Opposition to the government's NHS reforms

August 1989–June 1990

Growing opposition

From August 1989 onwards, opposition to the government's NHS reform programme grew. Over the course of 1989, the BMA ran a widespread campaign against the government's proposed reforms to the NHS. One poster ran with the slogan:

'What do you call a man who ignores medical advice? Mr Clarke'.

Kenneth Clarke, the secretary of state, said that the correct answer was 'healthy'.

Another depicted a driverless steamroller, with the caption 'Mrs Thatcher's plans for the NHS'. The campaign had a significant impact on the public, leaving some fearful that the introduction of the internal market would remove the principle of 'free at the point of use' from the NHS.

Thatcher’s initial response

In her speech to the Conservative party conference on 13 October 1989, Prime Minister Margaret Thatcher emphasised that the NHS would not be privatised, but outlined the government's desire to make service improvements. 

She also highlighted the importance of enabling patients to choose on the basis of quality and waiting time:

'The National Health Service will not be privatised. The National Health Service was never going to be privatised. No matter what the emergency, accident or disease; no matter how long or complicated the treatment, the health service is there, the health service will always be there, to provide the finest care...'

'Rubber Windmill' simulation

The East Anglian Regional Health Authority (RHA) undertook the 'Rubber Windmill' simulation of an internal market for the NHS in 1990. The 'Rubber Windmill' was an exercise commissioned by the RHA to simulate and 'test to destruction' an internal market for the NHS.

Towards the end of the exercise, the simulated system 'collapsed' under the weight of conflicting financial and competitive pressures, leading some to suggest that any internal market would require some level of 'management' to be successful. Overall, the exercise was seen as an excellent learning experience (and has been repeated on a number of occasions since).

'Cold feet'

As a result of increasing backlash against the Conservatives' reform programme, Margaret Thatcher allegedly got 'cold feet' about the reforms and wanted to postpone them until after the 1992 election.

Following a meeting in June 1990 dubbed the 'Spanish inquisition', Kenneth Clarke refused to back down on his reform programme. As she left the meeting, Thatcher told Clarke: 'It's you I'm holding responsible if my NHS reforms don't work.'


Margaret Thatcher speech.
Conservative party conference at the Winter Gardens, Blackpool: 13 October 1989.
Margaret Thatcher Foundation; 2019.

Liddell A, McMahon L.
Return to the windmill - behavioural modelling and the future.
The King's Fund; 2006.

Marks J.
The NHS: beginning, middle and end? the autobiography of Dr John Marks.
Radcliffe Publishing; 2008.

Edwards B, Fall M.
The executive years of the NHS: The England account 1985-2003.
Nuffield Trust; 2005.

Liddell A, Parston G.
‘How the market crashed’.
Health Service Journal.
1990; 730-732.

Timmins N.
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Harper Collins; 1995.