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Thatcher Cabinet's private consideration of radical reform of the NHS

Private plans for reform

Documents disclosed in December 2012 revealed that Thatcher's Cabinet had considered radical reform of the NHS. The Central Policy Review Staff prepared a paper for a Cabinet meeting on 6 September 1982, outlining longer-term funding options of public services.

The Cabinet considered introducing private health insurance and increasing or extending user charges. The Cabinet paper suggested that some of the options reviewed in the paper would represent the end of the NHS for the majority of the population:

'Even though a free state service would be retained for the uninsured and possibly for the non-working population, for the majority the change would represent the abolition of the NHS. To save substantial sums involves raising existing charges and breaking unpopular ground in three areas - imposing charges (eg for drugs) on patients who are now exempt (eg children); charging for seeing the general practitioner; and for hospital treatment.'

Public reassurance 

In her speech to the Conservative party conference on 8 October 1982, the Prime Minister suggested that her government had done more to roll back the 'frontiers of socialism than any other previous Conservative government'.

However, when it came to the NHS, Thatcher was keen to demonstrate the NHS would be safe in her hands. She was keen to emphasise that growth in private insurance was not incompatible with the protection of the NHS:

'Our opponents' picture of us as a party that doesn't care about the Health Service is utterly untrue... Of course we welcome the growth of private health insurance. There is no contradiction between that and supporting the National Health Service. It brings in more money, it helps to reduce the waiting lists, and it stimulates new treatments and techniques. But let me make one thing absolutely clear. The National Health Service is safe with us. As I said in the House of Commons on December 1 last: "The principle that adequate health care should be provided for all, regardless of ability to pay, must be the foundation of any arrangements for financing the Health Service. We stand by that."'


Longer-term options: Note by the Secretary of the Cabinet.
Memorandum by the Central Policy Review Staff.
The National Archives; 1982.

Margaret Thatcher speech.
Conservative party conference at Conference Centre, Brighton: 8 October 1982.
Margaret Thatcher Foundation; 2019.