of course, clearly interlinked: privatisation was seen as umbilically entwined with efficiency, indeed, to all intents and purposes, private was efficient.