One of the most enduring narratives of left-wing politics in the UK is that Margaret Thatcher dismantled and destroyed the welfare state.
For many of my parent’s generation, Thatcher is a by-word for evil – a political Voldemort – she who must not be named.
For others in the same generation, Thatcher brought Britain out of the dark ages and built a new economic outlook.
But, curiously, very little of the hatred for Thatcher is directed specifically at her handling of the NHS. As the modern Labour party models itself as the ‘Party of the NHS,’ it’s a notable omission.
This is for a several reasons.
Firstly, while Thatcher slashed other public-sector budgets, health spending was largely protected throughout the 1980s. Secondly, Thatcher kept health at arm’s length. On economic issues Thatcher led from the front, but on health she deferred to deputies, for example giving Norman Fowler licence to launch the public AIDs awareness campaign despite not agreeing with it herself.
Finally, Thatcher undertook what is broadly considered to be an effective and thorough consultation on the internal market reforms. In this, she held a better relationship and rapport with the medical profession than many who came before and since.
But what stands out most from Thatcher’s relationship with the NHS is that, by the 1980s, the NHS held such a special place in the hearts of the public and the media, that it became a fragile policy proposition that required careful care.
Many of the specific actions on health during the Thatcher government would make clear sense to contemporary health commentators. Roy Griffiths, the Sainsbury’s boss who led the influential Griffiths report published in 1983, near the start of Thatcher’s time in office, famously said: “If Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge.”
He wasn’t wrong. The system was, by all accounts, in a minor state of chaos and in need of proper management.
The outcome of the Griffiths Review and eventual report was to initiate more of a private sector managerial approach to management of the NHS, and clarify the roles and responsibilities of the NHS against the Department of Health.
Griffiths believed that just because the NHS was a public service, it didn’t mean it couldn’t benefit from the principles of private sector management. The outcome of this was the creation of the NHS Management Board and Health Services Supervisory Board, the purpose of which was to remove managerial decisions from clinical ones. Despite being sound in principle, the reforms were hampered by the fact the NHS found it challenging to recruit private sector managers into the health service due to poor pay.
Much more controversial were proposals put forward by the Central Policy Review Staff (CPRS) in 1982, recommending a raft of contentious measures, such as the introduction of charges for health services and visits to GPs. Thatcher went against her principles (and advice from trusted colleagues) to reject these changes, avoiding both a fundamental altering of the NHS and, no doubt, an almighty political battle.
When Thatcher left office, British politics and economics had changed beyond recognition. But, curiously, beyond some broadly sensible tweaks, the NHS remained much the same.
For a government and a prime minister whose political approach was decisive, speedy and driven by principle, it is noteworthy that Thatcher did so little to reform or change an organisation which accounted for 10 per cent of public expenditure.
But it was a shrewd political move. Not least because the 1980s were arguably the beginning of the so-called ‘political football,’ where both Labour and the Tories were both at pains to stress their NHS-friendly credentials.
It explains why Thatcher was prudent not to push ahead with controversial measures put forward by some of her most trusted economic advisers that would have put an end to ‘free at the point of use.’
“The NHS is safe in our hands. The elderly are safe in our hands. The sick are safe in our hands. The surgeons are safe in our hands. The nurses are safe in our hands. The doctors are safe in our hands. The dentists are safe in our hands,” said Margaret Thatcher in a speech shortly before the 1983 election.
Today, safe custodianship of the NHS is so important a political point that NHS funding is used as a justification for economic theory.
The Tories say that only through ‘proper management’ of the economy can we afford the NHS while Labour stress that investment in the NHS breeds broader improvements in the public purse. The foundations of this NHS-centricity in our modern-day politics, finds many of its roots in the Thatcher era.
Stan Jackson, Senior Account Director